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Inside AUGUST 2017 13
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COVER |
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BUSINESS BRIEFCASE |
18 CANCER CARE FACILITY Samaritan Medical Center is consolidating cancer care in one new state-of-the-art treatment facility.
36 DOCTOR RECRUITMENT The business of recruiting new health professionals in the tri-county area. |
12 $15K DONATION Trevor Garlock raises and donates $15k to the Foundation for Community Betterment. |
SMALL BIZ STARTUP |
13 WHITE CAPS WINERY Chaumont native opens new winery after years of planning and preparation.
FEATURES |
14 MIDWIFERY Expectant mothers in NNY choose personal delivery care through midwives.
26 END OF LIFE CARE Hospice works to ensure that continued care is available to families in multiple facets.
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TOP TRANSACTIONS |
51 JEFFERSON COUNTY The top 10 property sales in Jefferson County topped more than $4 million in June. |
BUSINESS SCENE |
68 NETWORKING, NNY STYLE
From Jefferson to St. Lawrence counties, business professionals connect for success. |
ONLINE |
NNYBIZMAG.COM Connect with us online for daily updates, more photos and exclusive Web content.
August 2017 | NNY Business
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INTERVIEW
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ABOUT THE COVER
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32 SHOWING PROFIT Rich Duvall, CEO of Carthage Area Hospital discusses tough decisions to bring the hospital out of debt and show profit for the first time since 2009.
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COLUMNS
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49 NONPROFITS TODAY 50 REAL ESTATE ROUNDUP 55 ECONOMICALLY SPEAKING |
DEPARTMENTS
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58 ENTREPRENEUR’S EDGE 59 SMALL BUSINESS SUCCESS 60 COMMERCE CORNER
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EDITOR’S NOTE PEOPLE ON THE MOVE ECONOMIC SNAPSHOT BUSINESS BRIEFCASE
13 SMALL BIZ STARTUP 66 CALENDAR 68 BUSINESS SCENE
For this month’s cover, NNY Business talks to hospitals throughout the tri-county region about the business of recruiting new health care professionals and what that means for the continued care of Northern New York residents. Featured on the cover of the magazine is River Hospital’s newly recruited Dr. David Wallace.
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BUSINESS BRIEFCASE
SLHS Congratulates Three CPH Employees of the Quarter
St. Lawrence Health System congratulated three hospital employees of the quarter who were nominated by their peers to receive the honor. Beth Woods, LPN, joined CPH in August 2014. Ms. Woods is a full-time LPN in the Pulmonology Department. Her colleagues and supervisor consider her a strong team player, who goes above and beyond to help both patients and coworkers. Nova Hogle, RN, began working at CPH in July 1996 and is currently working with infusion patients. Mrs. Hogle has worked in Ambulatory Surgery, Detox, and Oncology. Her colleagues say she, “treats every staff member with respect and kindness, always thanking colleagues for their help.” Michael Pinard, RN, began working at CPH in May 1994, on Medical Surgical Floors 2 and 3, and the Intensive Care Unit, joining the Emergency Department in 1998, where he currently works. His patients say he deserves the honor for taking the time to make sure that they are comfortable, and going above and beyond to ensure that their needs are met. Each was given a dish garden, chamber gift certificates, CPH gift shop gift certificates, a memento pin, and a designated parking space for the next three months.
Northwestern Mutual celebrates volunteer work with $15,000 grant to The Foundation for Community Betterment
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Northwestern Mutual, through its Foundation, presented The Foundation for Community Betterment with a $15,000 grant on behalf of Trevor Garlock, a recipient of the company’s Community Service Award. The annual program honors the company’s financial professionals for extraordinary volunteer work. Garlock presented the grant on July 22 at the 17th annual Paddle for Betterment. The Foundation for Community Betterment is dedicated to making an immediate, positive impact on the lives of those who lack what they need to succeed. Garlock has been involved with the organization since he was 14 years’ old, competing in the first ever Paddle for Betterment. He has been a part of the organization since, joining the National Board for the Foundation of Community Betterment in 2013 and serving in several leadership capacities.
Greater Watertown-North Country Chamber Accepting Applications for Leadership Institute
The Greater Watertown-North Country Chamber of Commerce is accepting applications for the 2017-2018 Jefferson Leadership Institute program. The Jefferson Leadership Institute is a leadership development program established in 1991 by local business and community leaders dedicated to enhancing the quality of life in Jefferson County. Each year, participants are immersed in community issues through 10 to 12 full-day sessions, including an overnight leadership retreat. The curriculum enables participants to develop their leadership capabilities, build strong relationships and encourages involvement in effecting positive change in the community while experiencing the north country with a hands-on approach. The GWNC Chamber of Commerce will accept participant applications, and a review committee comprised of leaders throughout Jefferson County will make selections. The Jefferson Leadership Institute is a tuitionbased program.
Application forms are available by contacting the Greater Watertown – North Country Chamber of Commerce at 1241 Coffeen Street or online at www.watertownny.com; and must be returned to the Chamber by August 18 at 4 p.m. If applications are faxed, e-mailed or mailed, please call the Chamber office to confirm receipt.
