Those are all true statements. However, they are not the reasons why Metro is downsizing. For years, Metro has been trying to compete with UH and the Cleveland Clinic for inpatient procedures... and losing. Especially now that UH is also a Level 1 Trauma center, Metro's trauma volume has gone down by almost 40% according to some sources. This is a reflection of having 3 major medical centers in a city and region with a shrinking population. At some point, one of the systems has to buckle, and it just happens to be Metro. To try to counter the lower patient volume, Metro is downsizing its inpatient capacity and focusing on outpatient procedures, which is cheaper to provide. Ultimately though, there are talks that the Clinic may eventually buy out Metro since the latter is constantly losing money. That would be consistent with the Clinic's goal of wiping out UH - they already took the medical school from UH, and if the Clinic joins hands with Metro to provide Level 1 trauma services, UH is pretty screwed. Healthcare politics is a pretty nasty business, especially in today's market forces.