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Canton-Potsdam Hospital CEO David Acker. Photo: Martha Foley
Canton-Potsdam Hospital CEO David Acker. Photo: Martha Foley

Why there will be fewer hospitals in the North Country

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In the latest installment in our series of health care conversations, David Acker. Acker has been president and CEO of Canton Potsdam Hospital for six years.

The hospital has 94 beds, admits about 5,000 patients a year, treats 26,000 people a year at its emergency room, and employs 930 people.

The last two numbers, staff and ER visits, are trending up. And the hospital is soon to open a new urgent care center to meet the rising need for primary care.

Canton Potsdam Hospital is one of a series of smaller hospitals stringing east to west between Plattsburgh to Watertown.

Acker says it's a network that's at a tipping point. There's just not enough money to go around. And he says these smaller hospitals will soon have to collaborate and consolidate care, or they won't survive.

These hospitals now rely on affiliations with large teaching hospitals in Syracuse and Burlington Vermont. Acker says those relationships will become "more meaningful and deeper as time goes on."

So what do the little hospitals need from the bigger medical centers? Acker says a lot of it comes down to money.

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David Acker: What community hospitals really are looking for from large system partners…they are looking for access to capital. Secondly, they're looking for assistance with physician recruitment. Thirdly, you are looking for expertise and bandwidth in managing an increasingly complex set of back room functionalities.

Martha Foley: Does that show up in the access to care in this region and the quality of care that people can count on here?

DA: In order to be competitive in today's market it's imperative that you keep ahead of the technology curve, that you provide not only the most modern equipment, the most state-of-the-art electronic medical records, and the physical space to allow for the care to be delivered. That's a product of the ability to invest capital. So, you see an intersection of quality and financial performance. And in order to perform well financially, you have to have the capital in which to do that, so on that level, yes.

MF: Last fall, you said on our air, that within five years you predicted there would be fewer independent hospitals in St. Lawrence County. Is that still the case, do you still think that?

DA: I absolutely think that there will be fewer independent hospitals in St. Lawrence County.

MF: Is the operative word there independent? And how is that going to sort out? Who goes and who stays?

DA: Well, I think there's going to be, not only fewer independent, but I would guess that there'll be fewer hospitals.

MF: When you say hospital, what do you mean?

DA: I think a hospital is primarily differentiated by the presence of inpatient acute care beds. If you look at the county in its entirety, we have in excess of twice as many beds as we need. That excess capacity carries with it tremendous cost. And I've always seen that the future of the care that's going to be available and the quality of the care that's going to be available to the residents of this county, being intregrally linked with the consolidation of the hospitals within this county into a singular unit.

MF: What would that singular unit look like and what would be left. I'm running in my mind, through the hospitals in St. Lawrence County and I'm trying to think, okay what's he talking about? What's the center here?

DA: What I'm talking about is a consolidated health care system that serves the112,000 people that live in this county. It's something that would be governed by proportional representation from each of the areas of the county. This would not be any singular hospital taking over anything. I think for political reasons it's going to require new management that's not currently in any one of the hospitals. And over time you would start to see the centralization, at some point that's geographically central to the county, of services.

If you think about the North Country, from lake to lake it's 200 miles. There's 400,000 people in the North Country. It's served by 13 hospitals. And if you look at the county by county breakdown, Jefferson County's got 120,000 people. They have one really large sized town, by North Country standards, and that's Watertown. Clinton County has about 90,000 people. They have one large town and that's Plattsburgh. And St. Lawrence County has 112,000 people. And just by the product of history of 100 years ago, there were five relatively similarly sized towns in Gouverneur, Canton, Potsdam, Massena, and Ogdensburg.

MF: And they all have a hospital.

DA: And they all have a hospital. Now that doesn't mean that those 112,000 people don't need that same level of size and breadth of services. And the distance is too far to suggest that either driving to Watertown or Plattsburgh is a reasonable alternative for this population. So there has to be a pillar in the middle. And frankly, the heart of the North Country, the central part of the North Country's economy, lies in the four colleges. And without good, solid healthcare to support this county, those colleges are just not going to be able to continue to thrive.

MF: So, people obviously are concerned about their own health care. Everybody has their issues. I think we're used to a pretty good level of care and a pretty good level of access in the North Country. Do you see that getting better or trending down, as far as patients are concerned?

DA: You know, I think in many ways we're at a tipping point, as I mentioned earlier. There is a direct correlation between financial performance and quality performance; because when you start to lose money and you can't open the newspapers in a week in the North Country without seeing something about layoffs or significant losses on individual hospitals' income statements.

When you start to see those trends and they are all over the North Country, you know that decisions are being made to either forestall hiring people that you need, buying technology that you need to keep up, or in actually, laying off people that you desperately need to ensure that that care is given. And as far as recruitment goes, one of the biggest concerns of providers, especially physicians who are coming to an area, is, is the hospital financially stable? And so, if the hospital is in financial distress, that makes the very difficult job of recruitment, doubly difficult.

MF: Is Canton-Potsdam Hospital in the black?

DA: Canton-Potsdam Hospital is in the black. We've been in the black every year, for the past six years. We're in the black this year, we contemplate being in the black going forward. But you know, New York is 49th in the nation in terms of acute care hospital profitability, so we will not defy gravity forever.

And so, my concern is, that as you saw in Gouverneur, where they ran into such financial distress that they were in need of the state to come in and infuse capital in order to give them a chance to turn it around. My concern is that we'll see other hospitals going over that same cliff. And we can project which ones will go first or last, but eventually we're all going to go that same way unless something significant changes. And my strongest hope would be that the parochialism that thus far has prevented the hospitals from collectively getting together and saying "how can we do something together that will improve our ability to continue to provide good quality care with good access?" can move forward.

Listen to Martha's conversation with David Acker.

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