Many Northern New York hospitals are in a health-care crisis, and now need each other in order to survive.
Desperation comes from struggling facilities here as they experience low federal reimbursement rates, rising pension costs, and state Department of Health deficiencies, among other issues.
Clifton-Fine Hospital has already warned that its future is uncertain if it cannot exit from the state retirement system a situation also plaguing Massena Memorial Hospital, Massena, and Lewis County General Hospital, Lowville. Clifton-Fines efforts to switch from a public benefit corporation to a non-profit failed last year when the state Assembly would not vote on enabling legislation because of opposition by Civil Service Employees Association.
Next year, the hospitals pension bill is estimated $800,000. As a nonprofit, it would be paying $220,000 for an employee retirement plan, Administrator Robert P. Kimmes said. Continuing in the state retirement system could eventually close the hospital, the smallest one in the state.
As a town-owned hospital, Massena Memorial Hospitals costs are expected to rise to almost $4 million annually soon.
As the pension issue started to become more troublesome, Clifton-Fine Hospital was simultaneously able to open a $2.5 million addition in 2010 to replace a clinic that burned and to add to the hospital proper a waiting area, a new entrance, a central registration area and an elevator. The addition was paid for by a fund-raising campaign, financing through Community Bank and a combination of local economic development sources.
A consortium of seven hospitals will map out an action plan. This group will share $3.8 million from the Healthcare Efficiency and Affordability Law for New Yorkers program to collaborate throughout the next two to three years on a plan to keep Jefferson, Lewis and St. Lawrence counties residents healthy, and to cut costs. Hospitals that have reamed up for the effort are River Hospital; Carthage Area Hospital, Carthage; Samaritan Medical Center, Watertown; Lewis County General Hospital, Lowville; E.J. Noble Hospital, Gouverneur; Clifton-Fine Hospital, Star Lake, and Claxton-Hepburn Medical Center, Ogdensburg.
River Hospital CEO Ben Moore III, also spokesman of the group, said the seven hospitals, known as the western section of the Northern New York Health Care Association, will be in a data study/planning period for about two years before any course of action can be taken or implemented.
Our intent isnt to close or consolidate, but if we operate as a system itd be better, he said.
Denise K. Young, executive director of the Fort Drum Regional Health Planning Organization, said the challenge of helping each hospital is their struggles are unique. Now is the time, through the HEAL grant, hospitals can identify problems and come up with a collaborative action plan to improve the health-care system for patients.
Meanwhile, E.J. Noble Hospital has to immediately work together with area hospitals in order to have business as usual resume for its emergency and acute-care services. Those services havent been offered since Sept. 28, after the state Department of Health ordered the hospitals lab shut down for deficiencies.
That move has prompted fears that the hospital will shut down for lack of a revenue stream. The hospital was already in a fragile state, having lost $690,000 last year. Kinney Nursing Home, which is affiliated with the hospital, lost $115,000 last year.
Were soliciting a line of credit from our bank, said Dr. Timothy J. Monroe, a veterinarian and board president. We havent received a response yet. That will better tell us whether we can meet our obligations.
In tough financial times, E. J. Noble was still able to unveil earlier this year a $11.2 million, 34,000-square-foot wing that provided patient rooms, treatment areas and offices. The project was financed by a civic facility bond through the St. Lawrence County Industrial Development Agencys Civic Development Corp.
Patrick J. Kelly, the agencys executive director, said he was unsure what would happen to the debt if the hospital were to close.
We want to see the hospital back in operation, he said. We expect thats going to happen.
Massena Memorial Hospital also has not been immune from challenges. The closure of the General Motors-Powertrin Plant caused the hospital to lose about $2 million in revenue per year, according to CEO Charles F. Fahd II.
While the economy has declined, so has the number of patients paying with private insurance.
This has been a difficult year for everybody and its only going to get worse, Mr. Fahd said.
While the hospital experienced a $1.6 million loss through August, officials also broke ground earlier this year on a $3.9 million, 20,300-square-foot medical building.
Like other area hospitals, Massena Memorial continues to add new services for patients to try and retain those who might otherwise go outside the area for care. Recruitment and retention of speciality physicians is a constant challenge for all north country hospitals.
Hospitals being proactive about those situations, Mr. Moore said, is just like routine preventative care patients need to continue to be healthy. With state approval, River Hospital closed its Medicaid-reimbursement reliant skilled-nursing unit before it faced losing as much as $812,000 alone that year. The hospital has since focused on money-making outpatient visits to improve financial stability, but Mr. Moore said additional measures will be needed to ensure communities along the St. Lawrence River that River Hospital is here to stay.
