MVHS CEO addresses Wynn Hospital concerns

UTICA — The Wynn Hospital has been making news — not all of it good — since it was just an idea, and not much has changed since the hospital opened its doors last October. Recently, MVHS made a series of announcements that once again sparked public interest and criticism in some cases. On May 8, the health system announced a temporary pause in open-heart surgeries at Wynn Hospital amid concerns expressed by the New York State Department of Health. MVHS then announced on June 5 that its Adult Day Health Care Program would close, effective June 7. On the heels of that, it announced its Senior Network Health plan would transition to another provider. MVHS President/CEO Darlene Stromstad recently spoke with The Central New York Business Journal about all these announcements and more. Talking about the Adult Day Health Care Program first, Stromstad said the decision to close the program was a business evaluation, based on declining interest in the program as well as ongoing staffing issues. “We had a fairly strong program for many years pre-pandemic,” she says. That changed after the program was shuttered for several years during the height of the pandemic. “We reopened it, but the volumes never came back, and we were never able to find the volume of staff we needed,” Stromstad says. It wasn’t feasible to keep the program going with such a low volume of participation, she adds. “We felt it was a decision we need to make.” MVHS worked with participants to help them find new programs, and was able to move staff from that program to other areas. The transfer of Senior Network Health, a managed long-term care plan (MLTC) has been in the works for several years and was the result of provisions enacted in the 2023-2024 state budget that requires all MLTCs to have a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) with three or more stars, As a small organization, MVHS’s Senior Network Health didn’t meet the criteria and was faced with the choice of either folding the program or finding a qualifying organization that could take it over, Stromstad explains. “This is simply the state requiring that organizations our size do not continue to offer programs like this,” she says. While other MLTCs in the same position decided to close up shop, Stromstad says MVHS didn’t want to do that and found a partner in VNS Health, which operates the largest MLTC in the state. The transition from MVHS to VNS Health, which was supposed to happen at the end of 2023 but got held up by the state, has gone smoothly, with employees keeping their positions with the new organization and as little disruption to clients as possible, Stromstad notes. As for open-heart surgeries and the cardiac program at Wynn Hospital, Stromstad wants to make one thing clear. “The state did not shut down our cardiac surgery program,” she says. “The decision was ours to shut down the program.” It wasn’t an easy choice, especially when MVHS — as are many other health-care organizations — is facing financial challenges now that federal pandemic aid has dried up, but “we recognized we had issues,” Stromstad says. “We recognized this was going to be a reputational blow,” she says, as well as a financial one. MVHS was issued an immediate jeopardy notification regarding the cardiac program. According to Cadence Acquaviva, a public information officer with the state Department of Health, immediate jeopardy is a term used by the Centers for Medicare and Medicaid Services to describe a situation in which a provider’s noncompliance with one or more requirements of participation has caused or is likely to cause serious injury, harm, impairment, or death to a resident or patent. Once it receives an immediate jeopardy notification, a health-care provider is required to submit an acceptable plan to remove the immediate jeopardy, Acquaviva said in an email. The immediate jeopardy is removed when surveyors verify the approved plan has been fully implemented. Prior to halting the program, MVHS had performed 299 open-heart surgeries in 2023 and wanted to improve the program, Stromstad says. It had two surgeons heading up the program, and MVHS was considering adding a third to round things out — as a surgeon must be available 24/7 for surgeries to take place. Health care is a team sport, she says, and personality conflicts can be an issue. “We had some issues, and we’re working those out.” In the meantime, while declining to go into detail, Stromstad confirms that MVHS now has just one cardiac surgeon, and that wasn’t enough to safely continue the program. MVHS could have brought in locum doctors — essentially outside travel physicians —but didn’t want to put the program in the hands of people it didn’t know, she says. Since halting the open-heart surgery program, MVHS is working with an outside organization to conduct a complete comprehensive review of the program and has a board committee overseeing the process. The health system is actively working on a permanent solution that would involve adding cardiac surgeons to its roster. In the meantime, three structural heart surgical procedures have resumed at Wynn Hospital. MVHS expects the review to wrap up by the end of this month, with it taking several more months before the program is completely restarted. Finally, going forward, Stromstad says the open-heart surgery program will have an external review every two years, “so I have outside eyes.” For those opposed to the hospital, including a group called No Hospital Downtown, the recent news has sparked new criticism of Wynn Hospital. “They have amped up their vitriol,” Stromstad