The Block Island Times
http://block-island.villagesoup.com/p/1145586

Health: Hospitals serving B.I. in transition

By Betty Cotter | Mar 28, 2014

The two hospitals closest to Block Island are undergoing changes that will affect patient care and services, but so far those involved say the changes have all been positive.

South County Hospital in Wakefield, R.I., the last independent hospital in the state, announced recently that it has entered into affiliation talks with Southcoast Hospitals Group of Massachusetts, which operates hospitals in Fall River, New Bedford and Wareham. Meanwhile, The Westerly Hospital is now known as L+M Westerly Hospital, since Lawrence + Memorial Hospital of New London, Conn., acquired it last June.

While locals may feel trepidation at the thought of their community hospitals being operated by out-of-state interests, hospital officials say the changes are necessary to keep the institutions viable. Lawrence + Memorial promised $30 million in capital investments over five years when it took title to The Westerly Hospital, which had been in receivership since 2011. South County Hospital also is hoping for an infusion of cash from Southcoast if the talks bear fruit.

“You have to look at it first in terms of all the changes that are coming down the pike,” said Louis R. Giancola, president and CEO of South County Hospital. In the future, hospitals will be compensated for insured patients on a managed care basis, or a set fee per month rather than a fee for service. This means that doctors and hospitals must have integrated systems for keeping track of patients’ conditions, medications and prognosis. For hospitals, it will translate to investments in information technology and expertise in the form of doctors, nurses and case managers.

To accomplish this, a hospital will need economies of scale — and smaller community hospitals don’t have the number of patients to afford the changes that will be necessary, Giancola said.

Enter the out-of-state affiliate, with access to capital and high patient counts. Spreading out the costs of managed care over more “covered lives” will decrease its costs, Giancola said. Capital investments in equipment and personnel will ensure that the hospitals are providing top-notch care.

For the fiscal year ending last Sept. 30, South County admitted 5,502 patients and Westerly admitted 3,232. (Of those, South County admitted 51 patients from Block Island, and Westerly admitted eight.) Neither hospital has the numbers to afford the sorts of investments needed.

On South County’s shopping list is a new $7 million cancer center that would consolidate most of its services under one roof. Its medical oncology facility is now at 85 Kenyon Ave., next door to the hospital. That would be moved into the hospital’s Read I wing, which would be renovated “to create the proper environment for patients and staff,” Giancola said. Because its equipment cannot be moved easily, radiation services would remain at 85 Kenyon Ave.

“Cancer is a multi-disciplinary disease,” Giancola said. “We want to be able to treat it on an inter-disciplinary basis.”

Creating a community cancer facility is among four recommendations of a community health needs assessment completed last year. Washington County has elevated levels of both breast and prostate cancer compared to state and national averages.

“It’s a disease that touches a lot of families and has a tremendous impact on those families,” Giancola said.

Although the public perception is you have to travel to Providence or Boston for effective cancer treatment, Giancola said 85 percent of cancer treatment occurs in a community setting – using protocols very similar to those used at urban hospitals.

L+M Westerly Hospital already has seen an infusion of capital since the acquisition took effect last year. The parking lot has been repaved, the HVAC system repaired, new ultrasound equipment purchased (for an off-site facility) and drainage repaired. In many cases, the investments make up for years of deferred maintenance while the hospital struggled to pay its creditors and employees.

L+M Westerly Hospital showed a profit of $680,000 in the fiscal year that ended Sept. 30 of last year, according to Michael O’Farrell, L+M’s director of public relations. This 2 percent operating margin has been maintained through this winter.

The profit comes from a mix of management decisions. Before L+M officially took over, a special master laid off 45 employees. The hospital also now shares the senior management team of L+M, for more cost savings. Its two unions, which represent nurses and service and skilled maintenance personnel, also will be voting soon on three-year contracts that have significant cost concessions.

But for Tricia Barber, an R.N. who has been at the hospital for more than 27 years, the changes are more than financial.

Barber was an obstetrical nurse, and her entire department was eliminated in the changeover. She now works in Westerly’s Emergency Department. She described those days when the hospital was threatened with closure as difficult.

“There was just lots of uncertainty. Lots of anger,” Barber said. “It was just an upsetting place to be. I think as an employee, as a community member, it was just sad.”

Since L+M purchased the hospital, community members feel more comfortable coming for treatment, she said, and the employees feel valued.

L+M has “breathed new life into us and has allowed us to continue providing the great care we prided ourselves on,” she said.

Shannon Christian, who had spent her career at L+M, is now director of patient care services at Westerly, and any trepidation she felt about moving into a new hospital was dissolved by the welcome she received.

She sees her job as “to promote nursing, to create a situation where nursing has a voice in the conversation and they feel empowered.” Strong nurses, she adds, lead to “excellent outcomes.”

The hospital lost medical staff as it closed its obstetrical unit (two, an obstetrician and nurse/midwife, went to South County) and the hospital’s future seemed uncertain. Now, L+M has hired a general surgeon, an orthopedic surgeon, a primary care doctor, and two obstetrician/gynecologists, one of whom begins work in June. The OB/GYNs will see patients in Westerly but deliver babies at L+M in New London. The hospital is recruiting another primary care doctor and a neurosurgeon.

While Westerly has retrenched some of the services it provides, patients now have access to L+M’s facilities, including a $34 million cancer center built in Waterford, Conn., in affiliation with the Dana-Farber Cancer Institute.

“I think whether you live on Block Island or Watch Hill or wherever, your questions and concerns have been answered,” O’Farrell said. “The place is here. It’s not going anywhere.”

South County Hospital has faced deficits in the past, and it had to restructure debt, mostly from its Frost Family Pavilion addition, during the recession. But the hospital is not in the dire straits that faced Westerly when a special master was appointed to oversee its finances.

The South County Hospital Healthcare System — which also includes VNS Home Health Services and other agencies – reported net income of $3.9 million in fiscal year 2013 and $4 million the year before. It is seeing an uptick in patient traffic, particularly in the Emergency Department (where 28,188 patients were served last year, up 7 percent) and its Women’s Wing (which delivered 510 babies last year, compared to 402 the year prior).

The hospital is just beginning the complicated process of forging an agreement with Southcoast and getting that agreement ratified by regulators. The hospital will need a certificate of need from the state, and the state Department of Health and state Attorney General’s Office will have to sign off on the deal as well. Giancola estimated it would take six months to forge a written agreement and another six months to get it approved by the state.

But he is optimistic that the “kindred soul” Southcoast and South County saw in each other will make the process smooth. Southcoast was one of three hospital groups asked to consider making a proposal for affiliation and one of two to submit a proposal. While he cautions that “this isn’t a done deal,” Giancola said the two seem a good match.

“The reason we chose to go forward [with Southcoast] is they committed to a role for a local board and a local management structure,” he said, and to invest in the hospital’s services.

“I think we’re going to learn from them, and they’re going to learn from us,” he added.

 

 

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