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LP emergency room cut being considered by Ad’k Health

March 11, 2013

LAKE PLACID - Adirondack Health is considering relocating, shutting down or curtailing the hours of the emergency room at its Lake Placid hospital as one of several options to cut costs amid a growing financial crunch.

Adirondack Health officials recently met with Lake Placid Mayor Craig Randall and town of North Elba Supervisor Roby Politi to update the community leaders on some of the fiscal challenges the organization is facing, and the options it is considering to address those challenges.

"The hospital leader, Chandler Ralph, has advised the supervisor and the mayor that they were looking at all options for the hospital in terms of Uihlein (Living Center nursing home) and (Adirondack Medical Center)-Lake Placid, and at the very least indicated that everything was on the table, including the ER," Randall told the News.

"Chandler hinted at the fact that, 'I've got to make some tough decisions, and one of those decisions could possibly be either moving the ER to Uihlein or moving the ER to (AMC in) Saranac Lake,'" said Politi.

Politi said Ralph had requested the meeting.

"I think Chandler just wanted to say to us, 'Look, the hospital is facing a crisis and this potentially could happen, so I don't want it to necessarily come as a shock,'" Politi said. "I think that is admirable on her part to do that, though it may not come at all."

Multiple sources told the News that the hospital's board of directors met last week to discuss its options for the Lake Placid ER, and that a meeting to inform employees had been scheduled to take place the next day. However, those sources, as well as hospital officials, say the board ultimately made no decision.

Adirondack Health spokesman Joe Riccio said a wide range of options are being considered to deal with the financial challenges the organization is facing. When asked if cutting back the operations of the Lake Placid ER was among those options, he didn't say no.

"I don't want to get in specifics because the board hasn't approved anything yet, but I can say we're looking at a wide range of options to meet these challenges," Riccio said. "To say that we're just looking at the Lake Placid ER or one particular thing, that's just not the case. We've been asked by the board to look at everything because the fiscal challenges we're facing are serious. We need to Identify where we can create efficiencies to continue to provide the quality patient care we've been delivering."

Riccio said he wouldn't use the word "crisis" to describe the situation the hospital is facing, but he said it's serious.

"It's a serious situation with what's going on with the (federal) Affordable Care Act; we're waiting to see what transpires with the state budget, the fiscal cliff, sequestration - you name it," he said. "Health care is facing an epic proportion of challenges, and this is having a real impact on every health system in the country, including Adirondack Health."

Among other things, Riccio said the legislation signed in January by President Barack Obama to avoid the fiscal cliff included a cut to transitional outpatient services that cost Adirondack Health $1.2 million. If sequestration - a series of automatic cuts to federal programs that went into effect Friday - is not averted, the hospital will lose another $500,000, Riccio said.

Adirondack Health has been showing signs of financial stress for some time. In December, Ralph announced a long-term restructuring plan for the organization. It would lay off 17 full-time employees, not fill another eight vacant positions, freeze management salaries, outsource medical transcription services, cut pharmaceutical purchases and ask employee unions for concessions.

Last year, Adirondack Health announced a major shift of its Lake Placid operations. It planned to move the services currently provided at its Lake Placid hospital, including its emergency room and doctor's offices, to existing space or a yet-to-be-constructed building on the 13-acre Uihlein Living Center property, which is currently home to a 120-bed nursing home. The former Placid Memorial Hospital, which Ralph said is not configured to provide modern medicine, would then be sold. Adirondack Health is also reducing the number of long-term-care beds at the nursing home from 120 to 60, but plans to add assisted living and senior housing facilities on the Uihlein campus, along with a medical fitness center.

Adirondack Health sustained a $1.6 million loss in 2011, $1 million of which was attributed to a shortfall in Medicaid reimbursements for its nursing home patients. Riccio said he couldn't provide figures on how the hospital fared financially last year as its audit report hasn't been completed yet.

Randall said he's aware of the financial challenges the hospital faces, but he said he'd be "very disappointed" if the round-the-clock emergency room services at AMC-Lake Placid were taken away without something done in the community to replace them. Politi expressed the same concern.

"I have no idea what direction their board is going to go in," Politi said. "It certainly will not be a popular decision no matter what they do, but sometimes you have to make those decisions. Certainly, Lake Placid doesn't want to lose the emergency room, given that we have so many international events here.

"They certainly have considered in the past the possibility of having to make decisions that could lead to a movement of the emergency service facility here in Lake Placid, whether it be at Uihlein or whether it be in Saranac Lake," the supervisor added. "I think we've made our position clear in the past, and that is, they have a responsibility to provide primary-care services and/or 24-hour, seven-day-a-week emergency room services in Lake Placid, and if they choose not to do that, then there is an option agreement between AMC and the town."

That agreement, crafted in 1990, was enacted at the time Placid Memorial merged with the General Hospital of Saranac Lake to form Adirondack Medical Center. It says the town has "exclusive right to buy the property" and its facilities for $10, but only if Placid Memorial, or its successor, no longer continues to provide round-the-clock emergency medical and primary health care services for the community.

If Adirondack Health simply moves its hospital services somewhere else in Lake Placid, like to the Uihlein campus, the agreement appears to be moot. But if those services should end in the community, the agreement would presumably come into play.

When the News asked Riccio about that agreement, he said it is premature to talk about it.

"We're going to do whatever is best to meet the health care needs of the community," Riccio said. "You're several steps ahead of us, where we are right now. That's something we'd have to look at. Certainly we're going to have those discussions with the community at the appropriate time, as we have been doing. But right now we're doing our due diligence to make sure all our ducks are in a row."

Riccio noted that Ralph traveled to Albany on Wednesday as part of a health care advocacy day event. She'll was slated to talk with state Sen. Betty Little, Assemblywoman Janet Duprey and Assemblyman Dan Stec about the fiscal challenges Adirondack Health faces.

Contact Chris Knight at 891-2600 ext. 24 or cknight@



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