CLEVELAND (AP) Cleveland’s two major hospital systems are building medical centers in the suburban city of Twinsburg, the latest in a series of new construction projects that mirror the demographic shift of the region’s affluent residents.

University Hospitals’ $29 million center will open in Twinsburg soon, and the Cleveland Clinic has purchased 84 acres in the Summit County city to build an outpatient medical and surgical center.

Hospitals across the country are following a similar building plan, erecting centers that are conveniently located off interstate highways in expensive, fast-growing suburbs. The satellite centers provide routine care, and refer patients to the flagship hospitals for visits to specialists or for surgery.

“The focus is on the buildings, but the key is not the buildings but the physician network,” said Achilles Demetriou, president of University Hospitals. The centers are efficient, one-stop shopping for patients who live outside the city, he said.

University Hospitals has spent about $100 million in the past 10 years building its suburban centers, driven in part by the migration of residents to locations outside the city, Demetriou said.

Messages seeking comment about the Clinic’s growth strategy were left with the Cleveland Clinic.

Although the Clinic wouldn’t disclose how much it has spent on new medical buildings, a review of building permits and land purchases around the region by The (Cleveland) Plain Dealer revealed it has spent at least $150 million on new projects in the last 15 years.

Combined, the Clinic and University Hospitals have spent an estimated quarter of a billion dollars erecting new centers, and millions more on medical equipment and interior furnishings for the facilities. The hospitals have a combined 33 suburban centers that are in operation, planned or under construction, the newspaper reported.

In many cases the two hospital systems have built their centers startlingly close to each other. In Twinsburg, the two facilities will be less than a mile apart. In Westlake, they are an exit apart on the interstate. The Clinic’s Beachwood facility is just over a mile away from University’s in Mayfield Heights, and the Clinic’s Solon center is about 9 mi. from University Hospitals’ in Bainbridge Township.

“They stalk one another geographically,” said Alan Sager, a Boston University public health professor. “The financial reasoning is, you may not get an advantage over them, but they can’t get an advantage over you.

Sager, who has studied hospital closings dating from the 1930s in more than 50 cities, including Cleveland, Toledo and Columbus, said the medical exodus to the suburbs may be hurting urban patients. As facilities sprout in more expensive areas, they are failing to ensure adequate medical care for all, he said.

“They’re drifting towards more and more care for fewer and fewer people willing to pay or whose insurers are willing to pay higher prices,” he said, calling Ohio residents increasingly “half over-served and half underserved.”

The strategy may be a defensive move to make up for the challenges of working in an economically stagnant area and the shortfalls the hospitals receive from Medicaid and Medicare, said Allard Dembe, director of Ohio State University’s Center for Health Outcomes, Policy and Evaluation Studies.

“You have to go after the lucrative people with private insurance,” he said.

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