A plan although not outlined on paper from the state Department of Health to north country hospitals regarding collaborations amid the changing shape of health care delivery in the region has local facilities scrambling to create improvements and efficiencies quickly.
Ben Moore III, chief executive officer of River Hospital, Alexandria Bay, said the theme of collaboration weighed heavily during a conference of the Hospital Association of New York State, an advocacy group. There, he said, state Health Commissioner Nirav Shah announced he was organizing three groups to develop collaboration strategies: hospice/long-term care; acute, emergency room and observation beds; and primary care.
This is the second meeting hes had like this, Mr. Moore said. The first time he went over the changing health care environment.
Mr. Moore said now Dr. Shah wants to see some progress. Hospitals, nursing homes and long-term care facilities should receive invitations to join the three groups relevant to our institutions.
Involved hospitals are River Hospital; Carthage Area Hospital; Claxton-Hepburn Medical Center, Ogdensburg; E.J. Noble Hospital, Gouverneur; Canton-Potsdam Hospital, Potsdam; Samaritan Medical Center, Watertown; Lewis County General Hospital, Lowville; Massena Memorial Hospital; Alice Hyde Medical Center, Malone; CVPH Medical Center, Plattsburgh; Glens Falls Hospital; Adirondack Medical Center, Saranac Lake, and Clifton-Fine Hospital, Star Lake.
Many of these hospitals have been plagued for years with a variety of issues, including declining federal reimbursement rates, rising pension costs and service deficiencies, among other troubles. Without support of each other, some facilities may not survive, as the cost of health care continues to rise and reimbursement rates continue to fall.
Mr. Moore said that during the September meeting, the commissioner said there was very little time to implement change. The fear, he said, is that a north country institution, because of its variety of funding and related issues, could be the next failed Brooklyn hospital.
According to Kaiser Health News, the Brooklyn-based Interfaith Medical Center has been bankrupt since December. The center was told by a federal judge this summer that the hospital would wind down operations beginning in August, end inpatient admissions in September and finish outpatient procedures this month.
To both help the situation in Brooklyn and potentially avoid that scenario here, the state awaits approval from the federal government on Medicaid waiver 1115, which would, according to the state Department of Health, allow the state to reinvest in its health care infrastructure as well as the freedom to innovate. The waiver will also allow the state to prepare for implementation of national health care reform as well as effectively bend the cost curve for the states overall health care system.
At least six Northern New York hospitals arent sitting back. Throughout the past two years, River, Samaritan, Carthage, Lewis County General, Clifton-Fine and Claxton-Hepburn have jumped ahead of the game.
Mr. Moore said hospitals anticipated new directives from state officials, and their organized planning efforts, with the help of a consulting firm and the Fort Drum Regional Health Planning Organization, worked together to help reduce the number of unnecessary repeat Medicaid admissions and improve patient outcomes.
In the works, from that, is a disease database. New developments include the idea of establishing a management service organization and a clinically integrated system. Mr. Moore, who serves as spokesman for the six-hospital effort, said the MSO will provide centralized nonphysician services and functions to all participating hospitals. What may be included could be joint purchasing, reference laboratories and synchronized revenue cycles, such as billing, coding, collection and admissions.
I can say that it is likely that not all components of a given service will be centralized, Mr. Moore said. The theory is that for some activities, centralization can result in less cost per unit of output when a larger workload is addressed under a special arrangement. Also, with centralization, a combined workforce can then specialize in specific areas which would not be possible for smaller institutions.
He said that the group has ruled out any outsourcing of potential MSO services and that it is too soon to know whether there will be a net loss of jobs.
The local effort, Mr. Moore said, is at least in line with what Dr. Shah is looking for.
If there is a desire on the part of the commissioner to have our effort become part of a larger issue, that was not said, Mr. Moore said. If that is the desired outcome, then I suppose that will surface in the work group.
Several attempts to reach a representative from the state Health for comment Department, including a possible telephone interview with the commissioner, were unsuccessful throughout the past week.
Moving forward with the MSO and toward a clinically integrated system, which would involve outcome-based measurements and physicians working collaboratively, would require more capital, Mr. Moore said.
To try to get them to function as a single medical staff, thats a tall order, Mr. Moore said. Thats several years away. We have part of that already, a data registry.
Local hospitals dont have extra funds, which is why they already are looking at collaborations and shared services. Funds throughout the planning stages came from a $3.8 million Healthcare Efficiency and Affordability Law for New Yorkers program grant. That money will dry up by December.
Throughout this entire process for the six hospitals, Mr. Moore said, no institution dominates other ones.
This is all a way to try to deal with these massive changes, he said. A stand-alone institution will get overwhelmed. You cant even afford to analyze whats going on if youre by yourself. The way were going about it allows the community to retain individuality with health care.
No health care institutions are expected to close, he said, but as they reorganize, responsibilities may change.