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Dr. John Rugge, founder od the Hudson Headwaters Health Network, is a vice co-chair of the North Country Health Systems Redesign Commission. Photo: Brian Mann
Dr. John Rugge, founder od the Hudson Headwaters Health Network, is a vice co-chair of the North Country Health Systems Redesign Commission. Photo: Brian Mann

Full work-up ordered for North Country health care

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The interlocking puzzle of the health care system across the North Country will get a thorough going-over in the next three months or so.

The North Country Health Systems Redesign Commission, announced this week by state Health Commissioner Dr. Nariv Shah, has a big job: improve preventive, medical, behavioral and long-term care from Glens Falls to Plattsburgh to Watertown.

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Reported by

Martha Foley
News and Public Affairs Director

The commission is supposed to provide recommendations for restructuring and capitalization. It’s also supposed to identify merger and partnership possibilities, and funding.

And the findings are due March 31.

Its 18 members include a broad cross section of health care experts, business and community leaders, elected officials and patients.

Dr. John Rugge is one of two vice co-chairs. He’s CEO of Hudson Headwaters Health Network, based in Queensbury. He’s also a member of the New York health planning council. He’s been involved in health care planning at the state level since the 1980s.

Speaking in depth with Martha Foley, he says the “intensely rural” region’s health care system is in crisis. A shortage of physicians and other primary care practitioners, and fragmented, widely dispersed services are working against the region in a time of rapid change.

Dr. John Rugge: I guess if you start with the coming of a crisis in health care – yes! It’s been a while, but I think the realization has been, over the last several months, that a number of forces are converging to create increasing pressure on health care providers, and a few of them on patients across the Adirondacks and the surrounding territory.

Martha Foley: Is the North Country system in some sort of crisis?

JR: Well, yeah. That’s a pretty good word for it. I think everywhere across the nation, health providers of various kinds are destabilized by the pace of change. And we feel it even more severely, in part because our population is more dispersed, and therefore there are associated expenses that are difficult to control. That much of health care is moving toward bigger and bigger institutions to achieve economies of scale, which is simply impossible in a rural area – one might say, densely rural.  Really, really rural.

And on top of that, there’s another curious reason for some instability. And that was, there was a recognition, some four or five years ago, that primary care was especially in crisis, and therefore with a lot of support from the Department of Health, and a lot of support from all the payers, there’s been a primary care Medical Home Pilot, trying to make primary care more robust, and therefore more effective. There are fewer ER visits, fewer hospital admissions, fewer readmissions to hospitals, that are already really on the margin of financial viability.

MF: So you’re building on that success? Is that the idea?

JR:  Well, I think one of the lessons is if you try to fix one part of the health care system, it can lead to destabilizing other parts as an unintended consequence. And the realization now by Dr. Shah as health commissioner that it’s time for a total look at the system.

MF: One of our local hospital heads predicted that unless the string of hospitals to, say, Plattsburgh to Watertown, cooperates more fully, or consolidates in some way, they’ll all suffer financial distress in the next few years. He said the business model doesn’t work for so many small, separate hospitals anymore. But the string of facilities across that geography is really essential. So how will the commission address that head on? Or is that your job?

JR: That’s the job. But that’s only part of the job. Another part is, we’re seeing exactly the same phenomenon  among nursing homes. Dispersed facilities that are geographically separated, yet small in scale. Overwhelmingly dependent on Medicaid, and therefore not having the reimbursement base necessary to survive. So, again it’s not any one part of the system that’s in trouble. We need to rethink how care is being given across the whole care spectrum, and across the entire North Country.

MF: So, do you have in your mind some picture of how this could come together? I have to say, it’s a huge task, and your findings are due March 31, so I’m wondering if there’s some sort of head start that’s already been made.

JR: Well, I’m sure that staff in Albany have been working at putting the data together. None of us has seen that yet – at least I’ve not seen it. So clearly we have sector-by-sector experience. I mean, we think that the Medical Home Pilot has been very effective in primary care. And yet that pilot legislation expires at the end of 2014.

So on the primary care side we need to find a way to expand and build upon experience of the last five years. And the acute care side, you’ve described very nicely the problem. And there is no – I don’t think there is any one magic bullet solution. But this commission is a group that is deeply involved in the community, with experience across all sectors.

I can’t believe that we’re going to have a fully developed set of refined recommendations as early as the end of March. The idea is to have an outline of an approach as soon as possible, and then work through the refinements.

MF: So what do you think this will mean for the people who live, who are served by this North Country health care system?

JR: If we do our job, it’s going to be more secure health care in the future. I’m not sure that everybody on the street or in the woods has a very clear sense of where medical practices are sitting right now, or how hospitals are doing, or the stresses that nursing homes are experiencing. But those are all very real, and this is a group gathered together for their broad perspective – different kinds of expertise –  to bring the best information available, to find the best solutions.  

Read Martha's Inbox post on the North Country health care system, and hear the uncut version of her conversation with John Rugge here.

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