Pa. hospitals like Crozer-Chester with a lot of Medicaid patients keep closing. Budget cuts would speed up the trend.

Crozer-Chester Medical Center’s shutdown is such a big deal that the governor of Pennsylvania turned up last week to rail against what he is calling a healthcare crisis. But the bankruptcy is only the latest in a troubling trend: More than half of the adult hospitals in Southeastern Pennsylvania with the highest shares of revenue from the Medicaid program have either closed or been substantially downsized in the last decade.

Four of the 10 hospitals most reliant on the government program for low-income Americans have shut down. The most recent is Crozer-Chester Medical Center in Upland this month. The region also lost Drexel Hill’s Delaware County Memorial in 2022 and two Philadelphia hospitals: Hahnemann in 2019 and St. Joseph‘s in 2016.

Those on the list that have been substantially reduced in scope are the former Mercy Philadelphia in West Philadelphia and Suburban Community in East Norriton. The ranking is based on 2015 data from the Pennsylvania Health Care Cost Containment Council.

Hospitals that low-income patients rely on most could find the going even tougher if Congress follows through on plans to save hundreds of billions of dollars by making it harder for people to stay on the Medicaid program.

“You’re exacerbating the healthcare crisis that’s brewing in our commonwealth,” Shapiro said Thursday at a news conference outside the shuttered Crozer-Chester Medical Center, urging federal lawmakers to seriously consider the consequences of the proposal.

The main purpose of Thursday’s event was to promote bills introduced last week that would require the Pennsylvania attorney general to review more healthcare transactions and block them if they are deemed not in the public interest.

The prime sponsor of the Senate version of the proposed legislation is Delaware County Democrat Timothy Kearney. At a May 7 hearing on hospital closures and broader financial woes in the hospital sector, Kearney noted that private equity funds — which invest mostly for pension funds and other institutions — are not the only problem.

“The Wall Street vultures are a symptom of a larger illness within the hospital sector, the illness of financial malnourishment,” Kearney said. “When hospitals keep running in the red because reimbursement rates don’t cover the cost of care, they put off investments that they need to make to survive.”

Medicaid covers, on average, 82% of the cost of hospital care, according to Nicole Stallings, CEO of the Hospital and Healthsystem Association of Pennsylvania, a lobbying group.

Among the 10 hospitals in the area most dependent on Medicaid in 2015 was Einstein Medical Center Philadelphia. During a 2020 antitrust trial over Thomas Jefferson University’s deal to acquire it, Einstein officials argued that they could not afford to upgrade Einstein enough to make it competitive with better-resourced hospitals. Jefferson completed the acquisition in 2021.

Jefferson has since closed the emergency department at the former Einstein Medical Center Elkins Park, which operated under Einstein Philadelphia’s license. The facility is now used by Jefferson’s MossRehab.

The hospitals on the Medicaid-reliant list that remain fully open without an ownership change are Temple University Hospital in Philadelphia and two hospitals owned by Trinity Health Mid-Atlantic: Mercy Fitzgerald Hospital in Darby and Nazareth Hospital in Philadelphia.

Temple receives substantial state aid to help it defray its losses from Medicaid and uninsured patients.

One of the nation’s largest Catholic health systems owns the Trinity hospitals, which means they have an organization with vast resources backing them. Even so, Trinity has recently consolidated some services at its Philadelphia-area hospitals. For example, Nazareth is no longer performing surgeries overnight, according to an internal announcement obtained by The Inquirer. That likely means the hospital must send emergency cases elsewhere, though Trinity declined to confirm this.

Trinity announced the closure of Mercy Philadelphia in West Philadelphia in 2020. Some services, including an emergency department, were preserved through a partnership among the University of Pennsylvania Health System, Public Health Management Corp., Children’s Hospital of Philadelphia, and others.

California-based Prime Healthcare announced this month that it will close the emergency department and downsize Suburban Community Hospital in East Norriton to a 15-bed geriatric psychiatric hospital. The hospital had already halved its staffed bed count to 60 from more than 120.

The number of hospital campuses that closed in the last decade is larger than The Inquirer’s count of full closures, since some systems have multiple facilities under the same license. Crozer-Chester’s license included Taylor Hospital and Springfield Hospital, which also closed. Data on Medicaid reliance at Taylor and Springfield were not available.

Before entering politics, Delaware County Democrat Lisa Borowski spent years working at the former Mercy Health System of Southeastern Pennsylvania (now Trinity Mid-Atlantic) and Einstein, two systems heavily reliant on Medicaid. Now a member of the state House of Representatives, Borowski is the prime sponsor of that body’s version of the bill meant to restrict private equity.

“I am no stranger to the challenges those hospitals face when it comes to their bottom line,” she said in an emailed response to questions from The Inquirer, adding that improving Medicaid reimbursement is another issue legislators must tackle.

“The answer can’t be to let bad actors pirate our hospitals, steal their value, and walk away, leaving everyone else to pick up the pieces like we’ve had to in Delco,” she said.