What is Changing?

We are adjusting services on both our Albert Lea and Austin campuses to ensure patients can continue to receive the most commonly-used care close to home. Both campuses will continue to function as top-tier medical centers, but with fewer duplicated services.

To make the best use of our resources and to be able to continue to provide safe, high-quality care for our patients, the 5 percent of care we deliver in the inpatient (hospital) setting will move to the Austin campus. This includes:

  • Medical, surgical and pediatric hospital care
  • Intensive Care Unit (ICU)
  • Major surgeries requiring overnight hospitalization
  • Childbirth

Consolidating most inpatient care on the Austin campus allows for higher levels of care and testing options for patients and makes the best use of resources by staffing single, larger units and avoiding duplication of expensive equipment and technology.

We will be moving our inpatient behavioral health services (also known as the Psychiatric Services Unit or PSU) and addiction services to the Albert Lea campus. Bringing these behavioral health services together in one location will create more opportunities for staff collaboration and keep related services located together for the convenience of our patients.

Remember, both campuses will continue to offer 95 percent of the services our patients use the most often, such as emergency room, primary and specialty care, outpatient (same-day) surgeries and procedures, cancer care, pregnancy care and services like lab, radiology and pharmacy.

Mayo Clinic Health System Mayo Clinic Health System

Why is Change Needed?

We need to make changes in how health care services are delivered to ensure we can provide high-quality and affordable services to the community, now and in the future. No community is immune to the challenges in today's health care landscape, such as staffing shortages, rising costs, a shift from inpatient to outpatient care, and declining payments from insurers for our services. Making the best use of staff and resources is particularly important to preserve the health care services patients expect and use the most.

The adjustments currently being made in Albert Lea and Austin focus on long-term affordability and viability in both communities. As health care organizations across the country are discovering, it's no longer feasible to duplicate hospital services in neighboring communities. Organizations that fail to respond to the changing health care environment often end up closing entire facilities. More than 80 rural hospitals have closed since 2010 (UNC Rural Hospital Health Research Program) and a 2016 report revealed that more than 670 rural hospitals across 42 states are vulnerable to closure (iVantage study). In order to keep the most-used care available, we need to reduce duplication of the most expensive and labor-intensive services by consolidating them on one campus. By proactively making these changes now, we are preserving jobs and local health care in both Albert Lea and Austin.

ABOUT THE PROVIDER SHORTAGE

  • The provider shortage in rural areas is critical, and getting worse every year
  • Half of the doctors in training have more than 100 job offers before they graduate
  • Albert Lea and Austin continue to experience vacated positions in primary care with no active applicants
  • This highly competitive environment means positions are sometimes open for years; we have to make the best use of our limited staff to cover the hospitals so we don't have to transfer patients to Rochester

ABOUT DECREASED DEMAND FOR INPATIENT SERVICES

  • A nearly 50% decrease in hospitalized patients in the last 20 years in Albert Lea
  • Many conditions, treatments and surgeries no longer require overnight hospitalization
  • Even with fewer hospitalized patients, provider coverage across two hospitals is challenging because the shortage is so severe
  • Examples of the declining need for inpatient services:
    • Average of fewer than 20 hospitalized patients per day on each campus (excluding the psychiatric unit)
    • That number will continue to decline as more treatments and surgeries are done in the outpatient setting
    • Average of 1-2 inpatient surgeries per day on each campus
    • Average of 1 birth per day on each campus
    • Volumes are dropping, yet in the current model we are staffing two inpatient units, two childbirth units and two ICUs 24/7/365

Mayo Clinic Health System is building a viable and affordable system of care with the future of our patients in mind. By adjusting our services across both campuses, we'll be able to offer higher levels of care to patients, and we'll be able to invest more in the latest technology and equipment because we won't be staffing and equipping two identical units. We anticipate higher staff satisfaction as our talented providers, nurses and other staff are able to care for more complex patients and have fewer nights on call.

How was this Decision Made?

There were many factors used to assist with determining what services will be important and beneficial at each campus, including:

  • Current staffing needs, including shortages in medical provider staffing
  • How services are currently being used (e.g. how many clinic visits vs. hospitalizations)
  • Current and projected need for services in each community
  • Market data for current and potential services offered on each campus and at other health care organizations close to each community
  • Current building space and future potential remodeling needs and costs
  • Patient and staff satisfaction data
  • Financial performance

A detailed facilities analysis showed that the Austin campus offered the best layout for the expansion of hospital rooms within the current facility, a larger Intensive Care Unit (ICU) and room for additional growth, making it the right choice for housing all of these services in one location.

