Ascension health care system retracts nationwide—but not in Indy

In the past five years, the nation’s largest Catholic health system, Ascension, has unloaded more than a dozen hospitals across the country, from New York to Alabama, as it restructures amid a growing tide of red ink.

In Indiana alone, it shut a critical-access hospital in Bedford, closed 11 immediate-care walk-in centers in central Indiana and shut down or repurposed five small “neighborhood hospitals.”

And there’s no sign the sell-off is over.

“Ascension continues selling spree,” said a headline last month in Becker’s Hospital Review, a trade news site, which added that the St. Louis-based system has more deals in the pipeline.

“Ascension hastens exit out of Michigan,” said a headline in Crain’s Detroit this month, after the health care system sold three hospitals in the northern part of the state to a large health system affiliated with the University of Michigan and set up a joint venture with another large system in the Detroit area.

Ascension, trying to dig itself out from a $3 billion operating loss in fiscal year 2023, has not limited its sell-off to hospitals. It has also sold its interest in laboratory operations and a health insurance group.

So does Ascension plan to close or sell more Indiana assets?

In an unusual move for a national hospital system amid a major restructuring, Ascension disclosed part of its plans. It is not considering offloading or closing any more Indiana operations, an Ascension corporate spokeswoman told IBJ in an email.

“The changes to our footprint in other parts of our national ministry are designed to ensure sustainable and favorable options for those communities,” the email said. “There are no plans to make any such changes to our Indiana ministry.”

Several health care consultants said they would be shocked if Ascension sold a large number of properties in Indiana or exited the state altogether, as it has done elsewhere.

“I wouldn’t just be surprised. I would be totally aghast,” said Ed Abel, retired director of health care practice at Indianapolis-based Blue & Co., an accounting and consulting firm. “I would just say it’s never going to happen.”

That’s because Indiana is one of the system’s most profitable operations, delivering $192 million in net income for the system for the fiscal year ending June 30, 2022, the most recent Indiana figures available. The same year, the system as a whole lost $879 million from operations.

Translation: Indiana is a moneymaker for Ascension, helping it to fund a huge system that otherwise would be posting much larger losses.

So any further cost-cutting in Indiana would be relatively minor, some experts say.

“In general, large health systems are constantly tweaking their portfolios,” said David Blish, director of health care consulting for Katz Sapper & Miller, an Indianapolis-based accounting and consulting firm. “I doubt Indiana Ascension will contract at a significant scale.”

Ascension pointed to its flagship campus on West 86th Street, where construction continues on $325 million worth of improvements, including a new brain and spine center, a new women’s and children’s tower, and a new parking garage.

The company said the investments will help the company’s operations here, known as Ascension St. Vincent Indiana, a “premier destination for care” in the Midwest.

Separately, Ascension St. Vincent this week issued invitations for a public celebration marking the 50th anniversary of the company’s West 86th Street hospital. It said the event will take place 2-4 p.m. April 28 on top of the parking garage at the corner of Harcourt Drive and Katie Knox Drive.

“The 50th anniversary of our 86th Street location gives us the opportunity to honor all of those who contributed to making the hospital what it is today as well as look forward to the future of health care,” the invitation said.

The event will mark the 1974 move, when staff of St. Vincent and the U.S. Army Reserves transferred 102 patients from the hospital’s Fall Creek campus (now part of Ivy Tech Community College) to a new campus on the northwest side of Indianapolis, which was then largely fields and forest.

Twenty-five years later, in 1999, Ascension bought St. Vincent for an undisclosed amount.

That marked the end of more than a century of independent ownership, since four nuns from the Daughters of Charity religious order arrived in Indianapolis in 1881 at the invitation of Catholic Bishop Francis Chatard and set up St. Vincent Infirmary in a house near Vermont and East streets.

Within a few years, the infirmary grew to 50 beds and changed its named to St. Vincent Hospital. It relocated twice before the move to West 86th Street. After decades of expansion, that campus now fills the better part of 20 square blocks between West 86th and West 79th streets.

Ascension said the six-story Women & Children’s Tower going up on the south side of the campus is designed to address the high level of maternal and infant mortality in Indianapolis. It will feature 109 private neonatal intensive care unit rooms along with an expanded pediatric intensive care unit. The tower is scheduled to be completed this year.

The four-story Brain and Spine Hospital is rising at the front of the campus and will include operating rooms, an intensive care unit, an intensive care step-down unit, and a residency training program. Ascension said it expects construction to be completed early next year.

The new projects, announced in 2021, represent one of the largest capital investments in decades for Ascension Indiana. It also gave the strong suggestion that the corporate parent was committed to the Indianapolis flagship, a major anchor on the busy West 86th Street commercial corridor.

So why is Ascension building here while unloading hospitals elsewhere and exiting some states altogether?

In many cases, the answer seems to be that Ascension is leaving where it cannot take advantage of a wide system of community hospitals in coordination with a top-tier hospital to handle complex cases.

In modern health care, hospital systems increasingly want a network of hospitals that can act as feeders for the major hospital in a large metropolitan area. And if they are a small player in a market that is dominated by a huge competitor, they have less chance to fill beds, negotiate favorable insurance plans and make money.

In Minnesota, the world-famous Mayo Clinic dominates the market with net patient revenue of $3.32 billion in 2022—far ahead of second place University of Minnesota Medical Center, which pulled in $1.68 billion.

“Who is ever going to beat the Mayo Clinic there?” Abel said. “Yes, there’s a lot of competition up there. But there’s a lot that have dropped out and said, ‘We’re never going to be as good as those guys.’”

Central Indiana has no single dominant player. Instead, there are four or five large players and a few dozen small players, mostly in the suburbs. And each system has a different claim to fame.

In the nine-county metropolitan area, Ascension St. Vincent has the most staffed beds, with 1,995, ahead of Indiana University Health (1,514), Community Health Network (1,124), Franciscan Health Network (563) and Eskenazi Health (333), according to IBJ research. (Those figures are from 2022, the most recent year available.)

Yet in the same year, Indiana University Health pulled in far more revenue across its statewide system, $8.1 billion, than Ascension St. Vincent ($3.7 billion) and Community Health ($3.1 billion).

Statewide, Ascension owns 19 hospitals from Anderson to Brazil, including facilities in Carmel, Fishers, Indianapolis, Anderson and Kokomo.

In addition to being a large player, Ascension St. Vincent is performing well financially in central Indiana and has no reason to start offloading assets, Abel said.

“Indiana is what I would call an aircraft carrier for Ascension,” he said. “They have a huge presence here, and they’re proud of it.”

And Ascension’s corporate leadership clearly has a soft spot for Indiana. The company’s CEO, Joseph Impicciche, was raised in Crawfordsville and earned his bachelor’s at Wabash College. He went on to earn a law degree and a master of health administration degree from Indiana University. He practiced for more than a decade at Indianapolis law firm Hall Render Killian Heath & Lyman, which specializes in health care law.

Ascension declined to make Impicciche or any other senior leader available for an interview with IBJ.•