How Crozer and Tower Health’s Closures Are Impacting Main Line Health – And Ambulance Squads

With staffing shortages, rising costs and an influx of patients, hospitals in Chester, Delaware and Montgomery Counties face financial crunches that threaten their survival.

by Davis Giangiulio, Managing Editor

Angela Neopolitano spent most of her more than 40-year nursing career at Crozer Health’s Delaware County Memorial Hospital (DCMH). Neopolitano, a registered nurse, even served as president of the DCMH Nurses Association. But in early 2022, Neopolitano watched as DCMH’s maternity unit was shuttered, the first in a series of closings that culminated in the entire hospital being transitioned from a medical facility to a behavioral health center. “It was like a slow death,” Neopolitano said.

Unfortunately, the story of DCMH is part of a worrying pattern. In 2021 and 2022, Tower Health closed facilities in Jennersville and Brandywine Hospital. By the end of 2023, Crozer’s Springfield Hospital will transition to only outpatient service. Hospitals are facing financial meltdowns that insiders say are as bad as, or potentially even worse than, the tsunamis caused by the COVID-19 pandemic.

With fewer medical options in Montgomery, Delaware and Chester Counties, the remaining hospitals face higher volumes of patients, further  stressing their facilities and medical staffs. Dr. Jonathan Stallkamp, senior vice president and chief medical officer at Main Line Health, insisted that the health system will operate as smoothly as possible, but acknowledged a patient influx. “We have patients seeking more care with us that didn’t seek care with us before,” he said. “They’re having to leave their communities to find medical care.”

In June 2022, Jack Lynch, the president and chief executive officer of Main Line Health, told WHYY that Paoli Hospital was at capacity. “Paoli for the last six months, for the most part, has been full,” Lynch said. “I mean, 100% of our beds are occupied and we’re boarding patients in the emergency room — which means patients that are ready to be admitted, are waiting in the emergency room for a bed to be opened up upstairs.”

More people in the hospitals means longer waits for care. Those longer waits lead ambulances and their crews to spend more time at the emergency room, delaying their ability to get to the next 911 call. It also means that patients may not get into the hospital of their choice. Simply put, if Main Line Health’s ERs are full, patients will have to go elsewhere.

How Did We Get Here?

Why are these hospitals facing financial losses? The problem, insiders explain, is that health systems’ expenses are rising while revenues stagnate. Medicare and Medicaid reimbursement rates, which make up the overwhelming majority of revenues at hospitals, have barely changed, despite surging inflation, Stallkamp said. “Unlike most industries… we can’t increase our prices,” he said. “We get paid by the government at a set rate.”

PA hospitals saw revenue losses totaling $678.3 million in the first half of 2022 alone. “In reality, the numbers are probably much higher,” said Jeffrey Bechtel, senior vice president of health and economics policy at the Hospital and Healthsystem Association of Pennsylvania (HAP). Main Line Health alone is reportedly preparing for another consecutive $100 million fiscal year loss.

Faced with huge losses, Crozer started reducing services at DCMH. Still, the hospital provided expert care and saved lives, Neopolitano said. But she felt like Prospect Medical Holdings, which owns Crozer, made her job harder. Neopolitano said that Prospect didn’t permit traveling supplemental staff at DCMH, a tool Bechtel said hospitals use to temporarily alleviate shortages. “It was all about greed and profit,” Neopolitano said.

When the hospital closed, Delaware County said that it was because of a “failure to adequately staff” the health center, and represented a “gross lack of concern for the well-being of Delaware County residents.” County officials’ outrage was similar to that of Chester County Commissioner Josh Maxwell when Tower Health announced its closures. “They are laying off thousands of employees that have worked there for decades because they didn’t know what they were doing,” he said at the time.

Neither Crozer nor Tower Health responded to requests for comments about the closures and their consequences.

The EMS Crisis

Paramedics still respond to every 911 medical call, but they are stretched thin as they crisscross the suburbs transporting patients to open hospitals, said Julian “JP” Watras, president of the Crozer Chester Paramedic Association. “It’s not uncommon for the closest paramedic to be halfway across the county,” Watras said. “If you’re the only truck in the county, you’re going where the need is.”

When they get to hospitals, paramedics have to wait for their patients to be admitted. Ambulances’ wait times at emergency rooms used to be 15-20 minutes. Now, that wait can be up to a couple of hours.

“Wall time” didn’t exist in 2019, said Al Davey, executive director and paramedic at Narberth Ambulance. As it increases, paramedics are spending more time treating the patients. “We’re waiting in the hallways and managing these patients,” Davey said. “We’re going back out to the truck for additional oxygen bottles. This is through no fault of anyone, it’s just the volume.”

According to data provided to Main Line Tonight, Main Line Health’s emergency department visits rose 8% in 2022. Crozer Chester Medical Center’s ICU is full 95% of the time, said Neopolitano, who is now an RN there. Patients are consistently waiting in the emergency room for beds. “It’s just a nightmare for the community,” she said. “It’s a living nightmare.”

So where are patients going for treatment? Davey said that patients generally have a preference of which hospital they want. But his squad members often call different emergency rooms to figure out where patients can be seen the quickest. “We talk to a doctor on speaker phone so the patient can hear the hospital say, ‘We’re really busy,’” Davey said.

Getting patients to open hospitals often takes EMTs out of their typical transport areas, Davey and Watras said. While Davey said 85% of Narberth Ambulance patients go to Main Line Health, he has been taking more trips to Penn medical centers of late, while Watras said his crews are, at times, heading to hospitals in Center City and Chester County.

The increased volume and urgency to get patients seen is an added stress for nurses, doctors and paramedics. “At this pace, it’s unsustainable,” Watras said. “It’s causing people to look for other employment and that’s going to have some bad long-term effects.”

And it makes delivering care more difficult, even if you’re dedicated and supported by hospital management, Neopolitano said. “There’s only so much you can do when you’re tired.”

HAP 2023 Roadmap Solution

Could more suburban hospitals close? Maybe. Even if they don’t close, they could curtail existing services and postpone the addition of new services, Bechtel said.

What can be done? In January 2023, the HAP issued policy recommendations for both lawmakers and individual hospitals to retain talent. Ideas relate to prioritizing and supporting the health care workforce and increasing investment in the industry. HAP is also calling on Gov. Josh Shapiro to create a health care workforce council to focus on this issue.

And, HAP will lobby Shapiro and the state legislature on raising PA’s  Medicare and Medicaid reimbursement rates to alleviate the revenue problem. “Like any complex problem, there’s no easy solution, and I think it’s going to require many things,” Bechtel saidWith no straightforward way to fix the crisis, it’s unclear when it might end. But the toll it’s taking, on patients, healthcare workers and the entire region, is clear. “This is the saddest I’ve ever been in my career, even more so than COVID,” Neopolitano said. “[Nursing] used to be one of the top professions, but now it’s just too hard.”

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