Mayo Clinic officials expanded on their review and rationale for the decision to consolidate most inpatient services to Austin on Wednesday in a letter sent to the Attorney General’s Office.

The health system said the decision to consolidate certain services across the two campuses was made in response to a provider shortage, a “sharp decrease” in the demand for inpatient services and a reduction in reimbursement levels.

“To address these challenges and ensure MCHSAA remains strong and able to continue to provide high-quality care to patients, now and in the future, the decision was made to consolidate certain services across the two campuses of the hospital,” it stated.

The intensive care unit will be transferred to the Austin campus in October. In early 2018, major surgeries requiring hospitalization are slated to move to Austin, and in mid-2018, the behavioral health inpatient unit is slated to transfer to Albert Lea. The inpatient medical/surgical unit will transition to the Austin campus in early 2019, and childbirth services will transfer to Austin at some point in 2020.

Mayo has stated the inpatient services being consolidated on the Austin campus amount to less than 5 percent of the overall care provided by Mayo Clinic Health System in Albert Lea and Austin. The remaining 95 percent of services will be offered on both campuses, including services such as the emergency room, outpatient surgeries, primary care, specialty care, laboratory services, radiology services and others.

The health system said patients requiring inpatient services — including the medical/surgical, labor and delivery, and intensive care units — have decreased at both the Austin and Albert Lea campuses.

In 2013, there were an average of 18 patients daily in Albert Lea, while that number decreased to fewer than 16 patients daily in 2016.

In Austin, that number has decreased from about 33 patients daily in 2013 to about 19 daily in 2016.

Combined, the two campuses utilize just over one-third of available inpatient beds and less than 25 percent of the total licensed beds.

Mayo stated this decrease in inpatient utilization combines with a struggle in recruiting and retaining physicians.

In the fourth quarter of 2016 alone, Mayo Clinic Health System in Albert Lea and Austin had 102 hospitalist shifts that were unable to be staffed internally at both locations that had to be staffed through locum tenens coverage, or coverage where a provider fills in for another provider on a temporary basis. 

Both campuses have reportedly had numerous physician positions across several departments that they have been unable to fill — in some cases for years.

These issues, combined with declining reimbursement from all payers led the health system to look at new models of care, it stated.

Mayo Clinic Health System and Mayo Clinic Health System in Albert Lea and Austin assessed over an 18-month period how services are being used by patients, what the current and projected need for services is, along with patient and staff satisfaction data, financial performance and future potential remodeling needs.

Financial statements were provided to the Attorney General’s Office but were not available for the Tribune.

The health system weighed patient satisfaction scores, quality and outcomes data, access to appointments and health care consumer data to evaluate how to optimize services between the two campuses and preserve access as close to home as feasible. It said guidelines were put in place so that any recommendations to consolidate would maintain or improve patient outcomes and improve access for primary and specialty care for patients.

It looked at both campuses for size, function, equipment and potential for future growth.

The health system said the review showed that the Austin campus provided the most optimal layout for the expansion of hospital inpatient rooms, a larger intensive care unit and room for additional growth to the facility, making it the best location for housing these services.

The health system said it did not need the vote of the local Board of Trustees because it was not discontinuing or terminating services across the two campuses, which together are classified as a single corporation. Because it was consolidating services — and the services would be on one of the campuses — the vote was not required or sought.

Save Our Hospital Co-Chairman Brad Arends issued a response to Mayo’s responses to the Attorney General’s Office.

“I think what you have here is what I will refer to as ‘legal magic,’ where the original intent of the original bylaws of the Albert Lea campus put in place after the Mayo acquisition magically disappear after the Albert Lea and Austin campuses are merged,” Arends said. “Everyone knows those original bylaws had provisions that would not allow this move to happen. Everyone knows that those provisions were put into place to protect the city and citizens of Albert Lea from exactly this.”

He said the health system’s actions reflect what kind of corporate citizen it is.

Arends also noted he thinks Mayo has created what he referred to as a “feeder system” in southern Minnesota for big-ticket expensive medical procedures to be shipped to Rochester that in turn has resulted in higher health care prices.

“Albert Lea may be maintaining 95 percent of its services, but what percent of the gross revenue is being transferred out?” he said.

He said he is convinced the Albert Lea  facility would be profitable if it were not part of the Mayo system.

Daily census at the Albert Lea hospital

2013: 18

2016: fewer than 16

Daily census at the Austin hospital:

2013: 33

2016: 19

(includes medical/surgical, labor and delivery and intensive care units)

By the numbers

1-2: Average surgeries requiring hospitalization completed per day on each campus.

1: Average number of births per day on each campus

102: Hospitalist shifts that were unable to be staffed internally at both locations in the fourth quarter of 2016.