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Editor’s note: This commentary is in the Jan/Feb 2023 issue of Adirondack Explorer magazine, as part of our “It’s Debatable” feature. In this regular column, we invite organizations and/or individuals to address an issue. For more on this particular topic, read this Adirondack Almanack post on the planned closure of the Lake Placid Emergency Room.
The question: What’s your take on closing emergency services in Lake Placid?
A community must be heard
In January 1991, Placid Memorial Hospital, including its emergency department, elected to consolidate with General Hospital of Saranac Lake creating what eventually became Adirondack Health. Neither hospital 32 years ago was projected to be successful on its own. Other community hospitals statewide were experiencing similar challenges. While this resulted in Placid Memorial merging its assets with the successor Adirondack Medical Center, Lake Placid required that the agreement provided for 24-hour emergency room services.
This continued until 2013 when Adirondack Health eliminated night ER hours in Lake Placid. Village leaders addressed a letter to Adirondack Health’s trustees seeking consideration of the issues that would be created by such change. Adirondack Health replaced the former hospital with a new facility that provided for a part-time ER among other health services that continued to serve Lake Placid and surrounding communities.
Now under ER closure plans, there are more questions than answers, especially by the LP Volunteer Ambulance Service. How will this affect their volume of calls; more or less? How will it affect their ability to bill insurance which they rely on today? How will it affect their staffing which is already difficult to manage? Lake Placid relies upon appropriate health services just as much as in 1990 when Adirondack Medical Center was created. The village should be treated as a partner and provided a voice when change must occur.
While emergent/urgent patients may be transported to the Saranac Lake ER, that leaves patients behind with less urgent needs. Today it is nearly impossible to be seen on a walk-in basis by providers at the Placid site. What happens to these cases? Do they travel to the Saranac Lake ER? Is this the time to establish a walk-in health service with reasonable hours for these people?
The reported money-losing must be addressed. Adirondack Health’s statements suggest a desire for collaboration with their partners and stakeholders. I advocate for Lake Placid and surrounding communities to be given a voice at the table as their future is being determined. Adirondack Health needs to take potential impacts into consideration before implementing changes. Remember the Adirondack Health mission statement: “Excellent health care close to home.”
Craig H. Randall, former Lake Placid mayor and former chairman of Adirondack Medical Center, lives in Peru.
To stem losses, the Lake Placid ER must close
As a trustee of Adirondack Health in 2013, I supported maintaining an emergency department in Lake Placid, albeit with limited hours and for less serious conditions than those that required access to our Saranac Lake hospital’s operating rooms, intensive care unit and more extensive diagnostic equipment. But now I have joined with the full board and medical staff in seeking to close it. Here’s what changed: The number of people using the Lake Placid ED is now so low, the financial crisis facing hospitals statewide so deep, and the healthcare workforce shortage so bad, it makes both clinical and financial sense to concentrate our highly skilled, talented and caring clinicians at Adirondack Medical Center in Saranac Lake.
For several years after the decision to keep the ED in Lake Placid, emergency visits there (and in Saranac Lake) increased except for a dip in 2017. Since COVID-19, visits plummeted. It’s not necessarily bad: If people have access to a primary care provider to help them stay healthy or to telehealth for an urgent consult, that’s great! But the result is that Adirondack Health today spends about $8,800 per day to staff and operate the Lake Placid ED, while generating only about $2,700 per day in revenue.
Moreover, there’s a widespread shortage of healthcare professionals—doctors, nurses, lab and radiology technicians, and more. Nationally, this was exacerbated by the pandemic; locally, by the fact it’s hard to recruit clinicians when finding apartments or affordable homes is near-impossible.
That’s increased reliance on expensive, temporary contract labor to supplement dedicated permanent staff. Plus, we’re paying more for drugs and other supplies and deal daily with commercial insurers who reap huge profits but refuse to pay for care they deem unnecessary and delay payments for the care they do authorize. The Healthcare Association of New York State says 60% of New York’s hospitals report negative operating margins because of these challenges and many are reducing services.
