🔒Editorial: Maternity care needs more than just an angry coalition

In the three-month battle over UMass Memorial Health’s plan to close its maternity center at its affiliate HealthAlliance-Clinton Hospital in Leominster, it’s easy for the coalition of community leaders and politicians to paint UMass Memorial as the big bad heartless business. As the largest employer in Central Massachusetts with more than 16,000 employees and $3.1 billion in annual revenue, the nonprofit healthcare provider can be a soft target. Advocating for maternity care is no doubt a winning political issue, and it’s easy to see why so many from northern Worcester County are rallying around it.

But simply forcing UMass Memorial’s hand to keep the center open isn’t the answer either. Our healthcare system, from national to local, is falling apart. The Family Health Center of Worcester was mere hours away from having to close permanently last year, before its financial ship was righted with a significant influx of state funding. Heywood Healthcare paused an expansion plan in Gardner this year in order to get its finances in line. Tenet Healthcare has had a high level of turnover on its executive team at MetroWest Medical Center in Framingham. These are all signs of major cracks in the industry. We need a strong coalition of business, community, and political leaders to tackle the many problems causing this threatening level of strain.

UMass Memorial insists the Leominster maternity closure is a clinical decision, not a financial one. As WBJ Correspondent Emily Micucci writes in her “The high cost of delivering babies” story, the Leominster unit is operating with essentially one OB-GYN on staff, doesn’t have a neonatal intensive care unit, and has limited capacity to deal with labor emergencies. UMass Memorial could do what Tenet did at MetroWest Medical Center to improve its maternity center: hire and train more nurses in labor and delivery, and bring on laborists, who are doctors who only handle deliveries. All that doesn’t make much sense in Leominster, though, as the number of births at the hospital fell 24.6% between fiscal 2018 and 2022.

Staffing up the Leominster maternity unit would also be a challenging financial investment, as the center already operates at a $4-million annual loss. Arguably UMass Memorial could absorb that loss, as the system generated $293 million in positive operating margin over the six months ending in March. However, UMass shouldn’t look to increase its burden at a time when nearly all hospitals are waving warning flags about federal funding cuts coming in October. Operating large healthcare systems is always going to be a balancing act of providing thin-margin or money-losing operations like maternity and pediatrics alongside those with larger margins like cardiology and neurology. Another growing problem for systems like UMass Memorial is private, for-profit operations running competing, streamlined operations for many of those high-margin specialties, like a colonoscopy center. We’re not that far off from a future where the for-profit providers have all the high-margin businesses while nonprofits like UMass are left to skate by focusing on low-margin, essential services.

The Department of Public Health is right in designating Leominster maternity as an essential service and UMass Memorial needs to develop a plan to service the marginalized populations to be impacted by the consolidation of maternity services to Worcester. Beyond this single issue, we need to provide some comprehensive, consistent fixes over many decades to return health care as the essential service it is.