Mayo Clinic's plan to remove core services such as intensive care and baby deliveries from the hospital in Albert Lea is drawing opposition from residents and community leaders, making this southern Minnesota city the latest to worry that a restructured medical system will force them to drive farther for care and lose the economic vitality of a fully equipped hospital.

"We don't think Mayo had any consideration for our community," said Al Arends, a retired Albert Lea business executive who is part of a group called Save Our Hospital. "We've got three large retirement homes here and those older people are now going to have to go to Austin … if they need to stay overnight in a hospital."

Mayo is hardly alone in the consolidation wave, turning jack-of-all-trades hospitals into specialist facilities. Allina Health orchestrated a similar switch last year in Anoka County, when it moved Unity Hospital's cardiac and obstetrics services to Mercy Hospital in nearby Coon Rapids, consolidating inpatient mental health units at Unity.

Industry executives anticipate declining revenue in coming years as more patients switch from private insurance to lower-paying government programs such as Medicaid and Medicare. In Albert Lea and Austin, specifically, Mayo argues that consolidating services is necessary to recruit top doctors and survive economically.

"We're still going to have a very busy hospital in Albert Lea," said Dr. Bobbie Gostout, Mayo's vice president.

Mayo leaders say there are unique reasons for consolidating the Austin and Albert Lea facilities, which are 23 miles apart and are technically licensed as one hospital with two campuses.

Mayo has struggled to recruit obstetrics physicians to Albert Lea because the small staff size forces them to be on call frequently. "It means a lifestyle choice of being on call every third or fourth night or every third or fourth weekend," Gostout said.

She acknowledged that every community has a gut reaction to losing services such as inpatient surgery. But, she said, the reality is that almost 80 percent of Albert Lea's surgeries already take place on an outpatient basis and the hospital will continue to have an active surgery schedule. A doctor there is preparing to switch his knee replacements from inpatient to outpatient procedures, for example.

Fewer independent hospitals

Mayo has faced community resistance before, notably when Fairmont and Lake City faced similar restructurings. Yet the proposed shift is a bitter pill for some in Albert Lea, where the hospital has had high quality ratings and where insurance rates are high because of Mayo's stranglehold on the local market.

Earlier this month, the Albert Lea City Council voted to oppose Mayo's plan, which would move all inpatient surgeries, maternity and intensive care to its hospital in Austin while moving all inpatient psychiatric and chemical dependency services to Albert Lea. The Freeborn County Board is scheduled to review the plan Tuesday morning, though no vote is anticipated.

Meanwhile, the Save Our Hospital group is taking an independent look at the hospital's financial stability, as well as the potential to attract a competitor to Mayo, said Mariah Lynne, an Albert Lea business consultant leading the grass-roots campaign.

"A full-service hospital, an acute-care hospital, is something that our citizens believe is a must-have," she said.

All across Minnesota, hospitals have realigned over the past decade — especially in rural communities, where Mayo, Essentia and Sanford have become the dominant networks. Only 37 hospitals in the state remain independent, according to the Minnesota Hospital Association.

But independent health care analyst Allan Baumgarten said consolidations like the one proposed in Albert Lea and Austin will happen only in pockets of the state where competition is lacking.

"Mayo has the only hospitals in Mower and Freeborn counties, and Allina has the only hospitals in Anoka County," he said. "So if you downsize one hospital, there is not much concern that a competing system will swoop in and take business away."

Albert Lea leaders argue that their community, which sits at the crossroads of two interstate highways and farther than Austin from Mayo's Rochester campus, would be a better choice to keep inpatient, maternity and intensive care services. Businesses to the west and even in Iowa list the hospital as a primary provider in their plans.

"We think we're getting the short end of it," Arends said.

Historically, the hospitals have been comparable in the number of births and ER visits, according to the state hospital association. But the average daily inpatient census in Austin was 30 in 2014, compared to 15 in Albert Lea. And staffing and operating costs were higher in Albert Lea.

Albert Lea leaders fear the financial picture will only worsen if their hospital takes on the majority of low-revenue services such as mental health, making the facility a target for eventual closure.

Gostout countered that both hospitals will be stronger and actually draw more complex patients away from Mayo's Rochester campus if they have their own areas of expertise.

"We need both of these places functioning," she said, "in order to make the jigsaw puzzle work."

Jeremy Olson • 612-673-7744