The slash of Medicaid/skilled nursing reimbursement rate would have put the entire institution under, Mr. Moore said. Even though that wasnt a pleasant experience, it was a wake up call for us to be extremely vigilant. You just cant make mistakes on the financial end.
Because there are several immediate crises, community members may expect to see immediate solutions to current problems. Hospital administrators, however, say while some are being worked through, its the bigger-picture future plan that will really shape hospitals sustainability plans and health-care delivery for patients.
Coordination of the HEAL grant will be done by the planning organization, whose role in the north country is to analyze the health-care system, identify gaps and leverage resources to fill those gaps. HEAL funds come about 14 months after the state health commissioner visited the north country, Samaritan Medical Center CEO Thomas H. Carman said, encouraging hospitals to work together.
Things are moving toward stability, Mrs. Young said. I think what people need to know is there is and has been proactive work with the seven hospitals weve worked with on how they can better manage and have stability in the system.
Do I see in the future a more regional approach? said Mrs. Young. Yes. Does everyone need a billing department and all these separate things to run them? I think not. With the cost of healthcare continuing to rise, she said, now is the time to push consolidation efforts to ensure healthcare is always available to north country residents.
The bottom line is the importance that the patient gets care, Mrs. Young said.
Richard A. Duvall, Carthage Area Hospital chief operating officer, said working with other hospital administrators should ensure health-care stability in the Carthage community.
With the future of healthcare, working collaboratively is a must to help streamline expenses and costs, he said.
Carthage Area Hospital has begun that process, a year after its former CEO Walter S. Becker was run out of the facility. Under directorship of interim CEO Adil Ameer, the hospital transferred ownership of its Harrisville outreach clinic to Lewis County General Hospital, and closed its Sackets Harbor clinic. Its school-based health centers are now run part-time, to cut costs.
Meanwhile, the hospital is progressing with its $9.5 million, 60-bed assisted living facility being constructed on Cole Road, Town of Champion. Most of the project is being paid for by state funds. Carthage Area Hospital has had its share of debt, and was recently awarded a $9.1 million state grant to pay down debt.
At Lewis County General, pension costs have grown from $1.6 million in December 2009 to a projected $4.8 million for this December.
Another challenge presented to Lewis County General is a reported year-to-date operating loss of about $980,000 through August. The hospital seeks to lower operating expenses by $500,000. Consultants were recently hired to review current clinic operations and make recommendations to maximize work flow and revenue. The facility is also considering seeking a critical-access designation to secure higher Medicare reimbursement rates.
The financial situation at Lewis County General is so dire over the past year that the hospital had to borrow nearly $6 million from the county, but a week ago the facility received $3.3 million in intergovernmental transfer funding, intended to reimburse health-care facilities partially for losses incurred on Medicaid, uninsured and charity-care patients.
Amidst the hospitals financial situation, a majority of physicians in late July cast a vote of no confidence in CEO Eric R. Burch, citing concerns about his managerial and leadership skills. Hospital administrators and managers are also taking steps to address those issues.
Despite its fiscal problems, Lewis County General continues to work toward development of a dialysis clinic on its campus.
Meanwhile, Mr. Carman said one of the biggest obstacles for north country communities to overcome is their strong views of their local institutions.
The problem is were all individual services and were fee for service, Mr. Carman said. Were not necessarily in alignment. Thats when case management comes in and the health information exchange.
Mr. Carman said north country hospitals have already begun that alignment process. Specifically for Samaritan, he said, the board took a look at succession planning to ensure we had the bench strength to reach out to others in the future.
We all have respect for other institutions, and we appreciate the value they bring to their communities, Mr. Carman said. This board is in-tune to having those collaborative relationships. Weve done smaller projects over time because it was the right thing to do.
He said Samaritan Medical Center has been committed to being a team-player, and its board has looked at all options from hand-shake deals to mergers. Samaritan has also provided consulting to Clifton Fine and E.J. Noble hospitals, and information technology services to River Hospital. Samaritan also entered into a receivership with Mercy Care Center of Northern New York, which ensured the Stone Street facility remained open until early next year when Samaritans 288-bed skilled-nursing and assisted-living facility is open.
He said while health-care systems are evolving nationwide, New York State seems to be behind the ball. That is something the north country is trying to change.
Times staff writers Steve Virkler and Martha Ellen, and Johnson Newspapers writer Brian Hayden contributed to this report.