Going broad and deep in the North Country’s health care system

I was surprised to be going on-air earlier this week with an Associated Press story about a state-ordered study of the North Country’s health care system. (to: “create an effective, integrated health care delivery system for preventative, medical, behavioral, and long term care services to all communities throughout New York’s North Country.”)

At least, I was surprised in the sort of minor way reporters are taken aback when they’ve been scooped.

I Googled the story, and found nothing more than the same AP text anywhere else in the media that morning. And it was taken from a press release at the state DOH website. So NCPR wasn’t really scooped. Check.

In a deeper way, there’s no surprise. When I spoke with Canton-Potsdam CEO David Acker months ago, our headline was: Why there will be fewer hospitals in the North Country.  He laid out exactly the problem the commission will address, according to Dr. John Rugge in our interview this morning: “…dispersed facilities that are geographically separated yet small in scale…  overwhelmingly dependent on Medicaid and therefore not having the reimbursement base necessary to survive.”

Except that where Acker was referring to acute care hospitals, basically in St. Lawrence County,  and Rugge is talking about everything, top to bottom, birth to death and in-between, from Glens Falls to Plattsburgh to Watertown.

Back in June, Acker closed with this:

Canton-Potsdam Hospital is in the black. We’ve been in the black every year, for the past six years. We’re in the black this year, we contemplate being in the black going forward. But you know, New York is 49th in the nation in terms of acute care hospital profitability, so we will not defy gravity forever.

And so, my concern is, that as you saw in Gouverneur, where they ran into such financial distress that they were in need of the state to come in and infuse capital in order to give them a chance to turn it around. My concern is that we’ll see other hospitals going over that same cliff. And we can project which ones will go first or last, but eventually we’re all going to go that same way unless something significant changes. And my strongest hope would be that the parochialism that thus far has prevented the hospitals from collectively getting together and saying “how can we do something together that will improve our ability to continue to provide good quality care with good access?” can move forward.

When I asked Rugge if the health care system in the region is in crisis, he paused, then said yes, and he agreed with Acker’s assessment that the business model isn’t working for small facilities (not just hospitals) strung across the sprawling “densely rural” geography. Just not enough people, and too few ways to cash in on the economies of scaling up. The edited interview, with transcript,  is on today’s news page. The uncut conversation is here.

The uncut version of Martha’s conversation with John Rugge

Notably, none of the region’s hospital CEOs were named to the commission.  I ask about that. (Dan Sisto, who just retired after 29 years as president of the Hospital Association of NY, is the chairman of the commission.) And we talk about the roots of this commission. Rugge, himself, goes WAY back in state health care planning history. He said he was first named to a state advisory post in the Carey Administration. That would be somewhere around 1980.

Does he think this latest step will improve care in the North Country? “If we do our job.”

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