All of the above factors are very important and played a critical role during the evaluation process. It is also important to note the knowledge and insights of our current staff were invaluable during this process and played a key factor in determining how to prepare for what our future care models will look like, while ensuring the needs of our patients are met.

We are Listening

We acknowledge and regret that we did not adequately communicate with the community about the scope of the rural health care challenges we are facing before announcing the necessary transition of some of our inpatient services. People want and deserve to be heard, and we need to listen. We are taking several steps to do this more effectively, including working with Albert Lea leadership to form a community stakeholder panel, scheduling meetings with service clubs and business organizations, and continuing to work with city, county and state officials to answer their questions and find ways to reduce the impact of changes all while recognizing the reality of today's rural health care challenges. Additionally, we have launched a series of ‘letters to the community' in the Albert Lea Tribune newspaper to address specific concerns and correct misperceptions. We are committed to improving communication as we move forward.

Myths and Misconceptions

Mayo Clinic's announcement of planned changes to the mix of health care services delivered at the Austin and Albert Lea campus has understandably received strong reaction from some members of the community. As we work with community leaders to address the most pressing concerns, it's important to refrain from spreading rumor and speculation that only serves to create unnecessary fear and confusion. Following is a summary of the most common misconceptions regarding the changes.

Is the Albert Lea campus closing?

No, in fact, the Albert Lea campus will continue to offer 95 percent of the services our patients use the most often, such as emergency room, primary and specialty care, outpatient (same-day) surgeries and procedures, pre-natal pregnancy care, the Cancer Center, and services like lab, radiology and pharmacy. Only the 5 percent of care we deliver in the inpatient (hospital) setting will move to the Austin campus. This includes:

  • Medical, surgical and pediatric hospital care
  • Intensive Care Unit (ICU)
  • Major surgeries requiring overnight hospitalization
  • Childbirth

Are these changes just a way to transfer more patients closer to Rochester/Mayo Clinic?

Actually, our intent is the opposite of that. The goal is to keep more patients close to home and avoid unnecessary transfers to Rochester. With today's national provider shortage, we are sometimes unable to keep both hospitals fully staffed, and we end up having to transfer patients to Rochester. That is not acceptable to our patients or to us. Maintaining two hospitals in neighboring communities means we must have 24/7 staffing for two ICUs, two inpatient medical/surgical units, anesthesia and surgical teams at both locations, etc. By combining all our staff to support a single inpatient practice in Austin, we will avoid unnecessary transfers and keep patients closer to home.

Won't the economic impact on Albert Lea be devastating?

Our work focuses on preserving the economic vitality and viability in both communities. As health care organizations across the country are discovering, it's no longer feasible to duplicate hospital services in neighboring communities. Organizations that fail to respond to the changing health care environment often end up closing entire facilities – which could be devastating. By proactively making these changes now, we are able to keep both hospitals open and functioning as Level 4 Trauma Centers, which also preserves their economic contributions to Albert Lea and Austin in terms of jobs, community tax base, the ability to recruit and retain quality health care providers, and the attractiveness to new businesses, families and retirees.

Mayo hasn't kept the promise that it made when the Naeve Health Care Association merged with Mayo Clinic Health System in 1997.

The promise we made when Naeve Health Care Association and Mayo Clinic Health System merged was to preserve and strengthen the tradition of delivering high quality care for patients in the community for generations to come. For the past twenty years, Mayo has kept that promise: from helping Naeve Hospital weather and survive changes in health care in the mid-90's by investing $11 million to update and equip the hospital; to providing access to the vast tools, resources and support of Mayo�s fully integrated health system. Today, rural healthcare is experiencing new and increasing challenges. Again, we need to proactively address these challenges to continue to deliver on that promise. By consolidating inpatient hospital care to one campus, we can keep both hospitals open and providing 95 percent of the care patients use most in their own communities.

Mayo talks about the financial concerns of maintaining all current services in Albert Lea, but what about the $585 million that they received for the Destination Medical Center project?

