SARANAC LAKE - Adirondack Health administrators and doctors spoke openly for the first time Thursday about their plan to convert the 24-hour-a-day emergency department at Adirondack Medical Center-Lake Placid into a 12-hour urgent care clinic.

During a 90-minute interview with the Enterprise, Adirondack Health President and CEO Chandler Ralph, Chief Medical Officer Dr. John Broderick and Emergency Department Medical Director Dr. Anthony Dowidowicz said the proposal makes sense from both a medical and a financial standpoint.

They said their Lake Placid ER doesn't have CT scan machines and other modern medical technology, and that most seriously ill patients already bypass it and are taken to the more state-of-the-art emergency department 10 miles away at AMC-Saranac Lake. They also say the low volume of patients at the Lake Placid ER doesn't justify keeping it open around the clock, and that converting it to an urgent care facility would still provide a valuable service to the community while saving the hospital an estimated $1 million.

Dr. John Broderick, right, Adirondack Healths chief medical officer, talks about the proposed conversion of the Adirondack Medical Center-Lake Placid emergency room to an urgent care center Thursday at AMC-Saranac Lake as the organizations communications director, Joe Riccio, listens. (Enterprise photo Chris Knight)

Dowidowicz said health care reform is pushing organizations like Adirondack Health to use its resources more efficiently.

"There are a lot of silos in medicine that are these hard and concrete structures that people cling onto that really don't fit with change," he said. "A lot of people don't want to give up what they've held onto for a long time. In order to survive in the future with the way things are going, you need to adapt."

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Visits to the emergency room at AMC-Lake Placid

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Health care in transition

Back in 1979, when the belief that government could and should beneficially control the prices of goods and services was popular, New Hampshire passed a Certificate of Need (CON) law. It forbade hospitals and other health care providers from buying expensive new equipment, or offering certain new services, without prior state approval.

The law "promotes rational allocation of health care resources in the state," it stated. Rational allocation. By the state. Let that sink in.

The next year, Jimmy Carter was defeated in a landslide, and in the years that have followed the public and policymakers have learned a great deal about economics and price controls. Here is what some of the official U.S. government studies have found.

A 1988 Federal Trade Commission study "finds that hospital costs are not lower in states that subject a larger proportion of proposed hospital expenditures to CON review. The study thus finds no evidence that CON programs have led to the resource savings they were designed to promote but rather indicates that reliance on CON review may raise hospital costs."

In 2004, the FTC and the U.S. Department of Justice revisited the CON issue. "The Agencies believe that, on balance, CON programs are not successful in containing health care costs, and that they pose serious anti-competitive risks that usually outweigh their purported economic benefits," the report concluded. "Market incumbents can too easily use CON procedures to forestall competitors from entering an incumbent's market."

(The 2004 study and several others are summarized nicely in a report issued last year by the Josiah Bartlett Center.)

Educated by such research, New Hampshire legislators voted in the last session to repeal the state's CON law. Incredibly, the state House of Representatives voted on Wednesday to reinstate the law before the positive effects of its repeal could be felt.

Why would New Hampshire, having just abolished a law that restricts the supply and increases the cost of health care services, bring it back? There are only two possible reasons. One, large hospitals, which benefit from the higher prices and reduced competition CON laws generate, have pressured politicians to revive the law. Or two, politicians don't want to give up the power CON laws give the state.

The CON law revival was part of the House budget. The Senate should strike that part and make clear that it will not find its way into any committee of conference report.

Read more from the original source:

CONned again Raising NH health care prices

Wayne Allen

PDT Staff Writer

On Thursday, the group Advocates for Ohios Future released a fact sheet showing the potential impact of extending health care coverage in the state budget, if approved by legislators.

The fact sheet states, Scioto Countys economy is stronger when everyone can participate in the economy. Healthy children become productive citizens, healthy citizens build strong communities, and health workers strengthen Ohios economy. If Ohio extends health coverage in the state budget 3,766 Scioto County uninsured 19-64 year olds are projected to gain health coverage by 2015.

According to 2010 figures the group estimated there are 5,422 eligible uninsured adults in Scioto County.

The fact sheet states that if Ohio extends its medicaid coverage, by 2015, only two percent of Scioto County would remain uninsured. Based on 2010 figures that would represent a 69 percent decrease.

In February the the Scioto County Health Coalition unanimously voted to endorse Gov. Kasichs plan to expand Medicaid in Ohio.

Kasich released his plan with this proposal for a $63.3 billion 2014-2015 state budget.

Kasichs plan would expand Medicaid eligibility to Ohioans earning up to 138 percent of federal poverty level (about $15,400 per person). But the extension comes with a condition: If the federal government fails to cover the bulk of the costs, as it has promised, the state will reverse course.

For a number of years weve lived with the reality that some of the unhealthiest folks in our community are unable to access health care services because they are uninsured. The Medicaid expansion will create a pathway for them to be able to access what we think is a very well developed system in our community, between primary care, hospitals and clinics that are available, Ed Hughes of Compass Community Health said. There is likely 20 percent of our citizens that can not access the services we have and this Medicaid expansion will create that opportunity.

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Group says health care expansion positive for Scioto County

Shainah Hughes knows shell find a job and support her family when she graduates.

Job security is one of the big reasons the 29-year-old student at Western Technical College is pursuing a degree in electronics and computer engineering.

When I graduate, theres going to be a need for that, Hughes said.

Health care, accounting and technology are big draws for grads who want to live locally, but college officials agree theres no hard and fast trend.

Job security is huge for todays graduates, said Beth Dolder-Zieke, director of career services at Viterbo University.

Many started college on the eve of the recession.

They heard you go to college, you do really well, get a job, Dolder-Zieke said. And then they go to college, and for those of them who were aware of what was going on, it was very discouraging.

College grads have high expectations from their first job. Nationally, they expect a salary approaching $50,000 and want opportunities for future growth, Dolder-Zieke said.

For that, many are looking to health care.

More than 160 students graduated from Viterbos un-dergraduate nursing and nursing-completion programs last year. Western, UW-L, Winona State University and Minnesota State College-Southeast Technical in Winona all offer degrees in health care, too.

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Health care , accounting, tech are hottest fields for Coulee Region graduates