Updated at 10 a.m.

Cook County-run Provident Hospital on the South Side is located in the shadow of the prestigious University of Chicago medical hub. But that research-focused campus is so busy, county leaders see an opportunity.

“It’s very busy and almost busting at the seams,” Dr. Jay Shannon, CEO of Cook County Health. “University of Chicago is probably, if you will, doing all that it can at this stage of the game. … And they themselves have limited ability to expand further, particularly for the populations that we have traditionally served.”

That population is uninsured and low-income patients. And around Provident, elderly patients on Medicare government health insurance. Provident and U of C are roughly a mile apart.

In a statement, a U of C spokeswoman ticked off a list of the health system’s in-demand advanced medical care services, such as a trauma center, a neonatal intensive care unit and an organ transplant program as a reason the medical campus is often at or near capacity for specialty services.

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“Having additional, high-quality hospital facilities with available patient capacity can only do more to serve the South Side community, which has very real and substantial health disparities that must be addressed at a systemic level,” the spokeswoman wrote in the statement.

Besides Provident being old and expensive to maintain, providing more access to specialists is why Cook County Health wants to demolish Provident and build a new modern facility. The two-hospital network, which also includes flagship John H. Stroger Jr. Hospital on the Near West Side and a network of clinics, is considered the medical safety net in the region for people who have nowhere else to go.

The plan to raze and replace Provident is estimated to cost about $241 million; much of that is debt the health system plans to take on and pay down.

The proposal comes as Cook County Health has had to defend its reputation after a searing report from Cook County Inspector General Patrick Blanchard. He questioned how the health system runs its Medicaid health plan called CountyCare, and alleges that CountyCare has a big IOU to doctors, hospitals and other vendors it does business with. The health system has disputed some findings, but has hired an independent firm to review the report.

Breathing new life into Provident is among a flurry of proposals Cook County Health revealed last month in its proposed strategic plan for the next three years. In the plan, the health system said it’s planning to “build a new, modern facility” on Provident’s campus that would consolidate inpatient and outpatient services “to provide exceptional care and attract new patients.” Provident typically treats older patients, the report said.

Almost half of Provident’s patients in 2017 were on Medicare, the government health insurance program for people 65 and older, and 93% of patients were black, the most recent state records show.

A risky bet

Building or replacing a hospital is unusual in Illinois. State regulators say they have approved fewer than 10 new or replacement hospitals in the last 15 years. There are more than 200 hospitals in Illinois. Most health systems are investing in outpatient centers instead. 

In fact, state lawmakers are dangling money to help hospitals throughout Illinois change how they do business. That means converting into smaller outpatient facilities or closing altogether, if that’s what their communities need.

That’s because hospitals are emptying out, for a host of reasons. Chief among them: Insurers are steering people toward cheaper, more convenient care. Think a doctor’s office or a pharmacy clinic inside Walgreens.

The South Side is a sea of small community hospitals like Provident that for years have struggled to fill their patient beds. Provident treated just 17 patients on the busiest day of the year in 2017, the most recent state records show.

The tale is similar for other South Side community hospitals. In fact, it’s common for CEOs of these hospitals to talk of potentially closing their doors because they can’t afford to stay open. Some of that has to do with slow payments from insurance companies.

The new Provident

Shannon acknowledges the changing reality in health care. The new eight-story Provident is planned to have nearly half as many hospital beds — from 85 to 48 beds. The hospital would offer new specialty services, such as dental, orthopedics and sports medicine, and expand others, like pediatrics and outpatient services. The emergency department would reopen to ambulances — another way to provide more access to patients and make money for the health system.

Cook County Health intends to help keep Provident’s beds full by shifting patients who typically go to Stroger now for treatment. About 60% of Stroger patients live near Provident, according to an application the health system has filed with state regulators.

Shannon said it doesn’t make sense for people to trek to Stroger for simpler care they could get closer to home near Provident. The hospitals are about 8 miles apart. Plus, the health system wants Stroger to be the place where doctors treat the most complicated health cases.

There have been times where Stroger has been too busy to accept patients who need more specialty care.

“Those are the things that we’d like to be able to avoid,” Shannon said.

Construction is scheduled to be finished in 2023. The current Provident Hospital would be demolished.

Provident has a storied history. It opened nearly 130 years ago, in 1891 as an African-American Hospital, according to Cook County Health. The hospital later closed for financial reasons. Then Cook County government took the hospital over, invested millions into it, and reopened Provident in 1993.

The Illinois Health Facilities and Services Review Board, whose members are the state regulators who decide the fate of hospital projects statewide, must approve Cook County Health’s proposal to replace Provident.

Kristen Schorsch covers Cook County politics for WBEZ. Follow her @kschorsch.