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If not the Lake Placid ER, then what?

April 19, 2013
Editorial , Adirondack Daily Enterprise

Understandably, many people are upset about the recommendation by doctors and administrators that Adirondack Health convert the 24-hour emergency room at its Lake Placid hospital to a 12-hour urgent care clinic.

Also understandably, the doctors and administrators have to cut services somewhere, given that Adirondack Health lost $3 million last year and, so far this year, has taken a combined hit of $1.7 million in Medicare payments from the fiscal cliff and the sequester. That's not counting annual reductions due to the Affordable Care Act (aka Obamacare).

The ER conversion is, so far, the most controversial of 30-plus steps Adirondack Health is considering to reduce costs. Others include farming out kidney dialysis and talking with other North Country nursing home owners about ways to team up.

Adirondack Health's board of directors will consider the ER change after a pair of public hearings on May 1 and 8 at the Lake Placid Center for the Arts. If you care about this, please attend, both to listen and to make your voice heard. An open process produces better results.

This is not a plan to close Lake Placid's Adirondack Medical Center entirely, as some have said recently. Sports medicine and doctors' offices would remain, along with the proposed urgent-care clinic, although they'd all eventually be moved across Old Military Road to a new building on the Uihlein campus, as announced last June. The old Placid Memorial Hospital building has served the community long and well, but Adirondack Health's plan to build a new, more efficient facility deserves appreciation. That investment won't pay off for a while, so it can only be seen as a long-term commitment to the community.

Adirondack Health has made other investments in this area, and some of them haven't paid off at all. That's an important context to put this debate in.

It's been more than six years since Adirondack Health took over the Lake Placid (Uihlein) and Tupper Lake (Mercy) nursing homes from the Sisters of Mercy, who could no longer take the financial bleeding. Unfortunately, Adirondack Health inherited those deficits, which have cost it millions of dollars. Each nursing home resident costs Adirondack Health about $200 a day, but Medicaid pays much less than that. It seems there's no way anymore to sustain a nursing home - in New York state, at least. Even Essex and Franklin counties are divesting themselves of their homes in Elizabethtown and Malone.

Adirondack Health, a private entity, can't keep doing this. To stanch the bleeding, Adirondack Health is greatly reducing its capacity at Uihein; beyond that, it is in talks with other North Country nursing home owners about the possibility of teaming up. This problem is bigger than here, but we hope local providers take a lead in solving it - perhaps with more home care and less expensive housing for those who can't live on their own but don't need round-the-clock nursing. Still, nursing homes are greatly needed, and the state and federal governments must help make running them possible.

Another example of Adirondack Health doing something good at its own expense is the medical home demonstration project, which emphasizes preventative care and outreach. That helps people stay healthier, which means they need somewhat less care, which means less revenue for Adirondack Health.

"It's the right thing for the patient and the right thing for the nation," Adirondack Health CEO Chandler Ralph told us recently. "But it's like we're standing with one foot on a boat and one foot on a dock, because the reimbursement changes have not caught up with how we're changing the system."

We see the emergency department at AMC-Lake Placid as another example of costly community service. Ms. Ralph said it ran a half-million dollars in the red last year. Plus, the U.S. health care system is wisely being steered away from using emergency rooms as cure-all drop-in clinics - an expensive way to operate - and toward people seeing their own doctors, urgent care clinics and preventative health.

The Lake Placid emergency department has a small and dropping number of patients. Dr. Anthony Dowidowicz, medical director of the AMC emergency departments, and Chief Medical Officer Dr. John Broderick have been saying for years that it's unnecessary, medically, to maintain two emergency departments 11 miles apart. Now that something must be cut, they say this would be a good place to start.

That makes sense to us, given the circumstances.

There is also a serious plus: The co-pay to visit an urgent care clinic is much less than that for an emergency department, especially with the newly popular high-deductible health insurance plans. For the patient, it could be the difference between $30 and $500.

On the other hand, many people in Lake Placid are against this move. The village board seems to be preparing to formally oppose it. Eleven of the 12 letters and Guest Commentaries we've received on this subject argued against it. The only one for it was written by Dr. Dowidowicz and Dr. Waguih Kirollos, president of the Medical Staff.

It's hard to know how many people would accept the ER's conversion, because they are likely to be quiet about it. It's hard to be roused to defend the lesser of two evils.

The arguments we've heard for keeping the Lake Placid ER are passionate, but if one wants to seriously prepare for the future, it's better to be logical. And logic tells us that converting the Lake Placid emergency department is a pretty small sacrifice, one worth making to help Adirondack Health stay solvent as a whole.

Some have written that they, or people they love, would have died if they had to go an extra 11 miles, but already ambulances take all patients in critical situations to AMC-Saranac Lake, where there is advanced medical imaging and an operating room. Some say, well, why not buy a CT scanner for AMC-Lake Placid? Because that would be incredibly expensive and medically unnecessary, given how few times a year it would be used.

Some bring up the medical need for major sporting events, but the Lake Placid hospital could and would ramp up its services round the clock for these, as needed - and those last two words are the key.

Ambulance squads from Wilmington, Keene and Keene Valley have said that if Adirondack Health makes this move, they would take all patients to Elizabethtown Community Hospital. They should do whatever is best for their patients. ECH is closer to Keene and Keene Valley than AMC-Saranac Lake is; they're about the same distance from Wilmington.

We're not happy about a reduced hospital service, but we don't think it's as severe as some people make it out. AMC-Lake Placid's emergency department doesn't go much beyond the minimum threshold now. Bringing it just below the emergency department threshold would save Adirondack Health a lot of money and lose relatively little: overnight hours, one nurse per shift and some lab capability.

Those are things Tupper Lake already doesn't have, and it's twice as far away from AMC-Saranac Lake - and has more residents than Lake Placid.

Again, one must look at the numbers. Lake Placid's residents and tourists simply don't use the emergency department all that much.

But maybe this doesn't have to happen. We're open to suggestions for other ways Adirondack Health could cut costs, perhaps allowing it to keep the Lake Placid emergency department open. We hope some of the proposal's critics suggest something along these lines at the public hearings, which start at 6 p.m. May 1 and 7 p.m. May 8.

In general, we feel this area is blessed to have Adirondack Health. Few communities the size of ours in the world have such excellent medical facilities. We personally know several people who choose to come here from the Potsdam and Malone areas instead of going to the hospitals there. The outcry coming from Lake Placid is partly a validation of that, as angry as it sometimes sounds. Placidians value their local hospital deeply, and some are willing to fight for it. Good. We hope Adirondack Health officials listen to them closely, and that they listen back.

 
 

 

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