Press-Republican

April 10, 2013

ER at AMC Lake Placid may close

KIM SMITH DEDAM
Press-Republican

LAKE PLACID — Adirondack Health may close Adirondack Medical Center in Lake Placid, including the Emergency Department.

Instead, an urgent-care clinic and physical-therapy facilities would be established at Uihlein Living Center, a quarter of a mile away, CEO Chandler Ralph told Lake Placid business owners Tuesday. 

Already, Adirondack Health has downsized staffing at the nursing home to accommodate 80 residents, which is its present population, Adirondack Health spokesman Joe Riccio said in a separate interview.

The total 156 beds at Uihlein could be reduced to as few as 60, Ralph said.

Adirondack Health owns and manages both buildings.

“The landscape is changing drastically in health care,” Ralph told business peers at an early morning meeting of the Lake Placid Business Association.

LOST $3M LAST YEAR

The reach for efficiency is driven, in part, by economics.

Ralph provided raw numbers: a 25 percent drop in inpatient hospital stays at Adirondack Medical Center in recent years is exacerbated by a $1.2 million reduction in Medicare funding in January, plus another $500,000 in cuts due to federal sequestration.

Adirondack Health has trimmed 36 jobs across all eight facilities since December 2012.

The hospital lost $3 million last year, Ralph said.

The goal, she said, is to “become more nimble and flexible as a health-care system and to protect the long-term stability of the entire organization. 

“We have a mission and a margin.”

It is an achievement, she said, if the hospital ekes out a 1 percent earnings margin.

“But that’s generally not sustainable in a business environment.”

AMBULANCE CALLS

Judy Shea, a volunteer with the Lake Placid Ambulance Squad, asked Ralph to elucidate on the proposal to shutter the Lake Placid hospital building, which is located at 29 Church St.

If Uihlein were renovated to add an urgent-care center, Adirondack Health would vacate the hospital building.

“What would the afterlife be for the building?” asked Wayne Johnston, owner of Ruthie’s Run on Main Street.

“We don’t know,” Ralph said. “It has a lot of asbestos in it now. It’s all contained and safe.”

But it presents a challenge for renovation.

The idea isn’t to remove emergency-care access from Lake Placid but to replace it with walk-in urgent care.

Emergency ambulance calls would be routed to Adirondack Medical Center in Saranac Lake for critical-care medical services.

That has been happening in a bypass protocol that Adirondack Health instituted about five years ago, according to Dr. John Broderick, chief medical officer for Adirondack Health.

“With the bypass protocol,” he explained at the session, “EMTs (emergency medical technicians) don’t always stop in Lake Placid, continuing instead to Saranac Lake, where advanced imagery and surgery can be performed.”

The Medical Center is 11 miles away.

DECLINE IN PATIENTS

Broderick provided additional data, showing a marked decline in Lake Placid’s walk-in emergency visits. 

The smaller hospital, built in the 1950s, sees about 750 fewer patients annually than four years ago.

Emergency walk-ins drop off sharply at 7 p.m. to 0.6 visits per hour and to less than a tenth of one visit by 5 a.m.

Converting emergency service in Lake Placid to urgent care would reduce duplicate health-care services, he said.

The nursing and medical staff would remain in place at the urgent-care center.

The dental clinic and Health Center would stay in Lake Placid.

Treatment for walk-in health-care visits would remain in place.

Osteopathic and sports medicine would remain in place, along with physical-therapy services.

Riccio said the proposal is part of a new vision for the Uihlein campus announced last June — one that would reflect the need for assisted-living services outside a nursing-home setting.

URGENT CARE LESS COSTLY

Doctors anticipate the move would add one or two patients per day to the Saranac Lake hospital’s patient load.

And, Broderick said, “urgent care tends to be less costly for the patient.”

Simply walking into an emergency department adds about $600 to the medical bill, he said, while urgent care costs hundreds of dollars less.

Dr. A.J. Dowidowicz, director of emergency medicine at Adirondack Health, said medical staff at Lake Placid hospital support the prospect of building an urgent-care center.

“They don’t feel it would affect patient care at all,” he told the business owners.

“Urgent care is a much easier type of business to develop and grow. I think that is kind of exciting for the community.”

NO DECISION YET

The true goal at Adirondack Health, the doctors said, is to get the patient to the right facility with the right equipment for treatment quickly.

In many cases, coronary-care patients, for instance, are brought from this area to heart specialists at CVPH in Plattsburgh.

Patients needing advanced medical imaging or surgery are taken to Saranac Lake.

The doctors believe that adding urgent care to the slate of options achieves opportunity for growth in Lake Placid.

No final decisions have been made about closing Lake Placid’s hospital.

“We’ve studied the issue extensively,” Riccio said.

“We have a responsibility to hear from the community and make sure their needs are being met.”

Email Kim Smith Dedam: kdedam@pressrepublican.com

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PUBLIC MEETINGS

Adirondack Health has set up two public-information sessions at the Lake Placid Center for the Arts on hospital closure and restructured emergency care, one at 6 p.m. May 1 and the other at 7 p.m. May 8.

Adirondack Health CEO Chandler Ralph is also available to meet with area civic or citizen groups to address concerns or questions. Reach her at 891-4141.