Even though Adirondack Health is a nonprofit, it needs a positive bottom line to sustain current operations; invest in needed primary, preventive and specialty care; and regularly update facilities and equipment. Generous philanthropy has enabled us to make many needed investments, but we can’t continue to operate underused services.
Closing the Lake Placid ED will enable us to staunch some of the operating losses, while maintaining emergency services nearby.
Jeannie Cross, trustee emeritus and immediate past chair of the Adirondack Health Board of Trustees, lives in Keene.
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I totally agree with Jeanie Cross’s position that closing the Lake Placid Emergency room is a financial necessity for Adirondack Health. Hospitals are always adjusting to changing conditions and something that was agreed upon 10 years ago no longer is serving it’s stated purpose. I live more than 30 minutes away from the hospital in Saranac Lake which is something that increasingly preys on my mind with every birthday. But that is life here in the Adirondacks. Rural health has been and is,increasingly, a national concern. Rural hospitals have very specific problems and I have been very impressed with the administration of Adirondack Health as it continues to address it’s financial health, it’s value to the community amid finite revenue sources. Nevertheless, it has decided to go ahead with the current Cornerstone Campaign to renovate the Renal Dialysis Center and redo all the patient rooms. We are determined to provide the best possible patient care under the most optimal conditions even under the most difficult financial conditions that I have seen in my years as a Trustee of the Adirondack Health Foundation.
What a sad state our country is in. Well if you dont use, i.e.,make it pay for itself, we cant continue to provide emergency medical care. Wow! When will we actually say medical care is a right, not a commodity?
The issue here is a lot larger than what’s been stated above. It’s really about our broken healthcare system and the power and greed of the insurance industry. The most important remedy would be universal healthcare for all with single payer system, as enjoyed by almost every other nation on earth. When will we learn?
Bob,
I agree. Folks here in Plattsburgh, which used to support a large SAC base, are being forced more and more to get healthcare in Burlington. For many specialties, in many respects Plattsburgh is becoming as isolated as Saranac Lake or Lake Placid.
One thing to keep in mind when pointing fingers is something often overlooked – what originally started the need for health insurance?? High prices – yes, but why? Drug prices, equipment, technology, etc. all exploded at about the same time. Why? Much of it originated with lawsuits and malpractice cases in the US. Healthcare liability drives much of what we do today, not logical and efficient treatment. At the ER (or anywhere) omitting a test or procedure that isn’t available, logical, or cost-effective and liability raises its ugly head. Remote ERs are out on a limb, expected to perform the current “standards of care” despite insufficient funding.
Every healthcare practitioner and facility operates under the spectre of malpractice liability. This, of course, drives the need for specialty equipment, procedures, and professionals which may simply be impractical and unaffordable in remote communities of limited means. As much as universal healthcare is needed, we need the ability to practice efficiently with the Sword of Damocles hanging over our heads constantly driving the cost of care upward. With aging citizens, it is no wonder America is becoming more urbanized.
You are correct Boreas about the litigious overreach of our healthcare system, and many other aspects of American life. All of this can be remedied by the implementation of universal healthcare and single payer legislation, along with tort reform. I also want to point out the moral and ethical bankruptcy of our nation that does not recognize the right to universal healthcare. For a nation that supposedly prides itself on the values of the Judeo, Christian maxims of compassion, etc. it is inexcusable, especially in the 21st-century for the richest nation on earth. We should be ashamed that almost all other “advanced nations“ have this for its citizens.
Sure, no system is perfect, but it is far superior to the broken, profit driven system that burdens all, but the wealthy and bankrupts many..
Not really. Medical liability costs in U.S. pegged at 2.4 percent of annual health care spending, per the Harvard School of medicine. The high cost of healthcare in the US is caused by greed. Example” Had five teeth pulled by an “oral surgeon” . I timed how long it took to pull 5 teeth, 20 minutes. Cost $1500.
