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What you need to know for 01/20/2018

Health care changes with times

Health care changes with times

The longstanding major providers in the Capital Region have waded into new territory, with some cros

After Long Beach Medical Center was destroyed in Hurricane Sandy and the community had to figure out a long-term plan to rebuild, the state urged them to look north to Clifton Park.

Both Long Beach, on Long Island, and Clifton Park are growing bedroom communities with significant populations in need of significant health care. But in 2012, the prospect of building or even rebuilding a full-service hospital was an unlikely one in New York, where consolidation and institutional downsizing had been mandated years earlier, and health care nationwide was on its way out of institutional settings and into smaller community settings.

“The community down there said, ‘We need a hospital,’ and [the state’s] response was, ‘Call Ellis and look at what they’re doing in Clifton Park,’ ” recalled Jim Connolly, president and CEO of Ellis Medicine.

The Schenectady hospital system had just opened a new urgent care facility off Exit 9 of the Northway. The 38,000-square-foot Medical Center of Clifton Park is open 24 hours a day seven days a week and offers all the equipment, staffing and layout of a modern emergency department, plus primary and specialty care physicians’ offices on the second floor.

“DOH likes our facility very much,” Connolly said. “It produces really good care for a community that needs really good care.”

As southern Saratoga County continues to grow, the community is searching for the right answer to its growing health care needs. The Clifton Park facility fills a significant need on the southernmost end and is held up by state officials as the model to emulate. The new 60,000-square-foot Malta Med Emergent Care facility off Exit 12, a partnership between Saratoga Hospital and Albany Medical Center, fulfills a significant need farther north, smack dab in the center of the county.

There are some local officials who believe more is needed, at least where the town of Halfmoon is concerned. Developer Larry Boni recently revived his nearly decade-old plan for a health care campus centered around a 225,000-square-foot medical facility on an 80-acre site off Route 146 in Halfmoon. The proposal has confounded local health officials, who say a third significant health care facility in the region is unneeded and redundant. Instead, they say, providers should look more at collaboration to enhance the existing network of care in the community and fill any gaps.

“It’s been a real uphill battle,” said Kevin Dailey, an attorney representing Boni on the Halfmoon project. “We’ve had resistance from downtown hospitals, and it also seems the Department of Health is not interested in seeing better facilities beyond urgent care. Everybody is telling us we’re not going to build out there, that it’s not economically viable and/or the best venue to deliver proper health care these days.”

A spokesman for the Department of Health said no one was available for an interview on the subject last week, offering an emailed statement instead that stressed its ongoing efforts to reduce costs and unnecessarily hospitalizations through community-based, patient-centered care.

The Commission on Health Care Facilities in the 21st century, chaired by Stephen Berger, issued a sweeping set of recommendations in 2006 that forced hospitals and nursing homes to restructure and downsize. The goal was to reduce redundancies in care, cut excess beds and find home- or community-based alternatives where possible. Regional committees looked at local health care through a prism of facility rightsizing, and Saratoga County was the one region of the Capital District where officials identified a need for more, not less.

Years later, it’s created an ambitious race for market share and some confusion over the intended goals of the Berger Commission. The longstanding major providers in the Capital Region have waded into new territory, with some crossing into markets traditionally dominated by others — not out of necessity, some say, but in an attempt to gain market share for the sake of it.

Local officials say one big gap is their inability to ship patients to the new Saratoga County urgent care facilities by ambulance. Both the Malta and Clifton Park facilities are seeking standalone emergency department status from the state, which would authorize them to accept patients this way, but the state has been slow to approve such requests while it works to identify the need upstate.

Ellis Medicine first sought this approval in 2009, when its Clifton Park facility was still just an idea. Its request was rejected, along with those of several other area hospitals that had been hoping to build freestanding emergency rooms in the area. At the time, the state said there wasn’t a need for full-blown emergency rooms in the area. It had also only been a year since the state forced hospitals to close and health care systems to consolidate.

As the population has grown, Ellis decided last summer to again seek full emergency department status for its facility, which saw 30,000 visitors last year and is on track for another 30,000 this year. Around the same time, hospitals in Brooklyn were floundering and communities downstate were worried about where they were going to get their care.

“DOH found itself in a situation where it had to come up with an alternative for these closing hospitals,” Connolly said. “And they started to say, we will now accept applications for satellite emergency rooms again.”

So Ellis resubmitted its application, but was told the department’s priority would be on first approving emergency departments at places where hospitals were closing. Realistically, Connolly doesn’t expect a decision until next year.