Community Bank N.A.’s Mallory Babcock Raises More Than $1,000 for United Way of Northern New York
Community Bank N.A. Customer Service Representative Mallory Babcock recently participated in Over the Edge for United Way of Northern New York. Babcock raised $1,083 for the fundraiser, giving her the opportunity to rappel 154 feet down Midtown Towers in Watertown. All proceeds from the event benefit United Way of Northern New York to support its mission and programs that provide prevention, intervention and crisis care across Northern New York. For more information on United Way of Northern New York or its Over the Edge event, visit unitedway-nny.org.
Got business milestones? n Share your business milestones with NNY Business. Email news releases and photos (.jpg/300 dpi) to associate magazine editor Holly Boname at hboname@wdt.net. The deadline for submissions is the 10th of the month for the following month’s issue. Photos that don’t appear in print may be posted on our Facebook page.
NN Y BUSINES S FEATURE “SAMARITAN CARES” IS A RECURRING THEME THAT BONNIE EPPOLITO OF THE MEDICAL CENTER’S FOUNDATION HAS REITERATED. This concept has carried through with the upcoming implementation of the Walker Center for Cancer Care. By this time next year, Samaritan Medical Center will answer the needs of the north country, providing its members with the care they require – right at home. The Walker Center will improve the way the community seeks, receives and experiences care. The local hospital with its ambitious initiative is working hard to continue its dedication to patients through this expansion. This “life-changing” project has been a dream of the hospital since 2013. During this time, Samaritan’s dedicated staff began conversations and initial plans for a new cancer center. This task has not been as simple as it sounds, requiring years of development and expertise. Samaritan treats about 600 cancer patients per year, a continually rising number as members of the Baby Boomer generation age. To get the ball rolling, employees took a step back and viewed the future of patient care at large. “It’s not just that we want a new cancer center. It’s part of a strategic plan that
the hospital put together,” said Krista A. Kittle, Samaritan Medical Center spokeswoman. “Number one, we identify what the community needs are and then do everything we can to meet those needs. Cancer was identified as one of the most prevalent ones.” Demographic research has shown that there are four core cancers affecting this immediate area – breast, colon, prostate and lung. Based on this information, it has become the center’s goal to make these sections of diagnosis and treatment as strong as possible. Kittle explained the other fundamental questions the hospital explored. “There was a lot of research that went into what we can do to make this as easy as possible for patients,” she said. “ Do most patients travel? Where do they go? And how do we keep them here?” It is through the convenience and location of the new Walker Center that Samaritan hopes to answer that last question. With new designs, new technology, and more space, this building provides an efficient, welcoming, and above all, comforting place for patient care. Samaritan Director of Oncology Dr. Day F. Hills looks forward to this convenience of care being implemented. Not only will the cancer center now be on
the Samaritan campus, but all oncology services will be provided in a single location. This unification means significant simplification for both medical staff and patients. Dr. Hills believes that care will be improved as she and her colleagues work next to each other, making discussions regarding patients easier and more effective. “Much of their care can be advanced all in one spot and that’s going to feel good all by itself. It’s going to be great for our region and our community,” she noted. One of the major advancements will come in the form of new radiation equipment. Having stereotactic body radiation therapy in the Walker Center will allow patients to receive treatment close to home. Currently, many people are required to travel lengthy distances to larger metropolitan areas in order receive the care they need. With this therapy now being offered in Watertown, the cost, time, and inconvenience associated with travel is eliminated. Additionally, SBRT shortens overall treatment time. The second floor of the Walker Center also will serve as a space for consolidated care. Here, infusion treatment will take place in one large suite. Chemotherapy and blood transfusions can all be done
CAD DESIGN PROVIDED BY SAMARITAN MEDICAL CENTER
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“If it means something to you, it means something to us. We have ways to honor those affected and help those willing to give.� ~Bonnie Eppolito, Samaritan Medical Center Foundation
Bonnie Eppolito stands near the site of the future cancer treatment center at Samaritan Medical Center.
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Main lobby/entrance of new cancer center with elevators and open stairwell to second floor.
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2. Complimentary coffee station just off the main lobby. 3.
2nd floor chemotherapy/infusion area overlooks rooftop garden. Nurses’ station is pictured on the right offering direct observation of patients undergoing treatment.
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Main exterior entrance to new cancer center with dedicated, covered pick-up/drop off for patients of the center.
5. Rooftop garden for year-round enjoyment by patients while undergoing chemotherapy treatments. The garden will feature a sculpture, the design of which is currently in development.
CAD DESIGN PROVIDED BY SAMARITAN MEDICAL CENTER
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N N Y BU SIN E SS F E AT UR E
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N N Y H E ALT H F E AT UR E
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or many, the thought of choosing hospice as a means of end-of-life care sends a message of uncertainty and confusion, especially when family members are not sure exactly what kind of care hospice service offers. Family members seeking help might avoid reaching out thinking they can’t afford it or that it might not be the right fit for their family member. The truth of the matter is that hospice isn’t just about caring for those who are near the end of their lives. It’s about enhancing the time they have left so they can leave this world with dignity and in peace. Diana Woodhouse, the CEO of Hospice of Jefferson County said, “Our families tell us they can feel the compassion and appreciate the honesty we have with them. This compassion builds a certain level of trust and rapport with the family. While we help them prepare for the death of their loved one, we also help the patient focus on the remainder of his or her life, making the best of the time they have left.”
