image description — The 'Tuesday night group' that has been meeting since North Adams Regional Hospital closed formed as North County Cares Coalition.

North County Coalition Lays on Reasoning for Full-Service Hospital

By Tammy DanielsiBerkshires Staff
10:40PM / Wednesday, February 11, 2015Print Story | Email Story

Residents rally at City Hall to advocate for restoration of inpatient services.

NORTH ADAMS, Mass. — A dogged group of community members gathered in the frigid cold on Wednesday evening to lay out their reasoning for restoring inpatient services in North Berkshire.

Armed with more research from the Massachusetts Nurses Association, the newly named North County Cares Coalition said it had the data to prove an 18-20 bed hospital would be sustainable.

"It really heartens us and gives us more incentive to keep at this," James Lipa told the more than 70 community members and elected officials shivering in the City Hall parking lot. "We're not going away, we're not going to stop, we're here until we meet our goal and that is providing inpatient services back at North Adams hospital."

Berkshire Medical Center purchased the former NARH property through U.S. Bankruptcy Court in August, established an emergency satellite facility and began restoring outpatient services. It also has invested about $13 million in upgrades, hired about 250 NBH employees and is making plans for more wellness and supportive services.

The reopening of inpatient beds, however, remains uncertain; BMC officials say it may depend on the facility's ability to obtain a federal designation to boost Medicare reimbursements. The coalition, meanwhile, has been advocating for the restoration of services and, if not a full hospital as NARH had been, at least a smaller facility on par with BMC's Fairview Hospital in Great Barrington.

"The costs of providing inpatient care to the residents of the Northern Berkshires are not unmanageable, especially given how profitable Berkshire Health System's facilities — BMC and Fairview — have been," writes Nykole Roche, a strategic researcher for the MNA, in her report, summing up that "all evidence points to a sustainable community hospital, and the Stroudwater report and community input are indisputable: inpatient services are needed in North County."

Roche said she'd undertaken a "comprehensive and ongoing review of the causes that led to the hospital's closure, health care needs in North County and also the financial viability of a full-service BMC North."

The study builds on previous conclusions made in a report released last year: that the financial problems of Northern Berkshire Healthcare were exacerbated by excessive debt, that the hospital itself was profitable and that patient volume, especially for maternity, was viable.

The closure has, in fact, helped the bottom line for Southern Vermont Medical Center in Bennington. In its budget summary for 2015, Roche quotes "the volumes which we have seen as a result of the closure [have] assisted in SVMC's positive financial performance in FY 2014 and FY 2015 budget development."

In this newest review, the Roche says the data continues to point to profitability since some of the arguments used in the state-commissioned Stroudwater & Associates report — that NARH had lower reimbursements and difficulty recruiting and retaining physicians — have been negated now that the hospital is the Northern Berkshire Campus of BMC.

"Stroudwater forgets that BMC North is not North Adams Regional Hospital but a campus of BMC so that problem doesn't exist anymore and more doctors who work for BMC can just as easily see their patients in North Adams or North County.

"... Stroudwater suggests that transportation to Pittsfield from North county is not too much of a burden for critically ill patients; surely BMC physicians can make the trip in reverse to treat patients."

The report also states nearly 100 more babies were born in North Adams than at Fairview in each of four recent years, yet Stroudwater recommends against reopening a birthing center in North Adams while the more affluent Fairview has one. That, Roche suggests, may be reflective of the higher private insurance coverage in South County.

In a statement sent prior to the rally, Berkshire Health Systems spokesman Michael Leary said health-system officials had not seen a copy of the MNA report but were aware it supported the view of a viable "full-service" hospital in North Adams.

Nykole Roche explains her findings that conclude a full-service hospital is sustainable in North County.

"The MNA report apparently contradicts the findings of Stroudwater & Associates, the nationally recognized health-care planning firm commissioned by the state to identify the health-care service needs of Northern Berkshire County and sustainable ways of meeting those needs. In contrast to the MNA researchers, Stroudwater concluded that a 'full service' hospital was not feasible, especially given the pressures creating a downward trend in hospital reimbursement and utilization.

"Stroudwater's concern about the immediate future of hospital reimbursement and utilization is supported by recent announcements at the federal and state level. The president's proposed budget and congressional proposals all forecast significant reductions in Medicare reimbursement to hospitals; the state and commercial insurers have echoed those plans to reduce in-hospital care in favor of more comprehensive outpatient and preventative services. The government has also stated a desire that in the next 2 to 4 years at least 50 percent of payments to health providers (especially including hospitals) be converted to payment systems that discourage in-hospital stays and encourage alternative systems of care."

But debating financial data and federal actions hasn't dimmed the hopes that beds will again be available in North Berkshire. For the 37,000 residents here and across the Vermont border, the 40- to 60-minute trip to Pittsfield can range from merely an inconvenience to a potentially life-threatening trek.

Shirley Davis blinked back tears when telling of a good friend whose critically ill fiance had to be taken by ambulance to Berkshire Medical Center on Saturday, a week before their wedding.

"She had to stay sitting up in a chair all night because she didn't drive and there were no buses running," Davis said, convinced that her friend's stress would have been reduced and the fiance's outcome better if they'd been able to stay in North Adams.

"The services that they're bringing here are great. But if they're talking about regional health care ... we can't have a region this big and have services this big," said Deb Lipa, stretching her arms out and then bringing her hands in.

A number of towns have passed resolutions supporting a full-service hospital and the North Adams City Council, at the group's request, formally invited health system representatives to attend on of the coalition's weekly meetings. So far, there has been no response.

James Lipa said the goal wasn't just to get the hospital reopened but to get BMC to join in a conversation with the community — something the Stroudwater report was supposed to facilitate.

"We want BMC to become an active member of the community ... there's been no dialogue," he said. "We just want to have open communication. They have yet to respond to a request for that meeting. ... Our communities deserve access to much-needed services."

After the gathering, Lipa and others were thanked for their commitment now going on a year.

"As a citizen of North Adams, thank you from the bottom of my heart for your efforts to restore North Adams Regional or BMC North to some more services here in North Adams, which are greatly needed," said Deacon Bruce Ziter in offering a closing prayer.