By JIMMY LAWTON

OGDENSBURG – Claxton-Hepburn Medical Center’s new CEO Nathan Howell says the entire health care system will see major changes in coming years and his hospital is prepared to face them.

But CHMC will not be facing the future alone. He said the key to improving health care for patients and providers is through collaboration.

The hospital will also need to adapt to nationwide funding models that are expected to reward healthy outcomes, not just reimburse “fee for service,” he said. Improved electronic records in clinics and increasing use of technology such as Skype should help upgrade services offered by Claxton-Hepburn, he added.

Howell, who has been on the job for roughly a month, says increased affiliation with health service providers will be a must.

In a recent interview, he said Ogdensburg’s hospital has already been working with several Jefferson County hospitals including Carthage, Samaritan and the River Hospital to create a clinically integrated network (CIN).

Working Together

Howell described the CIN as a group of health care providers working together to enhance outcomes and reduce expenses.

He said the loose affiliation is known as the North Country Initiative and was formed in the wake of another hospital network called Fort Drum Regional Health Care, which was originally designed to address the needs of soldiers at Fort Drum.

Howell said working and planning together has many benefits, from sharing specialists to reducing expenditures through group purchasing. That is one type of collaboration that will become even more common in the near future, but isn’t the only model, he said.

He pointed out that Canton-Potsdam Hospital recently acquired Gouverneur Hospital, which closed to due to financial stress. He said bringing multiple facilities under one umbrella may be another means for success.

But change is coming and in some cases has already arrived. Howell said the nation and federal government have come to a breaking point where they can’t afford to pay any more.

“The only way to stop paying more is to stop paying more. And what they are doing is cutting payments over time,” he said.

Howell said the future of hospital funding, in the best-case scenario, will be flat. However, operating costs are going to increase.

“If payments stay the same, but your operating costs are continuing to creep up, you will still fall behind,” he said. “Margins are shrinking. Massena Memorial is a good example. That’s what they are faced with right now.”

Howell said collaboration allows hospitals to reduce costs by using their combined size as leverage for equipment purchases and service costs.

“By creating economies of scale and sharing costs you minimize that creep of expenses,” he said.

To that point, Howell is interested in working with other area hospitals, including Massena Memorial, to create a stronger health care system in St. Lawrence County.

A Change in Care

Howell says revenue models are changing and they appear to be moving toward patient outcomes, rather than number of visits.

“We are going to be paid on outcomes. If you have fewer infections and more people getting better faster you are going to get more money,” he said.

Howell says funding models will be more focused on prevention than treatment after the fact. For example, a health insurance company may be willing to pay a particular amount for an individual for a year, thus giving the hospital an incentive to minimize the number of visits through preventative and primary care.

“My vision is we want to create vibrant health care facilities in a vibrant environment in different towns in the North Country,” he said. “We want to grow the quality and number of services we can provide.”

Howell said he sees care moving from hospitals into the community. He expects a broader focus on preventive and primary care and fewer trips to the emergency room.

“I think primary care will grow, but you are going to have some shrinkage in the chassis,” he said. “What we have now is clinics and individual providers. We need to grow both of those things. We need to grow clinical capabilities and well as the number of (doctors).”

Howell said he also expects the Ogdensburg area to see urgent care facilities that provide minor emergency and after-hours care.

“I do see a future for urgent care in Ogdensburg and will evaluate that as part of our overall plan,” he said. “You can’t fight the tide. It’s a losing battle. I think at some point we will need to embrace that model.”

Howell said urgent care is a mixed bag for hospitals. He said urgent care provides a cheaper alternative to emergency rooms for minor health problems, but added that there are some downsides.

“The problem with urgent care is that it is fragmented care. They often do not talk to the hospitals,” he said. “If you have a player that doesn’t communicate very well you can have problems.”

To avoid communication problems, Howell said he would like to partner with a provider.

“If we do get into urgent care, I’d like to partner with somebody so we are not absorbing all of the cost, but have a good communication line,” he said.

Electronic Records

One way communication of patient history can be improved is through electronic medical records. Howell said the hospital is using them, but is still working to get all of its clinics and primary care providers to follow suit.

Howell said electronic medical records (EMRs) have many benefits. He said it allows hospitals to develop better protocols by accessing information provided by hospitals across the country.

“You can see what you are doing well and what you are not per industry standard,” he said. “You can look at protocols and lists of ways doing things that may improve your outcomes.”

Howell said that medicine has traditionally been an art and a skill and it still is. He said different doctors approach different patients differently due to a wide variety of factors. He says electronic medical records allow hospitals to see what is working the best.

“So there is an art to it and where there is art, there is room for error and that creates problems,” he said. “With EMRs it becomes less of an art and more an agreement on the best way to do something.”

Howell said EMRs are also a key component of a one-time government funding incentive designed to bring health care facilities up to industry standards and reduce avoidable hospital visits. He said a program known as the Delivery System Reform Incentive Payment program allows hospitals to receive funding in exchange for getting their medical records filed electronically, among other requirements.

Looking Ahead

Howell says all the coming changes are destined to bring some growing pains, but he believes Claxton-Hepburn Medical Center is prepared for them.

He expects there will be fewer entities providing health care in St. Lawrence County, but he also expects patients will have more options for health care and better access to specialized and preventative care than they have had in the past.

Howells says electronic communication similar to Skype will allow specialized doctors from other hospitals to see patients and guide emergency room doctors in complicated diagnoses.

“The technology is there. We just have to put it to use,” he said.

He said providing a wider range in care is especially important in rural communities like St. Lawrence County. He said a lack of access to specialists can mean people have a lower survival rate simply because of where they live.

Howell said at the end of the day, the hospital’s job is to keep people alive and to do what they need to remain economically viable and ensure that the hospital is creating value by improving patient outcomes without exceeding revenues.

“It’s not just altruistic. It’s where we are going to have to be in five years,” he said.

Howell replaces Mark A. Webster who accepted a position as CEO at Cortland Regional Medical Center to be closer to his family.