Clifton-Fine is a tiny hospital in the northwest Adirondacks. It's searching for a larger hospital in the region to partner with, in hopes of gaining financial strength and better services.
Driving up, you might think Clifton-Fine Hospital is a resort or lodge , with its new Adirondack-style wooden entryway. And when you walk inside the small reception area, there’s absolutely no hustle and bustle. I had to rap on the window at the front desk to get someone’s attention.
Robert Kimmes is the hospital’s outgoing CEO. He takes me on a tour, and we stop in front of the emergency room. The old wooden door has a sign that says, "If the light is out, pull the cord."
Kimmes says Clifton-Fine Hospital may be small, but it’s important to the people who live here.
"The next nearest health care provider is an hour away. If someone’s having a heart attack, that’s a long way to go. I know that we’ve saved a lot of lives here, where these patients may not have made it if they had to travel an hour to a different hospital."
Here at one of the smallest and most remote hospitals in New York, there are two doctors and a nurse practitioner. It does provide a lab, radiology, and physical therapy. It provides primary care at an outpatient clinic. But it’s still not much business. More than half of its 20 hospital beds are used as a nursing home, which helps pay the bills.
Like many small, rural hospitals, Clifton-Fine’s financial future is uncertain. Kimmes says reimbursements from Medicare and Medicaid are down. While new regulations and the new health care law are increasing the administrative workload. But with its limited customer base, the problem is more acute here. Kimmes says Clifton Fine is going to need help to make it through the next few years.
"I think going forward it is going to be hard for small, rural hospitals to stay independent."
"We just started the process of seeking a partner to affiliate with, a larger hospital or health system."
Kimmes says a larger hospital should help Clifton-Fine become financially stable in the long-term. He would like Information Technology assistance, and with the new load of administrative work. He’d also like to improve patient care.
"By being able to provide resources that we don’t currently have, and that we’re not going to have in the future. We’re never going to be able to hire a cardiologist or an oncologist or a neurologist, but by partnering with a larger hospital, we would be able to have those services here on a part-time basis."
This sounds like a great idea. But the National Rural Health Association sounds a note of caution to any hospital embarking on a merger.
"Because not all affiliations, unfortunately, go very well."
Brock Slabach is a vice president at the rural health association. He’s watched as small hospitals have merged with larger systems around the country, and as some have undone those affiliations. He says it only works well if the two organizations are a good fit for each other.
"So those are things like what’s the style, how do you do business, how are decisions made within the organization? Because if you’re part of a system, you’re going to have to defer what you used to have as independence to a larger group, or to a larger system."
Slabach says it’s also essential to know beforehand how patients will be treated within the new structure.
"Are they going to be sent up to the motherhouse, if you will, and then they’ll never go back to the local facility for care anymore. Are they just going to, in other words, suck out the profitable services, and leave only a shell in the rural community, which isn’t viable long term."
Slabach says Clifton-Fine’s request for proposals sounds like a sensible way to find a good partner. Clifton-Fine CEO Robert Kimmes says they’ve heard of very informal partnerships, where the hospitals share some clinical services. And of others where the larger hospital purchases and takes over the smaller hospital.
"We’re not looking at either of those extremes. We’re going to fall somewhere in between. And at this point, we’re not sure what the affiliation or partnership is going to look like for us. We’re still working on that."
Kimmes expects Clifton-Fine to decide on its new partner by the end of the year. And it's around that same time Kimmes, himself will be leaving, and the hospital will need to hire a new CEO.