(Photo by Will Dendis)
The hospital scene in Kingston has been changing radically, more than most local people would have predicted but in line with national trends. Most dramatically, in just five years the number of locally controlled hospitals has shrunk from two to one and then to zero.
The era of hospital change is just beginning. With HealthAlliance of the Hudson Valley incorporated into the Westchester Medical Center Medical Network last March 31, after HAHV was awarded $88.8 million in state funding on March 4, the transformation of the local healthcare scene took a giant step. Other sources, including expected bank funding, will add to the state money in order to make the $132.6-million overall Kingston plan feasible. HAHV describes its status as “membership” in the ten-hospital system (hospitals in Valhalla, Poughkeepsie, Kingston, Margaretville, Port Jervis, Suffern and Warwick, with the Westchester tertiary-care “flagship” in Valhalla).
In terms of physical changes, what comes next in Kingston is the $112-million expansion and renovation of the former Benedictine Hospital, now HAHV’s Mary’s Avenue Campus, into a more advanced community hospital center. HAHV is currently discussing site-plan issues with Kingston city government and is seeking state health approvals.
According to an HAHV press release, the new, expanded HealthAlliance Hospital currently in development on Mary’s Avenue “…will provide technologically sophisticated surgical, diagnostic and therapeutic services for acute- and critical-care inpatients.” A new four-story, 110,000-square-foot tower will be built, and 70,000 square feet of hospital space will be renovated. Some 141 of the 201 beds at the newly configured hospital will be private.
The hospital’s emergency department will be larger than the current fairly recently constructed ED on Broadway. Its expanded capacity and new equipment “will offer an unprecedented level of readiness to care for a full range of emergency visits, currently at more than 45,000 a year.” The new emergency department will also have an enlarged fast-track walk-in care center.
“With a soaring lobby and cheerful, light-filled patient rooms, the new hospital will provide a welcoming and caring environment to advance the healing process,” Scarpino is quoted as saying. All current HealthAlliance services will remain available throughout the transformation. The current projection is that the work on Mary’s Avenue will be completed two years after approvals are received.
Almost by default, the healthcare sector has been the single most positive producer of new jobs in Ulster County. The number of paid Ulster County employees in healthcare and private social assistance increased in the 15 years ending in 2014 from 7636 to 9193. That 1557 jump is unmatched by any other local industry sector. Practically all other industries showed declines in employment in that 15-year period. In terms of new jobs, healthcare has been one of the two economic drivers in a less-than-robust economy. The other has been the commutation of Ulster County residents to jobs outside the county.
It is not the hospitals that have been creating new jobs. Hospital jobs numbered 1709 in 1999 and 1741 in 2014, according to the industry census for Ulster County. Jobs in several other healthcare categories were also flat. Employment in outpatient services and in doctors’ and dentists’ offices were pretty much unchanged in the same 15-year period. The growth in Ulster County healthcare jobs, in fact, was almost entirely due to employment in nursing homes and rehab facilities, which started with 1863 jobholders in 1999, increased to 2462 in 2004, dipped to 2297 in 2009, and soared to 3160 in 2014.
The most up-to-date estimates from the American Community Survey put the employed civilian population of Ulster County as declining from 89,787 persons in the 2006-2010 five-year period to 85,617 in 2011-2015. That loss in Ulster County jobs would have been even greater were it not for the positive performance of the health and non-governmental social services sector, which gained 1438 jobs (from 24,753 to 26,191) in the period. In other words, Ulster County would have lost 5608 jobs if not for this sector than the 4170 it actually lost.
Planning for the $20.6-million conversion of the former Kingston Hospital into “a medical village” will be happening simultaneously with the Mary’s Avenue hospital expansion, according to HAHV spokesperson Gerry Harrington.
If the Mary’s Avenue component of the plan is intended to create a right-sized community hospital, the Broadway part will define the relationship between the remainder of the local healthcare sector and that hospital. The medical village will be “a neighborhood focal point, providing advanced, easy access to the finest conventional and integrative health services,” a planning document says. “Plans are already well in the works for community partners to offer primary care, behavioral health and other support services.”
HealthAlliance will offer some outpatient facilities in the medical village, and “compatible retail shops will provide additional amenities.”
HealthAlliance CEO David Scarpino has promised that the investment in the two HAHV campuses will create a healthier community, improve the quality of services delivered to patients, and be an “economic driver” for the region.
Nationally, nearly half of total projected job growth in the next decade will be in professional and business services or in healthcare and social assistance. About two-thirds of that, approximately a half-million new jobs a year, will be in health care, where cost pressures, an aging population and technological change will combine to shift costs from inpatient facilities and hospitals to other types of care. Some hospitals in the sector will continue to play a central role. Others will not.
For most of Ulster County, the die is cast. A direction has been chosen. As the new Mary’s Avenue facility takes shape and the medical-village concept for HAHV’s Broadway campus slowly evolves, the outcome of the choices made will become more clear.
The same thing is happening with smaller practices. Local doctors no longer control their accounting and the practice of balance billing is much more widespread. It’s a shame, really. The insurance companies’ billing runarounds are to blame for driving doctors to sell out and the insurance companies are also benefiting while we suffer. Doctors who went into healthcare to help people find it difficult to navigate insurance billing rigamarole so they sell to corporate interests who care more about money.