News and analysis from The Center for Michigan •
©2015 Bridge Michigan. All Rights Reserved. • Join us online at

Original article URL:

Guest commentary

Cheboygan hospital’s turmoil, shrinkage part of necessary change in rural health

By Marianne Udow-Phillips/Center for Healthcare Research & Transformation

Debates about the Affordable Care Act will continue — in the Supreme Court, in the halls of Congress and around the country — but health reform is already happening all around us. All we need to do is look.

A case in point is Cheboygan on the shores of Lake Huron, where the local hospital was closed suddenly at the beginning of April, and then resurrected — in a different form — in mid-May.

Here’s what was in the press as it became clear the hospital would close in early April:

* The Cheboygan Memorial Hospital (CMH) is closing today leaving 300 employees without a job. Channel 9&10 News reports the hospital had filed for bankruptcy on March 1. (Michigan Radio)

Marianne Udow-Phillips is director of the Center for Healthcare Research & Transformation in Ann Arbor and a former director of the Michigan Department of Human Services.

* Cheboygan nurses and community leaders are in shock today. The sale of Cheboygan Memorial Hospital to Flint-based McLaren Health Care has fallen through at the last minute. (Interlochen Public Radio)

* “With this closure, we will have to close our emergency room,” said Shari Schult, CEO of CMH. “We will need to coordinate with area EMS services and local law enforcement to divert all ambulances to the most appropriate hospital. This closure … also means all of our employees are without a job,” she added. (Cheboygan News)

* The long-awaited proposed sale of CMH to McLaren Health Care was set to be finalized today. But now, federal regulations are causing it to come to a halt. CMH officials say the problem is with recertification and licensure under Medicare. And now, the organization is running out of money. (Cheboygan Memorial Hospital press release)

The impression left in the community was that the federal government was unreasonably blocking the sale by requiring new certifications, but later reports shed more light on the government’s position, which turned out to be more nuanced than originally reported.

By mid-May, a deal went through to restore emergency room and outpatient services at Cheboygan Memorial (and the rehiring of 150 staff) — but the inpatient beds were to remain closed.

Classic good news/bad news? Not so fast.

The compelling question that was lost in the story is this: Should we really mourn the closure of those inpatient beds? After all, Cheboygan Memorial was a small hospital, in bankruptcy, with fewer than 50 acute care beds.

People living in rural areas with small hospitals would say yes, citing critical access needs and reminding us that hospitals are often a community’s major employer. But while the strong community identity of these hospitals is completely understandable, the questions we need to ask and answer are: Do they deliver the best care? Is that care cost-effective?  Would traveling farther put people at risk?

In fact, there is considerable research to make us question the assumption that keeping small hospitals open is always a good idea, especially running as they have historically: as independent, community-based organizations.

Practice does matter. When it comes to certain health-care services, doing more of something is associated with better, safer outcomes for patients. Small hospitals don’t have the volume necessary for staff to practice the full range of service needs that larger hospitals do.

And if we are ever going to get a handle on the cost of care, economies of scale and efficiencies will certainly be part of the solution.

In the end, it was not only inevitable, but probably a good thing that Cheboygan Memorial Hospital closed and reopened — with scaled back services — as part of the much larger McLaren Health System. Emergency and basic care will remain in the community; inpatient care will likely mostly be delivered at McLaren Northern Michigan Hospital, 30 miles away.

Some are still unhappy: after all, Cheboygan Memorial was a major employer.

But this is health-care reform on the ground, and it ain’t all bad.

Bridge welcomes guest columns from a diverse range of people on issues relating to Michigan and its future. The views and assertions of these writers do not necessarily reflect those of Bridge or The Center for Michigan.

1 comment from a Bridge reader.Add mine!

  1. Bob Martel

    I don’t understand why maintaining community employment is seen as justification for keeping an inefficient and less effective facility open. Since when is a hospital a “jobs program?” As long as basic primary care and emergency services (with transport via helicopter if needed) are available, a 30 mile drive for hospital services is more than reasonable.

Leave your comment...

Your email address will not be published.

Currently on Bridge

Will we be better off if Proposal 1 passes? Former treasurer says yes

An Earth Day pitch: When you hang up the phone for good, toss it the right way

Michigan’s roads affect everyone, so a 'yes' vote on Proposal 1 makes sense

‘Diplomacy Begins Here’ conference aims to illuminate international relations

What NOT to post on Facebook: Jokes about prison rape, when you’re in charge of preventing prison rape

A program to give young offenders a second chance is sending many to prison

Similar accounts in suit over alleged teen prison rapes pose challenge to state's defense

‘New fish’ ‒ One teen inmate’s account of alleged sexual assault

Early learning summit in June could impact Michigan’s children

Money Smart Week: Be penny wise, and pound savvier

Plan B or no Plan B, here’s what happens if road proposal fails

The political tale behind the selling of Proposal 1

A Bridge primer: Untangling the pothole promise of Proposal 1

Who supports, and opposes, Proposal 1

Let's rebuild Michigan through its greatest asset: its water

Could a public boarding school model work in Detroit?

Coalition supporting Detroit schools a step in the city’s road back

Chasing fads? Today’s schools are struggling too much for that

For one Michigan legislative staffer, an hour or two in the spotlight

A cull is a kill, and it’s an overreaction to deer ‘problem’

Lack of college guidance keeps poor and rural students from applying

Those who can, do – and get their hands ‘dirty’ in the process

For one Detroit mom, a complicated path to employment

Detroit by the numbers – the truth about poverty

Michigan should require dental screening for all children entering kindergarten

Where in the world is the Center for Michigan?

After two years, hard to call ACA anything but a success

Bridge’s Academic State Champs emphasizes all the wrong measurements

A graying population poses challenges for Up North counties

Up North, isolation impedes health care for seniors

Enbridge oil pipes and the Straits of Mackinac: Too risky to ignore

Not bigger government, but better services when Community Health and Human Services merge

Two Michigans gaze across a widening gap

In northern counties, workers and business find each other lacking

Hidden poverty stalks a Pure Michigan setting

Postcard: How a git-’er-done spirit helps one rural school district

Postcard: When elk is for dinner

Postcard: Luxe life at Bay Harbor reflects changing economy

Postcard: A roof and a bed

Invest in non-partisan journalism.

Donate to The Center for Michigan. Find out why.