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NN Y H E A LTH FEATURE HOW HOSPICE WORKS Part of supporting the family in need is helping them understand how the cost of hospice works. According to Nicole Paratore, director of community relations at Hospice of Jefferson County, roughly 60 percent of their reimbursements come from Medicare. Medicaid, third party insurance, and private pay make up the difference if there is a shortfall. For families unsure whether or not they qualify for Medicare, part of the work done by hospice is helping them complete the necessary paperwork. To be eligible for hospice under Medicare benefits, the patient must have a physician tell them they have less than six months to live. For patients who don’t have any insurance or money to pay out of pocket, hospice will work with the family financially or offer open services in some cases. “We never turn down a patient because of their lack of ability to pay,” Ms. Woodhouse said. “So we do provide charity care when needed. What hospice actually pays out isn’t fully covered by our reimbursements, so we have fundraisers to help us cover any additional costs.” According to Kellie Hitchman, director
of development and community relations at Hospice and Palliative Care of St. Lawrence Valley in Potsdam, many people avoid reaching out to hospice because not only do they want to sidestep the emotional impact of losing their loved one, they don’t fully understand what hospice care is or what it offers. “The greatest misunderstanding we see is when family members don’t know the services we offer,” she said. “One of the things I hear a lot is, ‘I wish we had called sooner.’ For a lot of families, this is a scary time. They think they’re giving up hope, but that isn’t true at all. They’re simply seeking help.” THE RISK OF WAITING In May, the United Hospital Fund and the Alliance for Home Health Quality and Innovation found that patients who refused home care services, like those offered by hospice, once discharged from inpatient care have higher rates of hospital readmission and a lower quality of life. The report, “I Can Take Care of Myself!”: Patients’ Refusals of Home Health Care Services, includes a limited study of 495 patients in New York City and Phila-
delphia eligible for home care. According to researcher Kathyrn Bowles, PhD, of the Visiting Nurse Service of New York and the University of Pennsylvania, 28 percent of those patients refused services. Patients who refused home care were twice as likely to be readmitted to the hospital within 30 to 60 days – an indicator of not just lower quality of life, but of higher healthcare costs overall. According to the study, there are many reasons patients may wait to enter hospice or refuse home care. The most common reasons cited by the patients themselves are they are managing fine at the moment or see it as an invasion of privacy, they don’t think they need help or have had bad experiences in the past, they don’t know enough about the services or the costs, and fear of the unknown. Other barriers to end-of-life care the report found include misunderstandings on the part of family members, stories of abuse or neglect in the media, and undiagnosed or misattributed dementia or cognitive impairment. Hospitals themselves may also lack information on “post-discharge services” or options for patients leaving inpatient care.
Hospice nurse Michelle Wood helps a patient while sitting outside at the center.
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Diana Woodhouse CEO of Hospice of Jefferson County stands near the gardens at the complex on Gotham Street. August 2017 | NNY Business
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Hospice nurse Michelle Wood wheels a patient around outside at the center.
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20 QU E STIONS
PHOTOS BY AMANDA MORRISON
TOUGH DECISIONS, POSITIVE RESULTS
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arthage Area Hospital CEO Rich Duvall has been working diligently to bring the hospital out of financial debt, with 2017 showing a profit for the first time since 2009. Duvall says he was able to accomplish this through making hard decisions like closing facilities and decreasing staff. However, these decisions have increased efficiency and allowed the hospital to focus on educational and preventative programming and outreach. NNYB: Carthage Area Hospital struggled for many years, at one point having a debt that reached $21 million. What were the largest factors contributing to these deficits? Duvall: I would say the single largest factor is the hospital grew uncontrolled for a number of years. We opened up multiple clinics without allowing for the proper business maturation period for each clinic. So when those clinics were opened, kind of in rapid fire succession, there was no business there. You were opening a new business every time we opened a new site, and we had opened close to 30 clinics. I want to say that occurred in about a two-and-a-half to three-year period. When I first started with the facility, I actually recruited about 18 providers to staff the clinics – and we opened in relatively quick order – and it was a startup for each and every one of those. So you had the provider salary, all the office staff, supplies… all that type of stuff, without knowing whether the business was going to be there. So unfortunately those business models didn’t develop as quickly as they could have if that growth was controlled. So because of that, along with a major change
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n Carthage Area Hospital shows profit after years of restructuring and reorganizing strategic plan. in health insurance reimbursement – a couple of our major payers had changed the way they paid facilities like ours – it kind of created a perfect storm. And on top of those two things, in 2010 we implemented a new electronic medical record for the hospital, which was implemented quickly, and that caused all sorts of problems for the facility. So you combine the three and you truly had the perfect storm, which then led to over $20 million in losses from 2009 to about 2015. NNYB: In July 2014, CAH was designated a critical-access hospital. Why was that designation vital? Duvall: So a couple of things. One, we took a hard look at the organization and said, “Does it make sense for us to have 48 acute beds available in our community?” when the reality was our daily census was around 20. So it’s like owning a hotel and having 50 rooms with only 20 of them rented the majority of the time. So once we evaluated that, we looked at other options, one of which was converting to critical-access designation. Under that designation you’re only allowed to have 25 acute care beds, so that number obviously lined up with our average daily census. And it also shifted our reimbursement model to be based on cost-based-reimbursement. So because of that, that switch to costbased-reimbursement, appropriately sizing the facility to the service needed by the community, added the revenue we needed to the facility. In
