CLEARFIELD – Due to rising concerns within the community, Gary Macioce, president of the Clearfield Campus of Penn Highlands, addressed the decision to close the hospital’s maternity department during Tuesday’s Clearfield County Commissioner’s meeting.
Clearfield Penn Highlands will close its maternity department, the Armstrong Birthing Center, effective April 7. Beginning on that date, maternity patients of Clearfield‘s only obstetrician, Thomas A. Carnevale, M.D., will deliver their babies at The Maternity Center at DuBois Penn Highlands, said Macioce.
Carnevale, he said, will join the obstetricians at the DuBois Campus of Penn Highlands. He will continue to provide prenatal and postnatal care, as well as gynecological care at his office in Clearfield. He said that Healthy Beginnings, a prenatal program for income-eligible mothers, will continue to be offered at Clearfield Penn Highlands.
Mothers who require care for an emergency birth can still visit the emergency department at the Clearfield Campus of Penn Highlands. The staff of the emergency department has training to handle such cases, according to Macioce.
The main decision to close the maternity department, he said, was based upon the clinical and financial viability of its operation with only one obstetrician. Other factors, he said, included the declining reimbursements from government insurances; rising costs to operate a maternity department; and the declining number of births, which are fewer than 200 annually at Clearfield.
Macioce said that the Clearfield Campus of Penn Highlands is not the only hospital that has been faced with this decision. Since 2000, he said more than 45 maternity departments have closed in Pennsylvania, according to statistics provided by The Hospital and Healthsystem Association of Pennsylvania.
Many Pennsylvania hospitals, Macioce said, have closed their maternity departments due to losing their only obstetrician(s). This, he said, is not the case for the Clearfield Campus of Penn Highlands. Macioce said Carnevale will still serve the community full-time, but his patients’ babies will be delivered at the DuBois Campus of Penn Highlands.
He added that The Maternity Center at DuBois Penn Highlands includes experienced obstetricians, nurses and high-risk specialists and delivers more than 1,100 babies annually. The hospital, he said, is the only one in the region with a Neonatal Intensive Care Unit, as well as board-certified neonatologists who provide critically ill and premature newborns with the highest level of care.
Moving forward, he said, this will create a larger group of obstetricians at the DuBois Campus of Penn Highlands and a more sustainable model of maternity care for the community. The hospital, he said, has been planning for this transition in maternity care with its current patients and will with all new patients.
When asked by Commissioner Joan Robinson-McMillen, Macioce indicated that fewer than 10 employees will be impacted by the decision to close the maternity department at Clearfield Penn Highlands. The hospital, he said, will work with each employee in attempting to find them a position within the Penn Highlands system.
Macioce, however, wasn’t certain about how the hospital planned to use the maternity department once it’s vacant. Robinson-McMillen urged the hospital to implement a new and innovative healthcare service that isn’t offered elsewhere and that will also provide more employment opportunities.
When asked by Solicitor Kim Kesner, Macioce didn’t believe the low birth figures were attributable to patients migrating to surrounding hospitals because Clearfield has only one obstetrician. Macioce said there just wasn’t enough activity to support a second obstetrician, and prospective obstetricians are more likely to join a network over being one of two or three.
More generally speaking, the Clearfield Campus of Penn Highlands has greatly improved its financial performance over the past two years. However, it continues to operate “in the red,” said Macioce, noting it’s been the most challenging hospital environment that he’s faced during his career.
During the 2013 fiscal year, he said that 62 percent of Pennsylvania hospitals lost money providing patient care and 28 percent had negative total margins. This, he said, could be attributed to the effects of the national recession, which dates back to 2008.
According to Macioce, hospitals have been adversely affected by the increased unemployment rates on the local, state and federal levels. In turn, he said this has increased the level of uncompensated care. At Clearfield Penn Highlands, Macioce said the value of uncompensated care has risen to $6 million annually.
Additionally, he said that reimbursements to hospitals, including the Clearfield Campus of Penn Highlands, have been reduced by government entities. He said that two-thirds of the hospital’s revenue originates from a government payer. For example, he said last year the federal government cut 2 percent across the board for all Medicare services. For Clearfield Penn Highlands, he said this has resulted in a reduction in revenue by more than $350,000 annually, which will continue through 2024.
While the hospitals have been facing financial challenges, Macioce said they are also dealing with a significant new trend. Over the last four years, he said they have seen a declining number of patients being admitted to hospitals. This, Macioce said, can be attributed to factors, such as the overall improved health status of a community and more services available on a less costly outpatient basis.
According to him, in western Pennsylvania, admissions to all hospitals trended downward by 3.3 percent for the 2013 fiscal year. For hospitals with fewer than 99 beds, admissions trended downward by 6 percent as compared to the prior year.
Last year at Clearfield Penn Highlands, he said admissions trended downward by 6 percent as compared to the prior year. Over the last five years, the hospital’s admissions have trended downward by 34 percent.
“We’re seeing less utilization of inpatient services and more focus on the outpatient side,” said Macioce. “Hospitals were built to function on inpatient services . . . and Clearfield has also been adversely affected by the loss of physicians. It’s been difficult to replace them and the hospital is very aggressive in recruiting new physicians, as they’re the motor of the hospital.”
However, he explained that there’s a shortage of physicians across the United States and many opportunities for physicians to give consideration. As a result, he said it’s increasingly difficult to recruit physicians to Pennsylvania hospitals, especially ones in rural communities, such as Clearfield.
So far as the future of the Clearfield Campus of Penn Highlands, Macioce said these challenges neither mean the hospital will close, nor discontinue its inpatient services. However, it simply means the hospital board and management must pursue changes and switch its scope to outpatient care in order to make its operations more viable.
“It’s becoming harder for any small hospital to survive alone, and hospitals are consolidating more rapidly,” he said. “Joining with Penn Highlands Campuses in DuBois, Elk and Brookville will better position Clearfield, as they can utilize each other’s energies and resources.”
The hospital board and management, Macioce said, gives its decisions careful consideration with community impact as its top priority and followed by the viability of the hospital. Commissioner Mark B. McCracken encouraged Macioce to make sure each decision is heavily debated and transparent with the community.
“There’s been a lot of concern within this community,” said McCracken. “The linkage agreement has built a network with DuBois being the hub and Clearfield, Elk and Brookville being the feeders. We want to make sure the three smaller hospitals don’t wither on the vine.”
Macioce explained that each hospital in the Penn Highlands system has its own board of directors. He said Penn Highlands has a parent board of directors, which is comprised of directors from each subsidiary board.
Brenda and Tom Grice of Clearfield also attended the commissioners’ meeting. They encouraged Macioce to be transparent with the community and reminded him that it has always supported the hospital.