There was a lighter crowd at Wednesday's public meeting on the Stroudwater report at MCLA but a number of people continued to object the idea a full-service hospital wasn't viable.
NORTH ADAMS, Mass. — Berkshire Medical Center may consider seeking Critical Access designation for the former North Adams Regional Hospital with the help of the state Department of Public Health.
The federal designation, which allows for higher reimbursement rates from Medicare, is pointed out as a priority for the return of inpatient services in the just-released assessment report on the community's health-care needs.
"The primary question is whether it's possible and sustainable to have limited inpatient services," said John Rogers, vice president and general counsel of Berkshire Health Systems, BMC's parent corporation. "The Critical Care Access is kind of the linchpin in that without that, there really is no effective source of funding that would keep an inpatient unit open."
Rogers spoke after a second community meeting on Wednesday morning (the first was Tuesday night) at the Massachusetts College of Liberal Arts' Church Street Center to review the study by Stroudwater Associates. Commissioned by the State Office of Rural Health, the report focused on current and future trends in health care, health and wellness in the Northern Berkshire.
The study was prompted by the abrupt closure of NARH and the collapse of Northern Berkshire Healthcare in March. Berkshire Medical Center, based in Pittsfield, was able to step into the void to open an emergency satellite facility in the hospital and has, since, completed a purchase of NBH's assets through U.S. Bankruptcy Court.
Residents have pinned their hopes on restoring the hospital to full service but the Stroudwater report's numbers argue for more outpatient and diagnostic services — and adding about 18-21 hospital beds only if the CA can be realized.
Several people at the meetings have sharply questioned the data used in the report, and wondered why other financial factors in the hospital's demise were not mentioned. Brian Haapala, a managing director at Stroudwater, has said the consulting firm was asked to look forward and focus on the health care market.
The Massachusetts Nurses Association, which is developing a further response, said the data shows the hospital could be profitable. It points to a need for emergency surgery and inpatient care based on the nearly 40,000 ER visits over two years to NARH, nearly a quarter of which were high severity.
"North Adams Regional Hospital was a facility laden with crippling debt and constantly on the losing end of competition with BMC for physician practices, specialists and procedure volume," MNA's initial analysis states. "The Stroudwater report makes no mention of the North Adams' hospital's new membership in Berkshire Health Systems, focusing instead on these historical challenges, which no longer exist."
Carl McKinney, Clarksburg town administrator and a former accountant at NARH, ticked off a list of billing practices and administrative decisions that he says took a large chunk out of the hospital's potential profits, including "resume dressers" who commanded high salaries and left the health system bankrupt.
"We have lost our churches, we have lost our newspaper, we do not want to lose our hospital," said McKinney, arguing a full-service hospital could be profitable.
Haapala said Stroudwater stood by the report and that its recommendations were consistent with the health-care interests the community had expressed
"In our assessment we tried to really bring those ideas forward and connect them with some of the statistics and trends in the industry to provide our recommendations," he said.
1199SEIU, which represents health-care workers at BMC and the former NARH, said it was "encouraged" that the report and Department of Public Health recognized the need for a range of health-care services and for a Critical Access hospital.
Getting that designation, however, is not expected to be easy and is likely to take some time. Rogers said health care officials will consider its strategy before making any determination. The hospital was denied CA designation in 2011 because it was deemed too close Berkshire Medical Center when federal reviewers used Route 7, rather than the more commonly used Route 8, to determine if it met the 35-mile cut off.
BHS' Fairview Hospital in Great Barrington achieved Critical Access nearly a decade ago, but Rogers said the "rules have tightened up since then."
"We did then marshal the kind of community support that we needed for approval," he said. "We'll do that again here."
The 20-bed Fairview employs about 250, a number that would likely be similar in North Adams should it get the designation.
In the meantime, BMC is planning to broaden outpatient and diagnostic services at what is being called BMC North, including waiting on federal licensing for mammography. Rogers said he expected announcements on the services in the near term but was not ready to comment on them at this time.
Health and Human Services Secretary John Polanowicz said the Department of Public Health would work with BMC and other state and federal officials toward the CA designation.
"We now have a template for Berkshire Health Systems, and the state, along with support from the Legislature to develop what really is a sustainable health-care system for Northern Berkshire County," said Polanowicz.
DPH's 15 agencies would also see where it could help fund areas of health needs, he said, such as prenatal, behavioral or substance abuse services.
But "Version 2.0" of health care in North Berkshire will have to come from the community using the report as a guide.
"We need to change our narrative. Our narrative is someone is right and someone is wrong. We have to look at it as a lot of gray area in between. I think what you presented makes a lot of sense to me, I think what the speakers are saying make a lot of sense to me," Alan Bashevkin, executive director of Northern Berkshire Community Coalition, said.
"I know somewhere in between there is a lot of sense and lot of things that we might do. Our narrative impedes us from sitting at the table together and making plans and talking about what this community needs."
The Wednesday morning public session was also recorded for broadcast on Northern Berkshire Community Television.
Correction: The article originally stated as fact that BMC would pursue Critical Access designation. Rather, the health system is considering its options before determining whether to apply for the designation. iBerkshires regrets the error.
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If the "Critical Access" designation is dependent upon a 35-mile distance from BMC in Pittsfield, it doesn't matter if Route 7 or 8 is used -- we are closer than 35 miles.
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There was a lighter crowd at Wednesday's public meeting on the Stroudwater report at MCLA but a number of people continued to object the idea a full-service hospital wasn't viable.