addition to that we also restructured the entire organization. So we closed about 15 clinics and we laid off about 100 people at that time. NNYB: Why are Medicaid and Medicare reimbursements so important for a rural hospital? Duvall: If you look at the north country, most of the facilities in the north country are heavily reliant on both Medicare and Medicaid and I think the reason behind it is our population mix, if you will. We have a lot of elderly, and unfortunately with the industrial shifts in the area, we have a lot of folks that have to rely on Medicaid – the working poor if you will. So those two areas, I think, are important to just about every health care organization in the north country. Moving to the critical care access model makes sense because the reimbursement is based mostly on Medicare, so the cost-basedreimbursement comes back for those services provided to those insured with Medicare. NNYB: The move to a critical-access hospital compelled CAH to end its association with several outpatient facilities. Did that help or hurt the hospital’s bottom line? Duvall: I would say two things – back to the uncontrolled growth – this facility grew into markets that weren’t our primary service area. We had clinics in Sackets Harbor and Clayton and Cape Vincent, Edward Knox, you know all over the place, a 50-mile geographic radius, if
2 0 Q U E S T I O NS skilled nursing unit. What led to that decision?
The Rich Duvall File AGE: 40 JOB: Chief executive officer, Carthage Area Hospital FAMILY: Children: Richard, 15, Olivia, 12, and Sophia, 6 HOMETOWN: Burrville EDUCATION: Master of healthcare administration, American Intercontinental University (anticipated December 2017); bachelor of arts in interdisciplinary studies, Columbia College; associates in general studies, Columbia College; graduate, The Academy for Healthcare Leadership Advancement, Cornell University’s Johnson School of Business. CAREER: Chief operating officer, Carthage Area Hospital, November 2011-September 2014; Administrator of support services, Carthage Area Hospital, June 2008-November 2011; Chief executive officer, Northern Oswego Ambulance Inc., 1998-2008; Firefighter/Medic, U.S. Air Force; police officer, village of Pulaski. LAST BOOK YOU’VE READ AND WOULD RECOMMEND: “Start With Why,” by Simon Sinek
you will, around the facility. It just doesn’t make sense for us to be in those markets because it’s not our primary area. So pulling back from those areas helped us fortify the services needed for the Carthage community and our primary service area. NNYB: At the same time, CAH reduced its number of acute care beds from 78 to 25. Does that lower number meet the community’s needs? Duvall: It does. It’s a little misleading the 78. Thirty of those 78 were skilled nursing beds, 48 beds were actually acute care beds. So those were the only ones available if you were to arrive at the hospital and need a bed. So the reality
is health care is shifting from inpatient care to outpatient care and prevention. Luckily, we had put together a solid plan to be ahead of that shift, so reducing the beds did make sense for our community, because as I said, we did a study and found that our average daily census was somewhere around 20 including an OB. So it made a lot of sense to make that move. NNYB: You took over at CAH in 2014. What operational changes did you implement to try to turn around the hospital’s finances? Duvall: We had a kind of skeleton strategic plan. I would say the biggest thing we did was solidify that plan, and that plan we are still working on/working off of today. It included a lot of reorganization of departments to increase efficiency, included a lot of restructuring the way we provide care, and refocusing the entire organization on the patient. That’s what we are here to provide care for and it’s one patient at a time that we are doing that with. So there has been several pieces: I would say clinical, quality and building space utilization have been the biggest things that we have focused on. NNYB: The hospital was able to announce recently that 2016 was its first profitable year since 2009. How did it feel to be able to make that announcement? Duvall: It was wonderful to finally be able to prove, not only to myself and the board, but also to the staff who have worked so hard to make this happen, plus the community – to show that they can rely on our services for the long run. And we are going to make the choices, although some of our announcements – restructuring, reutilization of space, and clinic closure meant some adverse reaction from the community – but overall they are seeing that the plan was successful and we are able to produce a profit. NNYB: You are in the process of closing your
Duvall: As I mentioned earlier, we had put together a strategic plan and one of the points on the strategic plan was developing a strategy around long-term care. The reality is we have a 30-bed skilled nursing facility that is outdated. We have done a number of cosmetic things to try and make it more attractive, but there are other facilities in this market that are much more attractive than ours. The other piece to it is, out of the skilled nursing beds that we offer, a majority of the rooms are double occupancy rooms. Because of that, it’s challenging to keep that full census. For instance if you have a female room, two females in one room, and one of them moves to another facility you only have a female bed available. So if a male comes up on the net to be referred to our facility we can’t necessarily just drop them into that bed. Even if we had another room down the hall with just one female in it you have to ask the family, the resident and everyone to get permission to clear that room out to be able to put a male occupant in it. On top of that, if you look at national averages, it’s somewhere between 80 and 120 beds for a skilled nursing unit to actually break even or to make a small profit. So our scope and size just didn’t allow for that. So again, strategic plan dictated we determine a strategy for it. We had looked at partnering with other providers to run our skilled nursing unit so they could gain the economy of scale, but were unfortunately unable to put that together. We worked on it for about two years and then we made the decision to close the unit, which I think not only stabilizes Carthage Area Hospital, but also other providers in the community, because everyone has that same struggle. As you may know, we had 23 residents; we are down to three left in the facility, one of which is waiting for a bed hold and the other two already have them and are just waiting for the availability to move. So what does that tell