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BOSTON (State House News Service) - Lawmakers appear increasingly likely to make hospital expansions and closures an area of scrutiny this session, fueled in part by the planned shutdown of a Leominster maternity ward that has drawn vociferous criticism.
After a bipartisan coalition of legislators on Tuesday slammed UMass Memorial Health for its moves to shutter a birthing center, a top senator signaled that she's working with her House counterpart to subject those kinds of changes to greater state oversight.
Health Care Financing Committee Chair Sen. Cindy Friedman said the "determination of need" process used to review proposed expansions and shutdowns -- which the House sought to change last session without support from the Senate -- "is not working right now."
"It was put together, I think, the last time 13 years ago. The world has changed. We need to fix it," Friedman said. "I think [House] Chair [John] Lawn and I totally agree on that. We're really focusing on doing something around that, which would include these kinds of closures."
While there's still plenty of room for the branches to again go their separate ways, her comments at a committee hearing hint at a more unified approach to health care reforms and cost controls this term after the House and Senate in recent years have each been focused on different industry facets.
A bipartisan group of lawmakers and health care practitioners urged committee leaders to focus in particular on giving regulators more "teeth" to limit the impact of hospitals discontinuing services, like UMass Memorial Health's announcement last month that it intends to shut down the maternity ward on its Leominster campus.
They endorsed legislation (H 1175 / S 736) that would require a hospital to notify the state of a planned closure at least one year in advance, plus secure support, non-opposition or at least feedback from affected municipalities, according to a bill summary.
The state Department of Public Health would be required to determine if the services set to be axed are necessary for maintaining access in the region. If a hospital moves to discontinue a service deemed essential without an approved plan in place to continue patient access, the attorney general would be instructed to seek an injunction to keep that service in place for the full year-long notification period.
If the birthing center shuts down in September as UMass Memorial Health plans, residents in the area will need to travel to Gardner, Worcester or Concord for labor and delivery -- all at least 30 minutes away, lawmakers said.
"My folks in my small towns are greatly impacted by this in terms of just their travel time and the fear of, 'What if something happens? How am I going to get to the hospital in a timely fashion?'" said Republican Rep. Kimberly Ferguson of Holden. "Quite frankly, being told that you could take a cab to Worcester is not an option, and that is one of the options being given to them right now."
Several nurses from the Leominster campus told the committee they regularly admit parents who give birth minutes later and would not have had time to make it to a different facility.
Clinton Rep. Meghan Kilcoyne said that when her mother became pregnant in 1987, she had several options for delivery including facilities in Worcester, Leominster and others in north central Massachusetts.
"I'm 35 years old now. I also live in north central Massachusetts. And despite all the talk of progress we've made in women's health or women's rights, I will have less access and less choices than my mother did 35 years ago when I want to start a family," Kilcoyne said.
UMass Memorial Health proposed closing its maternity inpatient unit in Leominster effective Sept. 22, 2023, pending regulatory approval.
Existing regulations require hospitals to notify DPH, staff, patients and other affected parties at least 120 days in advance of intent to end an "essential service." If the department finds that the service "is necessary for preserving access and health status within the hospital's service area," the hospital must file a plan to assure patient access to those services.
"The current system allows DPH no real voice and no real mechanism to make sure our system works for every corner of our state," Sen. John Cronin said.
Amy Gagnon, a registered nurse in the Leominster maternity ward, told lawmakers that when the hospital closed its pediatric unit in 2018, DPH declared the unit necessary "but had no authority to enforce its ruling."
"The current essential service process is broken, and we need your help to fix it," Gagnon said.
UMass Memorial Health Alliance-Clinton Hospital President Steve Roach in a statement described "pervasive challenges shaping our health care environment."
"In recent years, industry-wide workforce shortages have exacerbated the challenges of fully staffing our maternity inpatient unit consistently at HealthAlliance-Clinton Hospital, despite our persistent attempts to recruit and retain clinicians in this region," Roach said. "This, along with the steadily declining number of births in North Central Massachusetts, has a significant impact on our unit's future capacity to provide labor and delivery care to our patients."
Lawmakers from the area and nurses in the hospital voiced skepticism about Roach's explanation.
Cronin, a Fitchburg Democrat, said U.S. Census data show the Leominster area is growing, not shrinking, and he described tens of millions of dollars in public aid directed to UMass Memorial Health for services in economically distressed communities.
"What workforce challenges could not be overcome with an $80 million shot to the arm over the past two years?" Cronin asked.
"Considering the support taxpayers have provided UMass Memorial, is it too much for them to come to the table in good faith and tell us what they need to keep the doors open for expectant mothers in our community?" he added.
Rep. Natalie Higgins, herself a Leominster resident, said the staffing challenges are "solvable."
"There are changes that they could have made to address the staffing challenges. They were having trouble filling four positions and told us that they could not find traveler nurses. After they announced the closure, they hired 12 traveling nurses to cover those nursing shifts," the Democrat said. "They manufactured this crisis because they don't want to sustain labor and delivery in Leominster, and we think that's unconscionable."
The Massachusetts Health and Hospital Association, an industry group that represents hospitals across the state, did not take a position on the former Rep. Ed Coppinger and Sen. Julian Cyr bills aired Tuesday but said Bay State providers "are struggling to balance steep financial losses, record workforce shortages, and the ever-evolving care needs of their local communities."
"MHA and our members support oversight reforms that help empower healthcare organizations through these pressures, include all elements of the care delivery system, and enable providers to restabilize while adjusting to changing patient needs," said MHA Senior Vice President and General Counsel Michael Sroczynski. "This includes regional health planning, monitoring independent medical practices that currently have limited oversight, and building a better infrastructure to support care delivered in non-hospital settings."
Several other lawmakers beyond the Leominster delegation expressed sympathy Tuesday about the impacts of changing health care service options.
"In my tenure in office, I've seen three nursing home closures, one maternal health closure and two behavioral health closures in my region, so I understand what you're experiencing now," said Rep. Lindsay Sabadosa of Northampton.
"This is a real issue, particularly for those of us in the hinterlands, as we continue to see this consolidated health care system," added Cyr, of Truro.
The House in 2021 approved legislation that would update the determination of need, or DON, process to subject large health care providers to greater scrutiny when they expand into markets covered by smaller, financially vulnerable community hospitals.
The bill never emerged for a vote in the Senate, where prescription drug pricing reform has been a focus in repeat sessions, and Speaker Ron Mariano has continued to eye DON changes as a priority.
Friedman said she is "deeply concerned" that broader legislative action to overhaul the determination of need review process "is not going to happen in the timeframe" the Leominster delegation might have sought, given the September closure.
In the meantime, Friedman said, the committee will reach out to hospital leaders "and see if we can facilitate a real conversation about this."
"Behavioral health, maternal health and primary care are closing because they don't make any money," Friedman said. "We need to just acknowledge that and have honest conversations about where we want to put our health care dollars."
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