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State wants Oregon hospitals to think twice before cuts

Legacy Health’s attempt to close a maternity unit last year has sparked a requirement that hospitals consider the impact to communities before reducing services
A sign on top a fire engine reads "save our legacy mount hood family birth center.
Activists on Feb. 13, 2023, protested the proposed closure of Mount Hood Family Birth Center in Gresham. | JAKE THOMAS/THE LUND REPORT
March 21, 2024

Last week, when a truck hauling a wind turbine through eastern Oregon shut down I-84 east of Baker City for about 17 hours, it meant people in the area looking for a hospital to give birth would need to change plans quickly.

In August, Saint Alphonsus Health System sparked controversy when it closed the maternity unit at its Baker City hospital.. That means pregnant people now have to travel about 45 minutes to the nearest birthing center in La Grande or two hours to Boise — when the road is open. 

Not just crashes but winter weather are a problem for residents needing a birth center, Baker County Commissioner Christina Witham, whose daughter-in-law moved near the hospital in time to give birth last June. The impact of the closure has been “huge,” she said. 

“We are a rural community,” she said. “We need a birthing center here.”

Over the last two years, hospitals across Oregon closed down services such as maternity units and home health services— or simply closed down, as in Eugene — in part because reimbursements have not kept up with increases in costs for things like wages. And the worrisome reductions in patients’ access to care likely will continue, one hospital group leader told The Lund Report recently.

In addition to sparking concern among patients and providers, the situation has caught the attention of unions as well as lawmakers and other officials. 

Recently, the Oregon Health Authority enacted a new regulation to require most hospitals to study the effects of proposed service reductions on their most vulnerable patients before moving ahead with closures. 

Hospitals wanting to close services will now have to analyze how doing so would affect people of color, low-income households, LGBTQ individuals and other marginalized or under-represented groups.

During controversy over Legacy Health’s attempt to close the maternity unit at its Gresham hospital, three east Multnomah County lawmakers introduced a bill in the 2023 session that would scrutinize the community impacts of similar closures in the future. The bill didn’t pass, but it prompted the health authority to begin drafting the regulation, which took effect in January. 

Health authority policy analyst Mellony Bernal said during a rules advisory committee meeting in October that the bill’s legislative hearings raised important points. She said the health authority “thought it was a really good idea” for hospitals to consider equity impacts when seeking to cut a service. 

The group of lawmakers applauded the health authority for adopting the regulation in a press release. 

“No one organization should be able to deprive our community of its only birth center without some comprehensive review process,” state Sen. Chris Gorsek, D-Gresham, said in the statement. “The Oregon Health Authority has made an important step towards protecting our community.”

Just in the last year, announced hospital cuts or closures included:

  • Mercy Medical Center in Roseburg eliminated its 50-employee home health services unit.
  • McKenzie-Willamette Medical Center in Springfield closed its midwifery unit.
  • In January, Mid Columbia Medical Center in The Dalles closed its medical oncology unit, Celilo Cancer Center, but had to reopen it as a state-required condition of merging into the Adventist Health system.
  • In March, the nonprofit Legacy Health closed its birth center at Legacy Mount Hood Medical Center in Gresham, only to be forced by the state to reopen it after critics cited harm to the lower-income and diverse populations nearby. 
  • Last summer, financially ailing Bay Area Hospital in Coos Bay announced that it would close its psychiatric health unit and lay off 56 workers. The hospital changed course after a public outcry.
  • PeaceHealth shuttered its University District hospital in Eugene last year, citing declining use. The result has been increased patient care delays, local officials told The Lund Report.

“We are finding that even if a closure is necessary — and that should be rare — we want to make sure that all of the alternatives were fully explored and how the hospital or health system can mitigate it or how other community organizations can step in,”

Slowing cuts

Of Oregon’s 65 licensed hospitals, 37 have a general acute care license, meaning that they must provide emergency, maternity and surgical services. The health authority can grant hospitals a waiver to stop providing the service if they explain how they tried to avoid the cut and how it would improve patient care. 

The new regulation requires these hospitals to also describe how the closure could affect people with disabilities, limited English or incomes, as well as communities of color and LGBTQ individuals. Hospitals would have to explain how they determined the impact and propose steps to mitigate any disproportionate effects. 

It doesn’t apply to low-occupancy acute care hospitals, which includes Saint Alphonsus in Baker City. It also doesn’t require the health authority to consider the findings of a hospital’s analysis on the effects of a closure when deciding whether to grant the waiver. 

Members of the Oregon Nurses Association often are affected by hospital service cuts. Kevin Mealy, spokesperson for the union, told The Lund Report it supports the regulation because it will put the brakes on closures and buy time for other solutions. 

Health systems often move quickly when cutting services, sometimes giving communities scant notice before a closure goes into effect. He said the regulations will highlight a closure’s potential community impact. 

“We are finding that even if a closure is necessary — and that should be rare —  we want to make sure that all of the alternatives were fully explored and how the hospital or health system can mitigate it or how other community organizations can step in,” Mealy said. 

In 2022, the announcement that  Bay Area Hospital in Coos Bay would close its behavioral health unit, allowed local Medicaid insurer Advanced Health to step in with funding to keep it open. 

In other situations, health systems might back off from cutting services after having a clear look at how it will affect disadvantaged populations, Mealy said. Critics of Legacy’s move to close its birth center at its Gresham hospital argued that it served a less-affluent and more diverse population who could face dangerous complications while traveling farther to give birth.  

When asked for comment on the new regulation, a spokesperson for the Hospital Association of Oregon referred The Lund Report to an official comment the trade group earlier submitted in a letter to the state regarding the regulation.

When the health authority grants a waiver, hospitals typically need to apply to renew them after multiple years. Danielle Meyer, the association’s public policy director, requested in the letter that hospitals be exempted from having to conduct the analysis if they are renewing a waiver. 

“Some of these waivers have been in place for a substantial period of time and we foresee challenges if the waivers are not renewed,” she wrote in the letter.

The regulation only applies to new waivers submitted after Jan. 1, 2024.  

You can reach Jake Thomas at [email protected] or via @jakethomas2009.