The $585 million allocated from the state for Rochester infrastructure needs to support Destination Medical Center did not go to Mayo Clinic. This common misunderstanding has been a distraction to the serious conversations we need to have about health care in Albert Lea, Austin and the southeastern Minnesota region. The state money will go to the DMC Corporation, a non-profit established by State statute. This is funding to build up the infrastructure in Rochester (for example, roads, sewers, schools, transportation) as Mayo Clinic and other businesses expand employment and increase investment in patient care, biomedical research and technology innovation.

Destination Medical Center is not a factor in the decision to transfer services between Albert Lea and Austin. In fact, the service changes in Austin and Albert Lea are designed specifically to keep care closer to home rather than require patients to travel to Rochester. Patients and community members have clearly articulated a desire to keep care as close to home as possible. If we can reliably and fully staff a single, larger inpatient hospital unit, an ICU and a labor and delivery unit in the Austin/Albert Lea area, we will transfer far fewer patients to Rochester due to staffing shortages.

Will Mayo Clinic Health System protect nurses' seniority if they transfer between campuses?

It's incorrect to say that Mayo is not recognizing employees' seniority – that is an issue for the unions to work out. This can be a confusing issue, as length of service and seniority are not one and the same. Any employee, union or non-union, who transfers between campuses will retain their length of service (which is determined by when they were hired), their vacation, and their other benefits. For union employees, there is a second issue of seniority. Seniority is determined within the union bargaining unit, and it guides things like accepting a position and scheduling PTO. When there are separate bargaining units at Albert Lea and Austin, as there are for our nurses, the unions and their members will have to decide whether to recognize each other's seniority, if an employee transfers from one campus to another. We hope they will choose to recognize each other's seniority and we'll work with the groups to find a resolution.

Will there be up to 500 jobs that could be lost in Albert Lea due to this transition?

There is no merit to this claim. We do not have an exact count on the number of jobs transferring between campuses, but we are moving fewer than 5 percent of the services in a hospital with roughly 1000 employees. It's way too early to predict the average census of patients in the hospital, at any given time, after the changes. In addition, while some of those services will move to Austin, others will move to Albert Lea. We will continue to be open and transparent about the total employment change as we learn more.

These changes will include staff layoffs, right?

As we've already noted, we will continue to offer 95 percent of our services at both campuses, so many of our staff and patients will not see much change in their day-to-day experience. Flexibility will be needed as we transition our inpatient services to Austin, and some staff may have to consider changes in their primary location or roles to meet the needs of our patients. As much as possible, we will try to meet our staffing needs through voluntary transfers between campuses. Our staff is our most precious resource, and we will do all we can to make the transitions as smooth as possible.

Are lives being put in danger by moving the ICU and OB services to Austin?

It concerns us that members of the community fear that lives will be put at risk by the changes we are proposing. Rest assured that the Albert Lea Emergency Room, where all providers are fully trained in delivering babies and in stabilizing patients so they can be safely transferred to the nearest appropriate unit, is not closing. It is and will continue to be available to all patients in Albert Lea 24 hours per day, 7 days per week, and 365 days per year.

Why can't money from the Super Bowl be redirected to keep inpatient care in Albert Lea?

Mayo Clinic has a culture of giving back to our communities and our state. We are capitalizing on the Super Bowl opportunity to promote and address a number of important issues facing our state. For example, Mayo Clinic is working with the Host Committee to address in meaningful ways the issues of childhood nutrition, wellness and physical fitness and, in cooperation with the Sisters of St. Francis, to raise awareness of human trafficking – an issue that our state faces 365 days a year. The Super Bowl provides a great platform and the resources to draw attention to these issues. As the largest private employer in Minnesota, Mayo Clinic's membership on the Host Committee is evidence of our commitment to the growth of our state and to ensuring a quality and safe experience for all Minnesotans and to the visitors to our great state. Mayo's sponsorship draws on existing allocated marketing funds and does not impact operational budgets for patient care, research and education.

Timeline

Here is the tentative timeline for when these changes in services will occur (keeping in mind that dates can change due to many unforeseen issues):

  • ICU – October 2017
  • Inpatient Surgery – early 2018
  • Inpatient Behavioral Health – mid-year 2018
  • Medical/Surgical hospitalization – early 2019
  • Childbirth Services – 2019-2020

Frequently Asked Questions - Updated 9/28

If a patient needs to be transferred by ambulance between the Albert Lea and Austin campuses, will the patient be billed for the ambulance ride?

