🔒When a hospital closes: Central Mass. ER visits rose after Nashoba Valley shuttered, as hospital finances are increasingly strained

When Nashoba Valley Medical Center closed its doors at the end of August 2024, its fellow regional hospitals were left to somehow absorb the Ayer facility’s approximately 16,000 annual emergency room visits and about 91,000 annual outpatient visits. “The UMass Memorial Health system started feeling the effects of the Nashoba closure, really immediately,” said Justin Precourt, president of UMass Memorial Medical Center in Worcester. UMass Memorial expects to alleviate some of the pain when its parent organization opens a standalone emergency room in Nashoba Valley in 2027. Yet, the volume in Central Massachusetts ERs is still expected to grow, exacerbated by a primary care shortage and incoming $1 trillion in cuts nationally to Medicaid. “There is a big crisis with access to primary care, and with potential Medicaid cuts, patients will be even [less] likely to get preventative care. And that will exacerbate the challenges that emergency rooms have,” said Rozanna Penney, president and CEO of Gardner-based Heywood Healthcare.

Strained systems

The UMass memorial system had begun to experience an uptick in its emergency department volume about 30 days before the 77-bed Nashoba Valley Medical Center’s closure. The emergency departments of UMass Memorial HealthAlliance-Clinton Hospital’s Clinton and Leominster campuses have seen a close to 10% increase since the Ayer hospital’s closure.

Even still, Precourt said the greatest burden has fallen on the region’s municipal emergency response systems. What was once a five-minute, one-way transport to take a patient to NVMC has now increased to 25 minutes to neighboring hospitals, said Arthur Cheeks, the fire chief for the Town of Groton. That, combined with an increased demand on the town’s limited emergency response staff, leaves local residents vulnerable when every minute counts. “Especially in the evening hours, we are essentially out of service for over an hour,” said Cheeks. “It leaves the town virtually unprotected.” Since NVMC’s closure, HealthAlliance-Clinton Hospital’s emergency department has seen about 15 to 21 more patients each day, forcing the facility to open up to 25 additional beds and hiring additional staff to meet demand. Behind the ED, the hospital’s psychiatric services have experienced the second-greatest rise in demand, especially as HealthAlliance-Clinton accommodates those who would have sought care at NVMC’s geriatric psychiatric unit. UMass Memorial Medical Center, more than 30 miles from NVMC, has seen a 3% increase in its ED volume. “Three percent is an additional 3,000 patients annually, which is not insignificant,” said Precourt. Outside of the UMass Memorial system, Emerson Hospital in Concord, about 17 miles from the former Ayer facility, has experienced a more than 10% increase in its ED volume between fiscals 2024 and 2025, said Christine Schuster, Emerson president and CEO. While NVMC’s closure is not solely responsible for that entire increase, through zip code analysis, Emerson has identified a surge in patients accessing the facility from Nashoba Valley. “As late as last week [we had] over 25 patients waiting for beds in our emergency department,” said Schuster. “And we think it just continues to grow.”

When NVMC shut down, Emerson set up a landing page on its website specifically to help Nashoba Valley patients transition their care. Emerson has been working closely with local EMS, attempting to make the hospital's wall times as short as possible, reducing the time between when EMS drops off a patient and when they are able to get back on the road. “We understand the strain they're under,” said Schuster. Groton’s fire department had been receiving an increased number of calls before NVMC even shut down, said Cheeks, and the problem has grown. The year prior to NVMC’s closure, Groton’s fire department had experienced a 13% increase in calls compared to 2022. Last year, that figure increased by 17%, totalling over 1,700 calls, and in 2025, the department is tracking approximately an additional 15% increase. “The number of requests for services aren't diminishing; it's not slowing down. And for the surrounding towns, they're feeling the same thing,” said Cheeks. In 2024, the fire department added two new firefighters, who are cross-trained as EMTs, allowing the department to keep its response times the same: between five and seven minutes. Still, the department spent all of its overtime budget last year, a figure between $160,000 and $200,000, to fill in the gaps. “You can't treat a patient and drive at the same time. So we hit this dire need for more staffing,” Cheeks said. The department relies on mutual aid with neighboring municipalities and volunteer firefighters when patient demand outpaces capacity. But volunteer firefighters are responding from their homes and must travel to the fire station first before heading to a fire. If one isn’t available, firefighters have to work alone. “A lot of this is affecting the next call. But if nobody comes back for station coverage, now you're getting a response of one person,” said Cheeks.

New ED, more problems

After meeting with fire and emergency response chiefs like Cheeks, UMass Memorial Health in Worcester decided to open a Nashoba Valley emergency department in the wake of NVMC’s closure. Located at 490 Main St. in Groton, the satellite ED is set to open at the very end of 2026 or in January 2027. Equipped with x-ray, lab, and CAT scan services, the facility can treat any condition a patient would typically visit an emergency department for, said Precourt. “The one thing it cannot do is house patients who need inpatient care,” he said. In those cases, the ED will use ambulance contracts to transport patients to neighboring hospitals instead of relying on municipal response. In the case of critical need, UMass will use its Life Flight program to transport patients via helicopter. While the new ED will alleviate some of the existing wait times and challenges for residents, Penney from Heywood said there will still be a greater demand for healthcare services than the region has supply. One of the most critical healthcare challenges facing the region is the primary care shortage, she said. While Massachusetts has the third-largest number of primary care physicians per-capita, the state has the fifth-lowest share in the nation of them offering direct patient care, according to a January report released by the Massachusetts Health Policy Commission.

Part of the issue of primary care deserts, felt most in rural areas, is due to the number of physicians closing their private practices, said Penney. The share of physicians who consolidated under a hospital system grew by 18 percentage points to 47% between 2012 and 2024, largely due to unsatisfactory payment rates, according to a study released in September by the U.S. Government Accountability Office. The Gardner region has seen a number of private practices close in the past couple of years, and area hospitals have had a hard time recruiting physicians, said Penney. Rural settings are less attractive to applicants to begin with, and doctors at smaller hospitals need to be on-call more often, another knock against them, she said. In December, an Athol private practice with 5,000 patients closed, a factor which may have contributed to Heywood’s Athol Hospital experiencing a 6% increase in ED visits year over year, compared to Heywood Hospital in Gardner, which had a 3% increase.

Patients postpone care when they don’t have equitable access to primary care providers, and thus, they often end up developing acute conditions that land them in hospital EDs, contributing to longer wait times, Penney said. This dearth in access will only intensify once Medicaid cuts are enacted. While estimates range, officials and governing bodies anticipate hundreds of thousands of Massachusetts residents will lose their health coverage due to Medicaid cuts outlined in the President Donald Trump Administration’s Big Beautiful bill, passed in July. In May, Massachusetts Gov. Maura Healey projected more than 250,000 would lose coverage while the U.S. Congress Joint Economic Committee in June estimated up to 326,262. With delayed care and limits to food due to slashes in SNAP benefits, more Central Mass. residents will need care, showing up to the one place they legally cannot be turned away from. “They will just show up in the emergency rooms. They're going to be sicker,” said Penney.

Mica Kanner-Mascolo is a staff writer at Worcester Business Journal, who primarily covers the healthcare and diversity, equity, and inclusion industries.