STAR LAKE, N.Y.-Walter Becker has learned a thing or two about fixed hospital costs since he became the administrator two days per week at Clifton-Fine Hospital.
Since it was founded as a municipal hospital in 1951 to care for the workers and families at the surrounding paper mills, Clifton-Fine has held a license for 20 beds. These days, however, with the last mill shuttered since October 2000 (125 people lost their jobs), the hospital needs to be staffed for only six to eight patients-that many despite an average daily census of 1.9 patients. "It's the same to take care of two as six or eight," Becker said. In the western edge of the pine-studded Adirondacks, 372 miles north of New York City, Clifton-Fine serves the townships of Clifton and Fine with a combined population of 3,800 in a service area of about 5,800 residents.
The community sustains two gas stations, but not a single drugstore. The three Catholic churches in the region share one 73-year-old priest. There's no service for cellular phones, and the closest major highway is Interstate 81, about 60 miles west.
In the winter, an average 120 inches of snow blankets the area, and it stays cold most of the year. It's the kind of town where, in a pinch, you can withdraw $50 from the bank without an ATM card or photo identification.
Clifton-Fine's motto, he said, is "the smallest hospital with the biggest heart."
Becker, who also is the administrator at Clifton-Fine's closest neighboring hospital, 78-bed Carthage Area Hospital, has been traveling the 42 miles to Star Lake weekly since Carthage signed a management contract in June 2000. About a year ago, after 10 years at Clifton-Fine, Becker's predecessor went on to a bigger job in Malone, N.Y. The board of directors and the nursing director held things together during the interim, Becker said.
The property owners of the townships of Clifton and Fine subsidize the hospital with a $438,000 yearly contribution. Even with public support, the facility is losing money: $785,571 on operating revenue of $2.2 million in 2000. The unaudited net loss after the property tax subsidy and state grants was $10,401.
Becker said he believes the simple fix to the fixed-cost problem is to convert 11 beds into long-term-care beds, adding perhaps a couple of nursing aides and a nurse to the staff. Becker said he could fill the beds practically from Day One with no impact on the 13 nursing homes in the two-county region, which are running close to capacity. He already has a waiting list of 15 people.
The skilled-nursing beds at Clifton-Fine could bring in another $535,000 in net patient revenue in the first year, he estimated.
"The economies of scale could reduce taxes for a community that is poor," Becker said.
But the hospital has run smack-dab into a statewide moratorium on skilled-nursing beds that was instituted about eight months ago to allow the state health department to assess the nursing home situation. The health department, which received Clifton-Fine's application for a certificate of need six months ago, has put it aside until the moratorium ends at an unspecified time.
Becker said hospital representatives with elected officials in tow have visited state offices four times in recent months to plead their case.
"The state is saying our county is overbedded for skilled nursing. It is not," Becker said. "We're saying, forget the moratorium for this hospital. It would affect no one but the people living within 20 miles of this community."
The hospital is running with a skeleton crew of 42 full-time-equivalents drawing $105,495 in monthly salaries. Still, Clifton-Fine represents the area's second-largest employer after the school. Soon after Becker came on board, he downsized the staff by 18, a 37% reduction in the workforce. But to run a 24-hour operation, the hospital must keep some level of social workers, cooks, laboratory and X-ray technicians, medical record keepers, nurses and doctors, Becker noted.
"There is no question we're overstaffed, but there is nothing we can do about it because we have to keep services afloat," he said.
Of the 48 people employed by the hospital, Becker said roughly half are nurses, nearly all of them registered nurses. The level of care is equivalent to that of a trauma center because on some days as many as three nurses will tend to two patients, he said. Dining services are top-heavy, even without a cafeteria. Two full-time cooks-not to mention a consulting nutritionist-are always at the ready to prepare three meals per day for patients. The staff bring their meals from home.
Along the same lines, three physicians who work in a nearby medical building, Clifton-Fine Medical Center, are always on call to staff the emergency room, which averages four visits per day. Specialists visit the hospital on a part-time basis.
Clifton-Fine long ago abandoned maternity and surgical services. But the hospital does a brisk outpatient business, with an average of 22 visits daily. Services include radiology, ultrasound, mammography, nuclear medicine, bone density, laboratory services and stress testing.
Closing the hospital is not an option in Becker's mind. For one thing, Clifton-Fine is a "major economic force for our community because it's the second largest employer," he said. For another, if the community is ever going to attract new industry, it will have to have a hospital. Without a hospital to which they can refer patients, the area's three doctors will leave, he added. Clifton-Fine also is needed because "it has saved lives and will continue to save lives," Becker said.
Becker won't say what the future will bring if the hospital does not win its fight for skilled-nursing beds. He doesn't have much patience for the politics of the situation, either. "This is so senseless. We can become more self-sufficient through a stroke of the pen in Albany (N.Y.)."