No, patients will be transferred between our two campuses at no cost. Mayo Clinic Health System is obtaining an exemption from the Centers for Medicare and Medicaid (CMS) current billing regulations so we can waive these costs for patients. It is our intention to continue to cover the cost of transfers between the Albert Lea and Austin campuses as permitted by CMS regulations that govern ambulance charges, and we will adapt as necessary if regulations change in the future.

What will continue to be offered on both campuses?

Both the Albert Lea and Austin campuses will continue to offer the vast majority (more than 95 percent) of the services our patients use on a regular basis, including emergency room care, primary and specialty care, pregnancy care, cancer care, outpatient (same-day) surgeries and procedures and services such as lab, radiology and pharmacy.

Are these changes just a way to transfer more patients closer to Rochester/Mayo Clinic?

Actually, that's the opposite of our intent. Our goal is to keep more patients close to home and avoid unnecessary transfers to Rochester. In order to do that, we have to optimize the services that we do have in the local community. Maintaining two identical hospitals in neighboring communities means we must have 24/7 staffing for two ICUs, two inpatient medical/surgical units, anesthesia and surgical teams at both locations, etc. With today's national provider shortage, we are sometimes unable to keep both hospitals fully staffed, and we end up having to transfer patients to Rochester. That is not acceptable to our patients, or to us.

Will childbirth services (labor and delivery) only be available on one of the campuses?

Yes, over time, all childbirth services will eventually transition to Austin.

  • Research has shown that mothers and babies have better outcomes in higher-volume labor and delivery units where staff members' skills are kept sharp by doing more, and more complex, deliveries.
    • The volumes at the separate units in Albert Lea and Austin are relatively small. Combining the two separate units into one will lead to an optimal situation for both patients and staff.
    • A single, larger labor and delivery unit may allow for additional services to be offered, such as a midwife program and enhanced nursery options, and creation of a state-of-the-art birth center that provides a top-notch patient experience for families.
    • It is becoming increasingly difficult to recruit and retain enough OB providers and nurses to staff two labor and delivery units so close together. Consolidating to a single birthing unit will lessen the call burden and help us to stabilize our staffing so we can continue to offer deliveries and post-partum care close to home for our patients.

What is the economic impact to Albert Lea if inpatient care, and the staff who deliver that care, moves to Austin?

Our work focuses on preserving long-term affordability and viability in both communities. In order to keep the most-used care available in both communities, we need to reduce duplication. As health care organizations across the country are discovering, it's no longer feasible to duplicate hospital services in neighboring communities. Organizations that fail to respond to the changing health care environment often end up closing entire facilities. By proactively making these changes now, we are preserving jobs and local health care in both Albert Lea and Austin.

How will the changes in services impact patients?

By adjusting our services across both campuses, we'll be able to offer higher levels of care to patients in larger, state-of-the-art units. We'll be able to invest more in the latest technology and equipment because we won't be staffing and equipping two identical units in neighboring communities. This will lead to higher staff satisfaction, as our talented providers, nurses and other staff are able to care for more complex patients and have fewer nights on call. This should help us reduce staff turnover, which results in more continuity of care for our patients.

Will there be transportation for patients who will need to travel to a different campus for care?

We are looking to determine if there might be additional options that could be offered. It's important to remember that the outpatient (clinic-based) care that most people use regularly will remain available on both campuses, so there will be no change in transportation needs.

Will the cost of these changes be passed on to the patient/consumer?

While we have no control over some costs for patients, such as insurance premiums and deductibles and co-pays, we are committed to delivering high-quality care as efficiently as we can in order to keep care as affordable as possible. Being careful stewards of our resources is part of that commitment. The long-term goal of these changes is to maintain a sustainable system of care in the Albert Lea and Austin area, where health care will be both available and affordable for patients. Maintaining two fully staffed and equipped hospitals in neighboring communities is becoming increasingly difficult due to costs, a nationwide provider shortage and declining payments from insurers for our services.

Was the hospital in Albert Lea not sustainable?

This hospital has a rich history, going all the way back to its beginnings as Naeve Hospital. Throughout that time, the hospital has adjusted to respond to changes in the community and health care, overall. Those changes continue and we need to proactively address them.