As with any skilled labor, you aren’t paying for the time they spent to perform the service, you’re paying for the years of training and experience that enabled them to perform the service (safely and quickly, it sounds like).
Bill,
There is a difference between direct medical liability costs and widespread over-treating and over-testing due to medical liability fears.
LP has always had a hospital or ER service,if closed everyone will have to call ambulance evan for non life threatening issues and let ambulance pay the bill, seniors and people with out ways to get to SL hospital because of lack of any transportation in area,and if governor gives more money to sports complex it is ridiculous, have the money to support medical in area, so if severe cut needs stitches the ambulance can transport to SL and if it cost a thousand dollars for the ride the governor or ambulance can pay for it ,just another thing taken away from LP ,
My husband would not be alive today if the Lake Placid Hospital wasn’t there a year ago. We live in Rochester and he was working in Lake Placid in The Oval, when he had a heart attack at work. He was revived by a wonderful doctor at the hospital before being transferred to Plattsburgh. This story is very upsetting to us and we don’t even live there. We were told if he wasn’t in the ER at that exact moment he would have died. If it wasn’t there I would no longer have him with me.
It is unfortunate that in a interest to address the bottom line, the hospital administration has chosen to use a broad sword as opposed to a scalpel. The dire financial situation within the facility can not take the front seat while the surrounding communities which it serves and are affected by it , are left to take a back seat. No plan for closure of the Lake Placid ER should be implemented much less discussed with out a concrete and well thought out plan addressing the effects in the community, the added burden on our EMS services and affected staff. At the end of the day both ERs are here to serve the community and the community should have a day.
The closing of the ER is disconcerting. However, the issues with providing and paying for healthcare are many. To those who think that nationalized healthcare is the answer, that type of system is failing maybe more so than ours. Below are a couple of paragraphs from an article titled “The U.K.’s Government-Run Healthcare Service Is in Crisis.” The problem is not as simple as issues of compassion, profits, morals, or being the richest nation on earth, which we are not, but perhaps the most indebted. Read it and weep: https://fiscal.treasury.gov/reports-statements/financial-report/where-we-are-now.html
A solution will have to be multifaceted, including malpractice and litigation reform as well as deep government reform which will be at least as difficult as anything.
Here are the aforementioned paragraphs.
“Now the state-funded service is falling apart. People who suffer heart attacks or strokes wait more than 1½ hours on average for an ambulance. Hospitals are so full they are turning patients away. A record 7.1 million people in England—more than one in 10 people—are stuck on waiting lists for nonemergency hospital treatment like hip replacements. The NHS on Monday faced the biggest strike in its history, with thousands of paramedics and nurses walking out over pay.”
“The NHS’s woes are an extreme example of issues playing out across the developed world. Healthcare systems, hit hard by Covid, are under pressure as people live longer and have a wider range of treatment options. Aging populations mean costs will keep growing. The U.K.’s experience is a warning of what happens when supply in healthcare provision can’t keep up with demand.”
Source: https://www.wsj.com/articles/nhs-uk-national-health-service-strike-costs-11675693883
If you doubt the source, just search Google news about national healthcare in the UK, France, Canada, all the way down the alphabet to Zimbabwe.
No system is perfect. And indeed, the countries you mention do have their problems. But in general, their systems of healthcare are superior to ours. some of the sources are you quote have their own political biases. Some of the complaints you hear about British Canadian and other healthcare systems are anecdotal as opposed to statistical.
Big Pharma is a major issue that is fairly unique to the United States. Have you looked at a hospital bill lately?
I think we probably agree on the need for litigation reform.
Unbalance the national healthcare system in a single payer system, is far superior to what we have now. And the last thing I want to hear is the old Socialism bogeyman argument.
Given their financial state (which they have been open about) if they dont close the ER then they are just going to end up closing something else. Cant keep every department open if the whole system is bleeding money. Would folks rather lose the ER when there is another one ten miles away or lose the whole organization?