Hospital honchos face the music

HealthAlliance CEO David Lundquist. (Photo by Dan Barton)

At a public forum Tuesday, the first of two to be hosted by Assemblyman Kevin Cahill on the proposal by HealthAlliance of the Hudson Valley to close one of its two Kingston-based hospitals, more than a dozen speakers expressed their anger and concern as a panel of HealthAlliance executives listened, and offered explanations.

Attended by approximately 90 people, the meeting, which was held June 27 at Kingston’s City Hall, raised painful issues surrounding the proposed closing. For their part, HealthAlliance President and CEO David Lundquist, board Chairwoman Cynthia Lowe, board Vice-Chairman and Secretary Kevin Ryan, and Dr. Mark Josefski, a board member and vice president of medical staff, appealed to the community for support. “The community can vote with its feet. If it doesn’t want to use our facilities, there won’t be any facilities,” said Lowe.

The revelation last month that HealthAlliance had concluded that having two hospitals in Kingston just wasn’t working came as a stunning blow to the community, setting off reactions of shock and worry. Asked “what happened” by Cahill, Lundquist blamed the economic collapse in late 2008, which led to fewer patients; reductions in reimbursement rates propelled by health-care reform; more out-of-hospital treatment facilities; and the multi-million dollar expense of implementing an electronic record system, which was nonetheless necessary in order to avoid “significant penalties” from insurance companies, he said.

“We were left with a choice: make necessary changes to keep the system dynamic and continue to move forward or not,” Lundquist said. “The changes in the environment require us to adjust.”

Lundquist said HealthAlliance’s 300 licensed beds, evenly distributed between the two hospitals, are at 70 percent capacity — a level that’s not sustainable. “Currently, we’re spread too thin and are not able to invest money in services,” he said. “It’s critical that we look at ways to be more efficient and streamline and reduce our overhead carrying costs. Our commitment is to come out better and stronger.”

Speakers accused HealthAlliance of not meeting the community’s health needs, of poor planning and lack of transparency concerning its financials.

Lundquist responded that in fact some HealthAlliance specialties had experienced two-digit percentile growth since the alliance was formed three-and-a-half years ago and the two hospitals, at the behest of the state’s Berger Commission, merged into one organization. The oncology center is doing very well, and HealthAlliance has one of the state’s nine chest-pain centers, he said. The 50 percent out-migration rate of patients from the two Kingston hospitals had been reduced by five percent since the forming of the alliance — a number he’d like to improve further, he said.

In explaining how the organization spent $48 million of state-funded HEEL money — not $350 million, as one speaker claimed — Lundquist said half of the money was spent in paying down debt when the organization was formed and the other half on capital projects. Another $250 million was paid to Medicare, but that obviously was for reimbursement of earned services.

Plan for failure?

Speaker Margie Griffin claimed the organization had implemented a “premeditated plan for failure.” Ryan said that on the contrary, HealthAlliance has always had a strategic plan and is currently “weighing every single detail” in charting its course for the future.  “Anyone involved in health care knows that a premeditated plan is impossible,” added Lowe. “We’ve rarely been able to control our destiny,” given the “extraordinary change in the economic environment.” She said merging two organizations that once “constantly battled and competed with each other” had resulted in much progress. “We’re closer to our mission than we originally thought.”

Noting that HealthAlliance, which has approximately 1,800 employees, is the largest employer inUlsterCounty, Lowe acknowledged this “is about not only about patients but employees and their families. I never let board members forget that. We don’t want to impact people more than we have to. It’s our community too.”

Geddy Sveikauskas, publisher of this paper, called for more public participation, given the cumulative impact of the closing of a hospital and several public schools. HealthAlliance, the county, the city and the school district account “for more than 6,000 jobs. This is cataclysmic,” he said. He suggested city, county, and state officials and agencies meet to discuss “how they can help each other with their problems and get out of their silos.”

Reproductive rights

Several speakers weighed in with concerns about how a closure would affect the on-going availability of reproductive services. Originally provided at Kingston Hospital, they were moved to the stand-alone Foxhall Ambulatory Surgery Center in the merger with Catholic-affiliated Benedictine.

Pro-lifers advocated strengthening those services. “Foxhall is barely functioning and has failed in its mission,” said speaker Jo Shuman. She recommended keeping Kingston Hospital open and folding reproductive services back into that facility.

Lowe, who also serves on FASC’s board, agreed that the Foxhall facility could do better. The doctor who performed abortions had retired last winter and not been replaced. “It’s very difficult to find a surgeon willing to do terminations,” she said. “Our commitment has not lessened” to provide reproductive services.

(Slideshow image: Dr. Mark Josefski, a HealthAlliance board member and its vice president of medical staff, talks at the Kingston forum while HealthAlliance CEO David Lundquist and board Chairwoman Cynthia Lowe listens. Photo by Dan Barton.)