you? Well, within a month we were able to place 23 people. So that tells you the market has the capacity to absorb more people - not only does it help us, but it stabilized the other facilities so they are not sitting on open beds. NNYB: Has the closure process gone as smoothly as could be expected? Duvall: I think, in fact, it has gone better than expected. Within the first week I think we had almost half of the residents placed, which I was shocked at. I knew there was capacity in the market; I wasn’t aware that there was that much capacity. I was also shocked at when we announced this and met with all the residents and their families how supportive they were at the decision because they could tell that, unfortunately, inefficiencies were present because of the 30-bed-unit. And several of the families said we are not happy that you are closing, but we certainly understand why you would make this decision. I think the other key piece is our staff worked diligently with all of the residents to ensure they were placed where they wanted to be placed and that was in the local commuAugust 2017 | NNY Business
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20 QU E STIONS nity; so either Watertown, Carthage or Lowville is where all of our residents have gone. NNYB: You’ve previously used the term “medical village” to describe CAH’s model. What does that mean? Duvall: In accordance with the Medicaid redesign and DSRIP (Delivery System Reform Incentive Payment Program) in New York state, the idea is to find ways to repurpose acute care space to be utilized for outpatient care or ambulatory care type services. So what we’ve done, is we’ve taken a look at the entire footprint of the hospital, plus our other clinics, and were looking at designing a clinical space, if you will, hence a ‘village’ with multiple services in one location. So that way a patient can arrive, have their vehicle parked by our valet service and then walk in and receive multiple services at one point of entry, instead of having to go to different locations. NNYB: Is recruiting medical providers a challenge for CAH? Duvall: I think recruiting medical providers in the north country is a challenge, it’s not just for Carthage Area Hospital. I think the reality is the north country has a lot to offer, but it’s not a big city. So as we meet with most of the providers, a lot of them are interested in the various things offered in the cities from airports to easy access to cultural things and shopping and those types of things so I think it is a challenge. The other thing I think we face in the north country that’s a challenge is, quite often, especially in what I’ll call the “sub-specialty care” area, most of the providers are one. So if you are able to recruit someone who is just out of school they are a little scared because they have no colleague or they have no one else in the area that they can lean on or talk to for support. One thing I think is there are positives. We do have, because we are in a health professional shortage area, the ability to offer various grant programs and incentives to help pay off student loan debt and things along those lines that I think do help. Also, another positive is our proximity to Canada. A lot of the medical professionals that we interview have some sort of tie to Canada and the various cities there with family members and whatnot; it gives them the ability to work close to family or home. NNYB: Carthage Area Hospital emphasizes wellness and educational programs. Why are these important? Duvall: Aligning with our strategic plan, another point on the plan is looking at ways that we can help influence the health of the population. One of the areas we had looked at as kind of a deficit area is that of education to the community. We focused this year on putting together a monthly series of wellness topics – everything from stroke and cardiovascular disease to diabetes and eating well. We even had a men’s health month, trying to promote different areas of men’s health, which was attended by about 34 | NNY Business | August 2017
25 people and was well-received. When we first started the programs, we had about five or six people at them. The stroke and heart events are probably our biggest, with attendance reaching into the fifties. Now, they’ve become so popular that we’ve actually had other community groups reaching out to ask if we could take these shows on the road. So they’ve been up to Croghan and other places along those lines to provide education to the area. NNYB: Carthage Area Hospital is credited with having the shortest emergency room wait period in the area. How is that accomplished and why does it matter? Duvall: I think there are two pieces to that. We have a doctor on staff, 24 hours a day, seven days a week. Then for 12 hours a day we have another model called a fastrack, which is staffed by a mid-level provider, either a physician’s assistant or nurse practioner. That allows for a quicker flow of patients through the ER. The other operational things that have been put in place are things like bedside registration. If available, patients are taken right to a bed rather than traditionally staying in the waiting area. If a bed is open, that patient goes directly to a bed. I think all of those things, the operational forces as well as the way we have it staffed, help support that. I think why it’s important is obvious. You’re coming to the ER for a reason and you wanted to be treated as quickly and as appropriately as you can. Back to the community education events, we are focusing a lot on why you need to come to emergency room, eliminating the unnecessary ER visits. There are folks who could be better treated in their primary care office or an urgent care. We are trying to educate when that makes sense, as opposed to coming to the ER. NNYB: Your maternity ward also receives frequent praise from the public. What makes Carthage Area Hospital a choice place to have a baby? Duvall: It’s a couple of things. Our OB unit is an eight-bed unit and there are LDRP rooms, which means labor, deliver, recover and postpartum. So once you are admitted to that bed, you don’t ever move again. The entire process is taken care of in one location. I think the patients find that incredibly comforting and also is well-received by family members because the patient is not constantly being moved around. The other piece that makes it convenient is that our OB unit is attached directly to the OR. If there was ever an emergency or you need to have a C-section, you are literally within 25 feet of the OR. Also, the staff on the unit provides that one-on-one care. Quite often, we hear from our patients that they never feel like a number. They receive the one-on-one direct care both from an RN and an LPN. The LPN usually takes care of the baby and the RN takes care of the mother. It’s a combination of all these things.
