Hospitals are embracing specialization as cost pressures and consolidation upend health care service models.

Expanding Chicago-area chains have begun reconfiguring themselves as networks of specialty hospitals with narrower offerings. Three-hospital Loyola Medicine is consolidating open-heart surgery at its flagship facility in Maywood. And NorthShore University HealthSystem is centralizing orthopedics, urology and open-heart surgery at various locations in its four-hospital network.

By centralizing services like cardiology and obstetrics at high-traffic facilities, hospital chains aim to improve care and save money on surgical equipment, space and staff. Intended to boost hospitals’ bottom lines, the move away from traditional one-stop shopping means some patients—even those in the Chicago area—could be forced to seek care farther from home.

“In urban settings, don’t underestimate how hard it may be for certain families to get from one part of town to another,” says Steven Shill, a partner and national leader at the BDO Center for Healthcare Excellence & Innovation.

Still, the consolidation of certain service lines is expected to increase as hospitals continue to combine and financial pressures intensify.

“Service rationalization has perhaps the greatest potential for transforming cost structure,” consultancy Kaufman Hall said in a 2018 report. “Forward thinking health care leaders . . . are concentrating resources in services that will result in long-term relevance and sustainability and consolidating or divesting services that are not expected to add value going forward.”

Amita Health, which acquired 10-hospital Presence Health last year, recently got approval from the state to discontinue certain services at three former Presence hospitals due to low utilization.

Amita Health St. Joseph Hospital in Lakeview cut its 23-bed comprehensive physical rehabilitation unit as admissions fell nearly 55 percent from 2014. It saw only 92 patients last year. Amita will continue offering rehab at Sts. Mary & Elizabeth Medical Center in Chicago, about 5 miles away. The Lisle-based 19-hospital network also discontinued open-heart surgery programs at Amita Health St. Francis Hospital in Evanston and Amita Health Sts. Mary & Elizabeth. While each hospital was performing about 40 to 50 open-heart surgeries annually, state regulators recommend at least 200 such procedures be performed on adult patients annually at facilities that have been open for three years. In its application, Amita says volumes cannot reasonably be anticipated to increase given the advent of less-invasive procedures. Open-heart surgeries still will be performed at Amita Health Resurrection Medical Center in Norwood Park.

“Physicians, nurses and the technical staff who work with patients are typically at their very best when they do a lot of the same thing,” Amita CEO Mark Frey says. “When they have high volume, they not only tend to become extremely proficient, but they become extremely efficient and effective. A lot of that drives better patient outcomes.”