notes. “It feels like we are in a constant war. It’s very demoralizing on our staff.” While acknowledging the move to the Wynn has not gone as smoothly as hospital officials had hoped, Stromstad states, “I’m very proud of the work this organization is doing.” In its early days, Wynn struggled with long emergency room wait times which kept both patients and ambulances waiting. Whether patients arrive on their own or are brought by ambulance, Stromstad says wait times are consistently dropping. These days, the average time it takes to complete the hand off from ambulance to emergency department — when the ambulance is free to return to service — averages 11 minutes, she says. At the same time, the volume of ambulance drop offs has increased from a out 65 a day to between 80 and 85 a day now. For patients that arrive on their own, the goal is a turnaround time of less than two hours. “We’re making progress on all of those areas,” Stromstad says. And MVHS is making that headway despite being short of both staff and funds, she adds. “MVHS and the bulk of hospitals in Central New York are all suffering post-pandemic financially,” she says. The cost of care has increased year-over-year by 17 percent, while reimbursement for that care has only increased 7 percent. From fuel to food to medications, costs have gone up across the board, Stromstad notes. At the same time, government funding to help hospitals through the pandemic exhausted in early 2023. In 2022, the most recent year for which a Form 990 is available, MVHS had revenue of $104,558,940. Of that, $11,924,610 came from program revenue with $92,537,032 coming from other contributions and grants. The health system’s expenses have escalated. Between the cost of moving, maintaining its two former hospitals until they are redeveloped, traveling nurse costs, and more, 2023 was “a really expensive year,” Stromstad says. Staff remains an issue both from a cost perspective and from a staffing-level perspective. There was an increase in retirements during the pandemic, while other health-care professionals left positions at the health system to become traveling providers. “We have about 220 travelers in our organization,” Stromstad says. She understands the popularity of being a traveler. “They make more money.” Travelers typically work anywhere from 13 to 26 weeks at a facility where they are not only paid for their services, but also their housing and food. The role became popular during the pandemic especially because it allowed health-care professionals to use their skills without having to get involved in politics or other issues at the facility. But for a health system, travelers are a necessary but expensive reality when it comes to filling vacant roles. “Our traveler budget was over a million dollars a week over budget,” in 2023, Stromstad says. MVHS is not the only health-care organization struggling since the pandemic, says Gary Fitzgerald, president and CEO of Iroquois Healthcare Association (IHA). Based in Clifton Park, IHA is a nonprofit regional health-care trade organization that represents more than 50 hospitals and health systems across 32 counties in upstate New York. “The cost of labor is continuing to go up,” he says. “That has impacted hospitals financially.” Labor costs make up about 65-70 percent of total expenses, he notes. According to IHA’s annual financial survey report released in January, vacancy rates at health-care facilities have increased 135 percent since 2019. The jobs with the highest vacancy rates are operating-room technicians at 28.4 percent, licensed practical nurses at 27.8 percent, and registered nurses at 27.4 percent. Across all job titles, the average vacancy rate is about 20 percent, Fitzgerald says. IHA is actively working to reach young people at high schools, BOCES, and community colleges to talk to them about careers in health care, but it will take a while to generate the workforce needed, he says. MVHS has its own efforts underway to find qualified, interested employees. “MVHS continues to work to recruit registered nurses into the health system,” Senior VP, Chief Human Resources Officer Allison M. Wollen said in a statement sent to The Business Journal. “Sign on/retention bonuses are being offered to RNs, and wages have been adjusted to ensure they are market competitive.” It’s been a challenge to convert traveling staff into full-time staff, she noted. “We continue to try and recruit travelers to become permanent staff, but the rich tax incentives, stipends, and ability to earn inflated wages will continue to create recruitment challenges that all hospitals are currently facing.” As the state focuses on economic development with news like Micron Technologies coming to Clay, Fitzgerald says there needs to also be more public investment in health care. “You can’t do economic development without a good health-care system,” he says. Going forward, MVHS is focused on becoming an efficient machine without sacrificing any quality of care, Stromstad says. MVHS is working with Guidehouse, a global consulting firm that works with both the public and private sectors. It consults with health-care providers to help them become more agile and financially resilient, according to its website. Work started in January on a one-year project with Guidehouse to define efficiencies across areas including revenue growth and how departments are run, Stromstad says. It was important to tackle the project early in the life of Wynn Hospital before bad habits set in, she adds. “It’s a real intensive project,” she notes. “We are trying very hard to just be an open book.”