NNYB: The Hospital has implemented a locally grown produce initiative. What do you hope to achieve through this? Duvall: The hospital obviously serves two purposes. One, as the health care provider in the region, but additionally as an economic driver in the area. I think we all know that one of the areas that struggles here is agriculture. Myself, the head of clinical nutrition, and head of our kitchen put our head together and thought, what is something unique we could do that would help us pair those two factors together? Having wholesome food grown by our local farmers to serve to our patients, staff, and visitors obviously meets the nutrition piece because it’s better than processed foods. It also stimulates the economy. In fact, when we started with the local group they had just a few farms and now they have over 20 in a co-op. They deliver to us once a week and also have a farmer’s market right outside the hospital that our staff goes to. Anyone else who happens to be by the hospital that day can buy fresh fruits, vegetables, honey, baked goods, and all sorts of things. In addition to preparing and serving it ourselves, we also use those things in our cooking classes. That way, if you enroll in one of our cooking classes, you are taught how to work with those things. We are also expanding that class to the local supermarkets so people can learn how to shop appropriately, buy healthier foods, and make healthier choices. This all pairs nicely with our diabetes and weight loss program called The Way of Life. They do everything from diet and meal planning to exercise and all of those things. We bring in physical therapists who teach people how to exercise correctly. We’re also going to start preparing box sets, similar to what you see on TV. So if you’re in the class, you can purchase the set, which comes with all of the ingredients and take them home to cook. It’s very exciting. NNYB: What uncertainties remain for the health care industry? Duvall: I think there are many. We read and hear things everyday about what’s going on in Washington with healthcare repeal and replace. Unfortunately, as a health care provider, we can speak to our elected officials, our community groups, and our hospital associations to influence change, but the reality is that our voice is relatively small. So we kind of have to roll with the punches as to whatever comes to us. What’s unfortunate about it, if you look over time, some changes have been very positive, some changes have been very negative and the healthcare market just has to suffer or prosper in those times. I think that’s the biggest uncertainty. The second area is actually finding providers. It is getting highly competitive, not just because of geographic location, but because there are fewer physicians entering the workforce. We also have an enormous amount of physicians that are at retirement age in the workforce. Especially for the north country, we are going to face some struggles with those two ideals.
Gary Rosenberg, administrator of support services, right, recruited W. Allen Fink, DO, MHA, FACEP,
| NNY Business | 37 August 2017 left, and Diane Keating Jones, D.O. FAAP, center, to work with Carthage Area Hospital.
C OV E R STORY
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everal Northern New York hospital officials say there are a variety of successful approaches to physician recruitment, but the process of attracting primary care doctors and specialists to the region still remains a challenge. In recent interviews, administrators shared their “secrets of success” behind their physician recruiting efforts in a field that remains highly competitive on a nationwide level.’
SAMARITAN HEALTH SYSTEMS
Anne M. Walldroff, Samaritan Medical Center’s director of physician recruitment, said the Watertown hospital has hired 17 new physicians since January, with a “few more in the pipeline” expected to start later this year. Education loan repayment is one popular incentive that may be offered to interested candidates, Mrs. Walldroff said. Some medical school graduates have as much as $250,000 to $400,000 in student-loan debt when they complete their residency programs, and “that debt can be a huge cloud over their heads,” she said. An education loan repayment incentive can put them on the road” to stabilizing their financial situation for themselves and their families, she added. Another key to successful recruitment is being able to offer a candidate the opportunity to join an existing practice, Mrs. Walldroff said. “Most people don't want to be the only doctor in a practice,” she said. “They like to work in a collaborative environment, and be able to exchange information with their colleagues.” This also allows younger physicians an opportunity to draw on the experience of their older colleagues, along with sharing on-call duties, Mrs. Walldroff added. Samaritan operates a graduate medical education program, and serves as an accredited teaching site for upper level 38 | NNY Business | August 2017
osteopathic medical students. “Many of those students have decided to return and practice at Samaritan,” Mrs. Walldroff said. The Watertown hospital also recruits physicians through an arrangement with Upstate Medical University, Syracuse. The cost of training a resident at that facility is covered by Samaritan, and in turn, that person agrees to practice at the Watertown hospital for several years after completing his or her residency. A major expansion and modernization project launched by Samaritan many years ago has helped significantly in the recruitment of physicians, Mrs. Walldroff said. “It’s been a huge help when they see the spacious and modern facilities where they can practice,” she said. “The new building has definitely made a difference
in the expansion of services we have been able to offer our patients as well.” It was more than a decade ago that Samaritan officials launched the $61 million expansion, citing increased competition for physicians as a major reason for the large scale effort. “Physician recruitment and retention is one of our strategic goals and one of the drivers of our facility master plan,” said Thomas H. Carman, Samaritan’s Chief Executive Office, in 2007 interview with the Watertown Daily Times. Mr. Carman himself still plays an active role in the hospital’s physician recruitment efforts by attending all physician candidate interviews, said Mrs. Walldroff. In recent years, Samaritan has been successful at expanding group practices in specialty areas such as general surgery, oncology (cancer treatment) and otolaryn-