Saratoga Hospital and Albany Medical Center are also pursuing the emergency room designation at their Malta Med facility, which opened in June 2013 and has had about 31,000 visitors to date.

“Many other states allow centers like ours to operate as freestanding emergency departments,” said Saratoga Hospital CEO Angelo Calbone. “We designed, built and equipped the facility to be able to operate at that level. It’s staffed with the appropriate level of expertise to function at that level. And we think it could be a great service to the community. I think the resistance from DOH is based upon need. They’re still questioning what communities need after Berger.”

Another trend that’s emerged in the region has been long-term planning for medical campuses that link urgent care facilities, walk-in clinics for less serious maladies, doctors’ offices and specialists. Campuses are already in the works at Northway Exit 12 in Malta and Tallow Wood Drive in Clifton Park, and are being planned for Boni’s Halfmoon site and Ellis’s Clifton Park site on Sitterly Road.

Saratoga Hospital has planned a Malta campus for some time now. Originally, the urgent care facility was to be followed by a second phase build-out that would include a full-service hospital. But as care shifted toward population management and away from filling hospital beds, it became apparent a Malta hospital was not appropriate, Calbone said.

“We do not believe it would be a good use of the community’s money to try to create a hospital there,” he said. “People tend to equate significant health care with hospitals, but more and more, very high levels of care are being delivered in the community, in outpatient settings and in ambulatory settings. This would be a very unusual time in our industry to try to justify an additional hospital in the system.”

Ellis, meanwhile, has been quietly planning a campus build-out at its Clifton Park facility. A second phase of development at a site next door could include an ambulatory surgery center, medical office buildings or surface lots to accommodate increased parking needs.

“If we get approval for a freestanding ER, we may need to build some more areas for patients that come in by ambulance,” Connolly said. “We’ve talked to physicians who say, ‘Gee, we’d love to have offices there.’ We are exploring joint partnerships with other hospitals or physician groups for an ambulatory surgery center. We’ve had discussions with [Calbone] about maybe doing something jointly in Clifton Park.”

The trend toward joint ventures and collaborations is not entirely a voluntary one. State and federal governments are dangling incentive dollars before providers who find ways to save money and create efficiencies through collaborations and alliances. In some cases, providers have been smart to avoid redundancies and possible rejection by going 50-50 on projects like the Malta Med facility.

“Hospitals have historically been competitive,” Calbone said, “but what you’re beginning to see is an evolution toward trying to find ways to collaborate and partner across institutions that probably didn’t exist 10 years or so ago. You’ve seen it in our partnership with Albany Med and our exploration of an alliance with Glens Falls [Hospital]. It is a change, absolutely, but we’re seeing there can be a real benefit to the community.”

Connolly, however, has spotted his own share of redundancies in a place closer to home: Schenectady County. He pointed to Albany Medical Center’s recent opening of a walk-in clinic for non-urgent maladies like flu and cold in Glenville’s new Socha Plaza building on Route 50. Ellis Medicine itself relocated its primary care practice there from just down the road and expanded the office’s hours. Another provider, Sunnyview Rehabilitation Hospital, has opened a satellite physical therapy office in the building.

Albany Med’s walk-in clinic and Ellis Medicine’s extended-hour primary care office are, at their core, the same thing, Connolly believes.

“That’s redundant,” he said. “I don’t see much difference. We had been planning our office there for the last year and a half. But the economics of health care are changing, and institutions are changing their strategies and tactics to do what they need to do to sustain their revenue stream, so you’re finding institutions entering into regions they haven’t traditionally been in ways that only dilute the resources we already have.”

When asked whether Albany Med views its Glenville clinic as a redundant service in the community, the head of the hospital’s Faculty Physicians Group, Dr. Ferdinand Venditti, said locating the facility there brings “a proven model of meeting urgent medical needs in a way that works for patients.”

The question of what care is redundant and what care is a welcome enhancement of services is not immediately obvious, though. In the past few months, both Albany Medical Center and Ellis Medicine have pursued new ventures to treat the growing incidence of diabetes in the community.

Albany Med is partnering with CapitalCare Holdings to establish a diagnostic and treatment center for diabetes and endocrine disorders in Niskayuna, while Ellis Medicine and St. Peter’s Health Partners of Albany are launching a new physicians practice designed to fight the same thing in nearly the same service area. The diagnostic and treatment center will be almost exclusively outpatient in nature, Connolly said, while the physicians practice will be inpatient-focused.

“There is an overwhelming need for endocrinology care in most regions,” he said, “so you can bring separate, seemingly similar programs to an area to fill a common need and if the demand is there, well, that’s a good thing.”

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