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NY approves part-time Lake Placid ER

May 8, 2014
By CHRIS KNIGHT ( , Lake Placid News

LAKE PLACID - The state Department of Health has approved Adirondack Health's plan to convert its around-the-clock Lake Placid emergency room to a 15-hour-a-day operation.

Starting June 16, the ER at Adirondack Medical Center at 29 Church St. in Lake Placid will be open from 8 a.m. to 11 p.m. seven days a week as part of a first-of-its-kind project with the state, Adirondack Health officials announced Monday, May 5. The ER at the larger AMC hospital in Saranac Lake will remain open 24 hours a day, seven days a week.

"We're the first in New York state to implement this innovative model for our community, and we're pretty excited about it," Adirondack Health President and CEO Chandler M. Ralph said in a Monday interview.

Ralph said other states have emergency rooms that aren't open 24 hours a day, but New York hasn't had one until now. She said it took some convincing for the New York Department of Health to approve the Lake Placid ER plan.

"We had the benefit of being able to speak with two Connecticut hospitals who've been doing it for over 25 years. We sort of modeled ours on theirs," Ralph said. "The Health Department did contact those hospitals and a few others throughout the nation. Trying to get them to understand, we had to give them information and documentation on how it will work, and I think they felt really comfortable that we can do it really well."

A Department of Health spokesman didn't immediately respond to a request for comment.

Monday's announcement comes nearly a year after Adirondack Health's Board of Trustees voted to transition to a part-time ER.

The organization initially planned to convert the Lake Placid ER to an urgent care clinic. They said the Lake Placid ER doesn't have modern medical technology and that most seriously ill patients already bypass it and are taken to the ER in Saranac Lake 11 miles away. They also said the low volume of patients at the Lake Placid ER, especially at night, doesn't justify keeping it open around the clock.

Adirondack Health officials have also said the change would cut costs at a time when the hospital has seen big operating losses due to state and federal budget cuts. The number of patients served at the Lake Placid ER has declined by 22 percent since 2009, which hospital officials say has resulted in a loss of nearly $588,192 in 2012 and $896,325 in 2013.

But the urgent care proposal drew strong opposition from people in Lake Placid who said the loss of around-the-clock emergency room care would leave the community's residents and visitors vulnerable. Local ambulance squads worried about losing revenue and the extra time it would take to get patients to Saranac Lake. The New York State Nurses Association, the state Olympic Regional Development Authority, and the Lake Placid village and North Elba town boards also lined up against the urgent care concept.

The idea of a part-time ER was then developed. It was seen as a better option because state law requires emergency rooms to have more staff on duty than urgent care clinics and because an ER is required to accept all patients, regardless of their ability to pay. Ambulance squads can also bill patients' insurance companies if they take them to emergency rooms, but not if they go to an urgent care center.

Adirondack Health pursued legislation in Albany that would have allowed the Lake Placid ER to go part-time and still remain a certified ER. The bill was approved in the Senate but failed to make it to the Assembly floor for a vote before the chamber adjourned in June. Supporters of the part-time ER concept, including state Sen. Betty Little, later learned that the Health Department can create such a pilot program on its own, without legislative approval.

Little said Adirondack Health's leadership has explored multiple options to ensure high-quality care while also ensuring the organization's long-term viability.

"I am hopeful that the best balance possible has been reached and, moving forward together, the hospital and the communities it serves will see the benefit in having done so," Little said in a press release.

Hospital officials had initially said the part-time ER would operate at least 12 hours a day. Dr. A.J. Dowidowicz, medical director of Adirondack Health's Emergency Department, said the 15-hour operation was picked based on census data showing when patients typically visit the ER. He said the schedule will be adjusted to accommodate events and busy times in the community like the Ironman triathlon, the Fourth of July holiday weekend and the Can-Am Rugby Tournament.

"We really need to continue to be in constant conversation with the community on times they think we may need to go 24-7, which we're willing to do," Ralph said.

Ralph said the reduction in hours of the ER will save an estimated $600,000 a year without cutting the department's staffing beyond current levels.

"What we've done, because this has taken such a tremendously long period of time, we've had the opportunity through attrition to get to a point where we don't have to lay anybody off as a result of this," she said.

Both Ralph and Dowidowicz acknowledged the change to a part-time ER, including Lake Placid patients having to travel directly to the Saranac Lake ER should emergency take place in the middle of the night, could be "scary" for people in the community, but they don't believe patient care will be seriously affected.

"I'm not sure how reassuring this will be, but the truth is there aren't many situations where minutes really change the outcome of something," Dowidowicz said. "The other issue people don't seem to really appreciate is the advances in EMS that have happened over the years. It used to be they were simply trucks that would take people from point A to point B. Now, medical care starts at the door."

The concerns raised by local ambulance squads were also considered in the decision-making process, Dowidowicz said. One of the main reasons a part-time ER was preferred, he said, was because the hospital didn't want EMS agencies to lose the ability to bill patients' insurance companies, which they couldn't do if the ER became an urgent care clinic.

"We pretty much chose those route because of EMS and because we wanted to keep them going and supporting them," Dowidowicz said.

As part of a plan announced in 2012, the ER, the doctors' offices at the Lake Placid Health Center and all of AMC-Lake Placid's services will eventually be moved to a new medical fitness and health center that's planned on the nearby Uihlein Living Center nursing home campus. Ralph said Adirondack Health is currently conducting a financial feasibility study on that plan. If it moves forward and gains Health Department approval, the project could "conceivably break ground next summer," Ralph said.

There is a clause within the hospital's deed that lets the town of North Elba take the former Placid Memorial Hospital property back for $10 if the organization no longer provides 24-hour emergency care for the community. Ralph acknowledged Monday that the decision to go to a part-time ER would mean AMC-Lake Placid, once it's vacated, would eventually go to the town.

The doctors' offices at the Lake Placid Health Center will continue to be open Monday through Friday from 8:30 a.m. to 5 p.m.



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