gology (ear, nose and throat). But recruitment for psychiatrists and dermatologists continues to be a challenge. “We have to be straightforward and paint an honest picture of the pros and cons of the region,” noting the tough winter weather may be offset by “the beauty of the four seasons,” she said. The quality of life in Northern New York is often a draw to potential candidates, including the region’s school districts and the housing market, she said. Some physicians have commented how they could find a new house in this region for a fraction of what they would pay in an urban area, she said. The proximity of places such as Syracuse, the Thousand Islands, the Adirondacks, and Canada, all within an hour or two drive from Watertown, may also work as an incentive, she added. In an effort to further meet the needs of some physician recruits, Mrs. Walldroff took steps to bring an au pair service to the area. An au pair is a person from a foreign country who obtains a specific VISA to come to the United States and live with a family fulltime and help care for their children. Mrs. Walldroff is partnered with a U.S. Department of State authorized program headquartered in Cambridge, Mass., which offers an extensive worldwide network of au pair international recruitment, screening and orientation services. She started the service after an inquiry from one of Samaritan’s latest recruits, Dr. Daniel Krebs, a board-certified family practitioner. Dr. Krebs and his wife have four young children and had used the services of an au pair in Washington State, His family was attracted to Northern New York region because of its smaller school districts (they chose Sackets Harbor Central School), and the many outdoor recreational opportunities available, including downhill skiing.
COV E R STORY CARTHAGE AREA HOSPITAL:
The physician recruitment efforts made by a hospital are in large part driven by the needs of the community it serves, and “those needs can vary widely from area to area,” said Gary Rosenberg, administrator of support services for Carthage Area Hospital. “I can recall more than fifty years ago when I was growing up in rural Minnesota, the same doctor who delivered me had also delivered my mother,” Mr. Rosenberg said. “And he was my grandmother’s primary care doctor as well.” It used to be that most primary care doctors “did everything from birth to death, including minor surgeries and deliveries,” but that’s been changing as medicine has become more specialized, he said. “Once you find a suitable and interested candidate, the process then becomes one of negotiation,” Mr. Rosenberg said. “Some things are valued more than others, but we are all looking for some sort of quality of life and work balance.” Typical incentives include salary offers, bonuses, vacation days, moving allowances, flexible work schedules, assistance with student-loan debt repayment and the opportunity for growth and advancement within the facility, Mr. Rosenberg said. The physicians who are recruited by Carthage Area Hospital have real potential to make an impact on the services and care provided by hospital because of its smaller size, an advantage to practicing in a larger, urban facility, he said. Each physician candidate may be looking for something different, depending on what point they are in their medical career, Mr. Rosenberg said. 40 | NNY Business | August 2017
“For the right people, we have the right niche,” he said. “It’s just sometimes challenging to find them.” It’s not uncommon for younger physicians who have just completed their residencies to be very “idealistic, skillful and bright, but with hopes of practicing in a large urban hospital with well-known specialists,” he said. Providing assistance with student loan repayment is a major incentive for this particular group, because the amount of their debt can be an “incredible burden for them,” after graduation, he said. Another group of potential recruits are well-established physicians looking to “slow down” because they have already spent years doing “that high
speed workout,” Mr. Rosenberg said. “That group is easier to reach with the ‘softer’ incentives,’” such as the quality of life in the community, the outdoor recreational opportunities, and other amenities of a rural lifestyle, he said. There is a third group of physicians who fall “in between” those who are fresh out of residency programs, and those who are working toward retirement, Mr. Rosenberg said. “This group is looking to raise a family and become settled in a community,” he said. “They are looking at the quality of the schools, the safety of the communities, the sports programs, etc.” The hospital has some recent success stories, including the recruitment
of two physicians who had previously practiced at Fort Drum, Mr. Rosenberg said. Dr. W. Allen Fink started as Carthage Area Hospital’s Emergency Department Medical Director in January, after working at a larger hospital in the Seattle, Wash., area. Dr. Fink, a Fellow of the American College of Emergency Physicians, had previously worked at Fort Drum, and was drawn back to practice at Carthage for several reasons, including the ability to have a greater impact in a smaller hospital, Mr. Rosenberg said. “We pride ourselves as being a place for personal care, how we interact with the patients and each other,” Mr. Rosenberg said. Another former military physician recruit is Dr. Diane Keating Jones, a board-certified pediatrician who had served as Chief of Pediatrics at Fort Drum, and at the West Point Military Academy. Last year, she joined the Carthage Pediatric Clinic at 117 N. Mechanic St. “She is a mid-career physician, and very highly regarded,” Mr. Rosenberg said. “Both she and her husband loved the Northern New York area, and wanted to return.”
