Health system patients see increased services, less friendly atmosphere

When the local, independent hospital becomes part of a larger health system, whether Sanford Health, Essentia Health, Mayo Clinic or another, patients often gain services and even doctors. But the hospitals also can become more impersonal and bureaucratic. That's what we heard from members of our Public Insight Network in communities where local medical centers had recently sold to or become managed by systems.

Hospitals are experiencing a new wave of consolidation in Minnesota, driven by the struggling economy and the federal Affordable Care Act, which pushes facilities to adopt expensive electronic medical records and strives to impose a new health care model based on quality of outcomes.

Sixteen independent hospitals have become affiliated with health systems since 2005, according to the Minnesota Hospital Association (that includes the hospital in Deer River, which will join Essentia on Sept. 1).

The trend is especially prevalent in rural parts of the state, since much of the urban consolidation happened a decade or more ago. Of the 145 hospitals counted by the Minnesota Hospital Association, only 42 remain independent.

When asked to tell us how these changes have affected health care on the ground, respondents in our Public Insight Network gave a wide variety of opinions. No system was immune from praise or criticism, but themes did emerge.

Patients liked getting quicker test results and the benefits of electronic medical records. In some locations, they praised systems for expanding local medical services. But some reported shortened appointment times, a less friendly atmosphere and the loss of familiar doctors and nurses.

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Bob Lloyd of Aurora, where the hospital recently affiliated with Essentia, reported that an old clinic has been replaced by a new one. "The new clinic has been open for a couple of months now and is just wonderful. I have also had use of the rehab facilities of Northern Pines on two separate occasions. Both times the facility and personnel were great...The possibility of a 'Small town USA' being able to run/own a hospital is a thing of the past."

Katie Longanecker of New Prague, where the hospital is now owned by Mayo Clinic, said she was satisfied with the care and "the doctors were amazing." Still, she said service was slow in the emergency room and she lamented the loss of local control. "Decisions regarding the major hospital in the community (are) no longer part of the community."

The merger last year between Sanford and North Country Health Services in Bemidji was a high profile one, met with both excitement and trepidation. So what has been the upshot for patients? That depends on whom you ask.

Connie Berg, of Red Lake, rues the loss of familiar doctors. "I feel more comfortable knowing the medical staff and I knew nobody providing the care and had never heard of their names before. I used to call doctors by name...that small town flavor has definitely disappeared."

Yet, Patricia Kelly of Bemidji, who worked for the hospital when it was independent, had an entirely different view. "(We) felt some uneasiness about giving up our independence, but with today's health care market, an affiliation was inevitable," she said. "It has brought numerous new physicians and enhanced services to our community, i.e. cancer care, orthopedics, cardiac... We are fast becoming a regional center with first rate medical staff, the most modern technology and job opportunities with good paying positions. Health care is an economic engine in this community."

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