When asked to discuss 2013, Eastern Long Island Hospital CEO Paul Connor had plenty to say. After all, the year included a bunch of new additions to the North Fork’s health care system.
But those changes mean the conversation must also focus on what lies ahead.
We sat down with Mr. Connor to review the changes the hospital expects in dealing with health care reform, the upcoming expansion of its surgery program and look back on the year that was.
Q: What exciting changes or advancements has the hospital realized this past year?
A: We have some physician additions we are excited about. For us, being a small hospital, the recruitment of primary care physicians and sub-specialists is very, very important and also very challenging. So that’s a big deal for us to have these physicians join our staff this year.
We are pleased to introduce Dr. John Cosgrove, general surgeon extraordinaire, to our community. Someone who has been in academic medicine for many years but also did 200 cases a year on a regular basis, he was chairman of Bronx-Lebanon Hospital Center’s Department of Surgery and their surgical [teaching] program.
We have a new primary care physician we’re also excited about — Dr. Yuliya Vinnitskaya, an internist and a woman, which is terrific because there is only one other female internist on the North Fork. So introducing another out here, I think is a real benefit. She will be working with Dr. Lloyd Simon, who has been here at least 30 years, at the Southold-based office.
Also, Dr. Mark Creighton, an orthopedist, the first to join us in 12 or 13 years. Dr. Creighton lives on the North Fork, in Laurel, I believe. His offices are in Hampton Bays and East Hampton.
Q: Shortages in primary care have been reported nationwide. Do you believe that trend is affecting North Fork residents? If so, how?
A: The doctors are always busy. I speak to the doctors and they are getting new patients, and all the primary physicians’ offices really have a very full panel — so the addition of primary care out here is desirable. Plus, I think if you follow the number of primary care physicians who historically have served the North Fork, we’ve lost about eight over the past seven years and we’ve added about three. And I’m talking about the doctors serving the 23,000 or so people on the North Fork, so there is a need for primary care.
If you look at the demographic out here, we have the oldest population per capita in the State of New York. At least 25 percent are 65 and older and if you compare that to the rest of Suffolk County, which is 13 or 14 percent, we are a whole order of magnitude older. Medicare folks have a higher utilization of health care services than the general population, so you’re going to have a greater demand for health care.
So access to primary care is very important to a healthier population. That’s one of the reasons we brought in Dr. Vinnitskaya, to be able to address that need, and the other, of course, is that many women prefer a female physician and we hope that begins to address that need.
Q: What concerns you most regarding dealing with the implementation of health care reform come January?
A: The combination of the Affordable Care Act with a sluggish economy has driven down utilization of hospital resources. And we see across Long Island, a consistent reduction in [hospital] inpatient volume and, for the first time we also have outpatient volumes trending down. This is in almost every one of the 23 hospitals — there are maybe three or four hospitals that have flat or positive volumes.
The vast majority of hospitals are feeling this locally.
So we have the economy and features of the Affordable Care Act, which are combining to reduce utilization. Mechanisms featured in the Affordable Care Act are designed to reduce inpatient and emergency room utilization and designed to promote outpatient care, like in physicians’ offices or urgent centers or any other outpatient modality — so hospitals are now looking for other ways to be able to meet the needs of the population.
Q: How is the Affordable Care Act changing the health care system?
A: The Affordable Care Act is looking to have providers of health care, the hospitals and physicians, be able to manage risk. It’s not a bad idea if managed correctly, because who controls the pathway of the patient? The doctor, through the stroke on the computer, because we have electronic health records, they give the patient a directive of what to do about their health care — get a test, an X-ray, go see a specialist. So physicians control where the patient goes.
The hospital is there to meet the needs of the patient through the physician directive. If we understand how to accept and manage risk, especially the physicians, then it’s a good idea to manage risk. It’s complicated because it’s turning the system on its head in that historically you don’t have many success stories where providers have accepted risk.
We are also moving from a volume-based system that has paid for every transaction. Now the government wants to pay for outcomes, and they will do this through a mechanism called value based purchasing. For hospitals it is a measurement of how well that hospital meets the standard of care but that measurement also includes a patient’s perception of their care.
This year hospitals are taking 2 percent of Medicare revenue and putting it in a pool. Medicare for us is 40 percent of our revenue. So now I’m taking that 2 percent, I put at risk that 2 percent, and the value based purchasing will decide how much of that 2 percent will come back to me. It gets to be very challenging. We are competing with hospitals nationally on ability to meet standards of care and, for some reason, patients in the Northeast are more critical about their perception of care … It is a subjective measurement.
Q: What are some of the major health care needs of the community?
A: All hospitals, as a part of the Affordable Care Act and through New York State, were required to complete a Comprehensive Community Health Needs Assessment this year. We needed to identify some of the major issues out here we can respond to as hospitals. We’ve identified chronic illness and two specifically — obesity and type-2 diabetes.
We’ve started a lifestyle coaching program. The participants are not diabetics but they are at risk to be diabetic and at risk to be obese. If this proves to be worthwhile, we will promote it and expand it. It’s a free service.
Q: Is it hard to attract physicians to this area?
A: Urban areas and rural areas are hard to get physicians to come to. We’re on the cusp of rural. Were not considered rural, but we have sort of all the disadvantage of what a rural hospital has — especially recruiting a workforce. It is difficult to attract physicians out here. Look at the land values out here, the geography. Time and distance are the enemy of the physician, and you also have seasonality.
The summer is a boom and then folks go away, so you have these features here that make it difficult to sustain an ongoing practice. Especially for sub-specialists. It’s hard. The doctors are all racing to the hospitals for employment because private practitioners are finding it more and more difficult to sustain an independent practice.