RIVER HOSPITAL, ALEXANDRIA BAY:
River Hospital has also been successful in recruiting former Fort Drum health care practitioners. One recent hire is Dr. David M. Wallace, who is board-certified in family medicine and joined the River Family Health Center in March. The health center is located adjacent to the hospital, and provides comprehensive primary family health services. Dr. Wallace had served in the
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Gary Rosenberg, administrator of support services, right, recruited W. Allen Fink, DO, MHA, FACEP, left, and Diane Keating Jones, D.O. FAAP, center, to work with Carthage Area Hospital.
C OV E R STORY United States Army on active duty for 24 years, transferring to the reserves in 2015. He had arrived at Fort Drum in 2007, and worked as the Division Surgeon for the 10th Mountain Division Surgeon’s Office. It was there he worked with a colleague, Bradley Frey, one of the division’s senior physician assistants. The two colleagues stayed in contact, and are now both practicing at River Hospital. Mr. Frey is the River Community Wellness Program Director. “It was nice to finally be back working with him,” Dr. Wallace said. “In the transition from military to civilian medicine, it has been wonderful to have a seasoned ex-military provider and leader to lean on for expertise during my transition period.” Dr. Wallace said he “chose to be a family physician for a reason.” “I love the ability of caring for the whole family, from birth until death, and nurturing the community involvement in the approach to the individual patient,” he said. River Hospital “provides that supportive atmosphere,” which results in “better and lasting care for all patients,” he said. “It builds a wonderful experience when you are speaking with other staff members about a patient, and they automatically know the patient’s first name, their family history, and the social dynamics of their care,” Dr. Wallace said. The St. Lawrence River communities “seem to be entirely dedicated to the success and welfare of their families,” which has been shown by the hospital’s growth
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in recent years, he said. “I have never seen a community so committed to the local health care facility through their generosity and giving,” he added. Dr. Wallace is originally from Rochester, where his parents and brother and sister-in-law still reside. His wife’s family is from Vermont, so staying in the Northern New York region made sense because it provided a “middle area” in proximity to both families, he said. River Hospital officials have made it a priority to recruit primary care physicians and other health care providers to “ensure the members of the St. Lawrence River communities have their health needs served close to home,” said Andrea Pfeiffer, director of marketing and community relations. There are a variety of incentives for recruitment, including the “promotion of our small, friendly work environment, and close knit community,” she said. “It hasn’t gotten easier, as recruiting in a rural community is sometimes tough,” Ms. Pfeiffer said. “But we have found some wonderful providers that are excited about serving a small community and practicing in a rural hospital.” The River Family Health Center is fully staffed with mid-level providers and physicians, she added.
CANTON-POTSDAM HOSPITAL, POTSDAM:
“Physician recruitment is not easy,” said Marlinda LaValley, vice president for administrative services,
Canton-Potsdam Hospital. “We have to compete not only regionally, but also nationally.” The location of the hospital in Potsdam has been a draw for those who “want a rural lifestyle, but also access to urban areas” including places such as Montreal, a major metropolitan city, she said. Others seek out the beauty and tranquility of the Adirondacks in places such as Lake Placid. “We explain what this area has to offer,” Ms. LaValley said. “It must match the personal, professional and family needs of the candidate.” The hospital also works to provide a support system for its physicians by “putting related practices together” in the same building, if possible, she said. For example, Canton-Potsdam Hospital has a team of orthopedic and sports medicine specialists, including a specialist in hand surgery and pediatric orthopedic surgery. These physicians work as a team, and can consult with a specialist in pain medicine, and staff in the physical rehabilitation services, all located on the St Lawrence Health System Medical Campus, Canton. “We cluster practitioners when it makes sense,” Ms. LaValley said. Canton-Potsdam Hospital officials review upcoming retirements when establishing their physician recruitment plans, and seek input from the medical staff itself to determine the community’s health care needs, she said. “Our hospital has a strong relationship between physicians and administration,” she said. “That relationship is a huge factor in recruiting.” Potential candidates “feel comfortable asking questions of the medical staff, such as what it is like to work here, and to live here,” which enhances the information they already receive from the hospital administrators during the recruiting process, she said The hospital’s medical director, Dr. Robert T. Rogers, is board-certified in internal medicine. Dr. Rogers and Carlos Alberto, vice president of physician practice management, often work side-by-side on physician recruitment
DAYTONA NILES n NNY BUSINESS Dr. David Wallace is a new physician at River Hospital in Alexandria Bay.
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RE A L E STATE QUARTERLY
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HE A LT H FEATURE always let me ask questions, and they explain everything to me, until it makes sense. I never feel rushed, and I always feel heard.” “We are most appreciative for the generosity of the Berry and Hale families,” Said Ben Moore, River Hospital CEO. “Their support for the triage room in our emergency room is especially meaningful for all of us at River Hospital as this is the site where we have “first contact” with many of our patients. Their generosity will enable us to have a state-of-the-art and patient friendly environment so important to our patients when they are seeking potentially lifesaving care.” Community members wishing to join the campaign effort can direct their giving to any one of several programs that will be upgraded through the Hope + Healing project: physical therapy, behavioral health, primary care and the emergency department. For a list of naming opportunities by department contact Stephanie Weiss at 315-4862920.
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