The staff of the Albert Lea hospital, and the care they provide, is second to none. We don't want anyone to think that there is a problem with the care being provided here. What is unsustainable is having two fully staffed hospitals fewer than 25 miles apart. In today's environment of declining payments from insurers and critical staffing shortages, that model does not work from a staffing standpoint or a financial standpoint. What works is to create larger units and make the best use of all the staff available, and to keep the majority of services used on a regular basis available on both campuses. We are absolutely sincere when we say that 95 percent of the care you use most often will remain in Albert Lea, and you'll continue to visit your doctors, be seen in the emergency room and come here for labs and X-rays without anything changing. If the time comes that you need a major surgery or a stay in the ICU, you'll be admitted to a unit just down the road with the latest technology, and cared for by our great team of staff from both Albert Lea and Austin.

Will there be staff layoffs and how many staff will be impacted by these changes?

We are very early in the implementation process, having just announced the changes. As we've already noted, we will continue to offer 95 percent of our services at both campuses, so many of our staff and patients will not see much change in their day-to-day experience. Flexibility will be needed as we transition our inpatient services to Austin, and some staff may have to consider changes in their primary location or roles to meet the needs of our patients. As much as possible, we will try to meet our staffing needs through voluntary transfers between campuses. Our staff is our greatest asset, and we will do all we can to make the transitions as smooth as possible.

How will changes affect the local unions?

We are committed to working with the respective unions and the existing collective bargaining agreements. Staff satisfaction is incredibly important and is second only to our patients' satisfaction. Just as we need to plan for our physical building changes, we will need to work with staff on how we make staffing transitions over time where needed.

While everyone retains their length of service, the question of union seniority transferring between Albert Lea and Austin is not something I-90 leaders can determine alone. While I-90 leadership is recommending to all groups that union seniority from other campuses be recognized, we will need to negotiate this with the respective groups in the coming weeks and months. We are hopeful that the groups will be open to this recommendation. Questions on this should be directed to the respective union stewards.

How will length of service be determined if staff transfer between the two campuses?

Length of service is determined by the employee's original hire date, whether it was with Naeve Hospital, Albert Lea Medical Center, Austin Medical Center or Mayo Clinic Health System. Everyone (union and non-union employees) preserves their length of service, no matter which campus they work on, because Mayo Clinic Health System – Albert Lea and Austin is a single organization.

Will these changes improve your ability to recruit and retain providers and staff?

Provider recruitment and retention is a nation-wide challenge. There simply are not enough providers to fill all of the open positions. These changes will improve our ability to recruit and retain physicians, nurse practitioners, physician assistants and nurses to the practice. Whenever an organization makes improvements and enhancements to its services and improves working environments, such as reducing on-call schedules for providers, it can be a positive draw for potential new providers, as well a positive for current providers to stay and be a vital team member in the organization.

How many beds are currently in the Albert Lea hospital and Austin hospital? How many beds will there be, total, on the Austin campus, once all inpatient (hospital) services are consolidated?

The average daily census (the average number of patients in the hospital on any given day) is 16 in Albert Lea and 29 in Austin. This includes the daily average of 10 patients in the Psychiatric Services Unit. We are generally staffed for 26 beds in Albert Lea and 43 beds in Austin. The numbers in Albert Lea reflect medical/surgical and Special Care Unit. In Austin, the numbers represent medical/surgical, ICU and Psychiatric Services Unit.

The plan calls for a total of 40 medical/surgical beds and 12 beds in the ICU on the Austin campus, when the remodeling and integration are completed, plus 12-16 beds on the Albert Lea campus for the Psychiatric Services Unit that will move from Austin to Albert Lea. The design and sizing of the Women's Center is in the planning stages as well.

How many beds are currently in the Austin Psychiatric Services Unit and how many nurses staff this Unit?

There is an average of 10 patients in the Psychiatric Services Unit each day, with a total of 24 nurses that staff this Unit.

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“We are keeping the services that patients use most close at hand, and we are committed to continuing to be an active part of our communities. Our work was guided by an unwavering commitment to both Albert Lea and Austin, and a goal of keeping high-quality care affordable and available on two strong campuses that are positioned for long-term viability and growth.”

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