Ascension Wisconsin cutting services at St. Joseph hospital

Ascension Wisconsin will no longer provide surgical and other services at St. Joseph hospital as part of a long-term plan to lessen its financial losses and transform the Milwaukee hospital’s role in the largely low-income neighborhood.

The health system will continue to operate its emergency department — one of the busiest in the state — and will continue to provide obstetric care, including operating its neonatal intensive care unit, at the hospital.

It also will continue to provide primary care on the campus at 5000 W. Chambers St.

Ascension Wisconsin envisions two phases in the planned changes.

The first will be to close the surgical and medical units and discontinue other services at the hospital. The second will be to invite organizations and agencies to use the available space at the hospital as a base to help address the health and social needs of the surrounding community.

"We want to try to be a catalyst for further action to come in and invest in that neighborhood,” said Bernie Sherry, the senior vice president of Ascension Health who oversees the Wisconsin market.

Wheaton Franciscan’s operations in southeastern Wisconsin, which include the Wheaton Franciscan-St. Joseph campus, became part of Ascension, the country’s largest nonprofit health system, in 2016.

St. Joseph hospital and affiliated services still will have an operating budget of $150 million to $160 million a year after the pending changes, Sherry said.

Ascension Wisconsin and Wheaton Franciscan before it have been reducing the services available at the hospital for several years because of its losses.

The hospital, which serves primarily patients covered by Medicaid and Medicare, lost a total of $81.9 million in the 2012 through 2016 fiscal years, based on the most recent information available from the Wisconsin Hospital Association.

Those figures include some other operations, such as an outpatient clinic in Wauwatosa, and the losses at the hospital could be larger.

Roughly 51% of the hospital’s patients are covered by Medicaid, and an additional 5% are uninsured.

By comparison, 14.5% of Aurora St. Luke’s Medical Center and Aurora St. Luke’s South Shore’s patients and 15.9% of Froedtert Hospital’s patients were covered by Medicaid in a comparable period.

What Medicaid pays hospitals overall doesn’t cover the cost of providing care, and the percentage of patients covered by the health program often determines whether hospitals make or lose money.

That also can be seen at Aurora Sinai Medical Center, where 47.5% of patients were covered by Medicaid in 2016. The hospital in downtown Milwaukee lost $8.7 million that year.

St. Joseph hospital has the equivalent of about 900 full-time employees, said Kevin Kluesner, chief administrative officer of the hospital.

Ascension Wisconsin has about 500 open positions in the Milwaukee area and plans to help the employees affected by the pending changes at St. Joseph hospital to find positions at the health system’s other hospitals and clinics.

"We are working with everybody to try to find a fit if it's there," Kluesner said.

The decision to offer fewer medical services at St. Joseph was made after an 18-month analysis of the Ascension Wisconsin system.

“Since certainly I landed in Milwaukee, there’s been concern about St. Joe’s being closed,” Sherry said. “And we wanted to take the time to discern how does St. Joe’s fit into this broader system of care and make sure that neighborhood has access to care.”

Essential services

Ascension Wisconsin decided that the emergency department, obstetrics, including perinatal care, and primary care were essential services.

The emergency department has about 75,000 patient visits a year. The hospital also provides prenatal care to 700 to 800 women and delivers about 2,200 babies a year.

Its neonatal intensive care unit has an average of roughly 25 babies a day.

The planned move — projected to take six months or less — leaves no general acute care hospital north of downtown Milwaukee and in an area with widespread health disparities.

"I’m definitely concerned," said Jenni Sevenich, chief executive officer of Progressive Community Health Centers, which provides primary care, dental care and other services to more than 12,000 people a year. "Any time they scale back services it affects the population we serve.”

The move will affect the hospital’s medical patients, such as those hospitalized for pneumonia and other illnesses, surgical patients and others.

It also will mean some patients and family members — many of whom rely on public transportation — will have to travel longer distances to receive treatment.

St. Joseph hospital is 4.1 miles from Aurora Sinai Medical Center, 4.6 miles from Froedtert Hospital and 5.6 miles from Ascension Columbia St. Mary’s-Milwaukee hospital.

The planned move is likely to increase the number of low-income patients seen at Froedtert Health and Aurora Health Care.

“We are concerned with Ascension Wisconsin’s decision to withdraw vital health services in the community by significantly scaling back inpatient operations at St. Joseph hospital,” said Tami Kou, an Aurora spokeswoman.

“With community needs growing, we ask Ascension to rethink its decision and, at the very least, have a community conversation and gather input before making any final decisions. Aurora Sinai Medical Center is firmly committed to serving the needs of the community, as such we are gravely concerned about the additional pressure that this will put on the hospital, given that we’re already at capacity.”

St. Joseph hospital has been steadily reducing the number of services it provides for several years.

For example, a total of 3,438 surgeries were done at the hospital in the fiscal year that ended June 30, 2015, according to Ascension Wisconsin. In the 2017 fiscal year, the number was 2,712, an average of fewer than eight a day.

Last summer, neurosurgery and cardiac surgery patients were transferred to Ascension Columbia St. Mary’s-Milwaukee, one of Ascension Wisconsin’s hospitals that provide tertiary, or the most complex, care.

'Primary-care desert'

Patients in St. Joseph's emergency department who need certain care now are transferred to Ascension Columbia St. Mary’s-Milwaukee or another hospital. Trauma patients, for example, are stabilized and transferred to Froedtert Hospital.

Only 5% of the patients in the emergency department are admitted to the hospital, Kluesner said.

He likens the hospital's neighborhood to a "primary-care desert."

At Elmbrook Memorial Hospital in Brookfield, the average age of a stroke patient is 82, Kluesner said. At St. Joseph, the average is 62.

"The patients in our neighborhood don't get the care upfront," he said.

Ascension Wisconsin hopes to add primary care services, possibly in partnership with other organizations, at the hospital.

Other services

Long-term, Ascension Wisconsin officials also hope other organizations and government agencies will make use of the available space at the hospital to provide needed services in the community.

“We really hope that others will step up and join us,” Sherry said.

Ascension Wisconsin would welcome Milwaukee County Behavioral Health Division’s moving its psychiatric emergency department and observation unit to the hospital.

“That would be a community neighborhood need,” Sherry said.

The Behavioral Health Division must find a new home within the next two years for its emergency department and observation unit at the Mental Health Complex in Wauwatosa or no longer provide the service, shifting responsibility of caring for severely mentally ill patients to the hospital systems in the county.

RELATED: County's Behavioral Health Division has only one option for replacing its Wauwatosa hospital

RELATED: How should Milwaukee provide care when mental illness becomes an emergency?

Other services could include job training and education.

"That's what gets us excited," Kluesner said. "I'm hoping we get three years out and we look back and say it was the best thing we've ever done."

Sherry stressed that Ascension Wisconsin is committed to staying in St. Joseph’s neighborhood.

“This is our commitment, but it also is a call to action for others,” he said. “That is so critical. For us to be able to continue to be there for the neighborhood, we really need this call to action. If we get no one, it will speak volumes from a community standpoint.”