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New York
HealthAlliance of the Hudson Valley
Story Number is : 071110100
Hospital Newspaper

Kingston Hospital
David Lundquist, CEO of HealthAlliance
Benedictine Hospital
Hudson Valley residence put their health under one umbrella with the combined forces of HealthAlliance of the Hudson Valley.

Around the turn of the last century two hospitals opened to provide health services to the community of Kingston, an area located in the middle of the Hudson Valley. Benedictine, a Catholic entity was established in 1894 while Kingston, a non-secular facility, was formed in 1901. These two medical centers, just four blocks from one another, operated on an adversarial basis through the years.

Over the years, there was a serious effort to merge the two hospitals. Three attempts for unification over the years failed for various reasons. With each attempt, the community became more aware that an alliance should occur.

In 2006, New York implemented the nonpartisan Berger Commission to evaluate and make recommendations for hospitals throughout the state. The commission’s proposal centered on issues concerning the elimination of excess hospital beds capacity, duplication of hospital services, and modernization of facilities in an effort to improve state residents’ quality and affordability of primary and preventive healthcare. This affected Benedictine and Kingston hospitals because the facilities were in such close proximity of the other and on tentative ground regarding financial viability.

“Either one of the two hospitals would have to close or they would have to come together and join or consolidate services to better serve the community and eliminate duplication which was the premise behind the Berger Commission mandate,” said David Lundquist, CEO of HealthAlliance. “Neither one of them wanted to close. The other option was to come together - what was the choice by the community.”

It took nearly two and half years of intense planning to merge the two healthcare providers. A mutual operating agreement was created and signed establishing a passive parent, the Health Alliance Planning. It included six members from each of the hospital’s boards and three independent community citizens who had not previously served on either of the two boards. This group put together what eventually evolved into the master alignment agreement, which became the HAHV’s operating structure.

According to Lundquist, the master alignment agreement set the tone to guide the alliance from its passive state to its active state, which occurred on March 11, 2009. “Since that time we have operated under the umbrella of the HealthAlliance board of directors,” he said.

Through the master alignment agreement, the Catholic and non-Catholic hospitals addressed many issues that are consistent with ethical and religious directives along with other differences that were raised over the years.

There were six recommendations by the Berger Commission that involved Catholic and non-Catholic partnerships, HAHV was the only one successful in keeping both hospitals open.

Also under the agreement, the hospitals retained their distinct licenses, but the two organizations have a common parent board and a single executive staff.

After a national search for an administrator, Lundquist was hired in 2008 as CEO and manages the entire consortium.

In addition to the two primary hospitals, the alliance includes the 15-bed critical access Margaretville Hospital, which received over 4,900 emergency visits last year. Adjacent to this rural campus is the 82- bed Mountainside Residential Care Center, for residents in need of quality 24-hour skilled nursing services in a comfortable, comprehensive, accessible setting.

Woodland Pond, the newest member of the alliance recently opened in New Paltz, is the first continuing care retirement community in the Mid-Hudson Valley for individuals age 62 or older who desire a gracious but vibrant retirement setting.

The Margaretville and Woodland Pond campus have executive directors while at Benedictine and Kingston has site administrators that are responsible for the facilities.

Lundquist admits that it is “not the norm” for most hospital systems to have such varied units but says, “It works extremely well for us.” Both Margaretville hospital and the Woodland Pond venture were originally part of Kingston but now report directly to the board of directors.

As a commitment to the employees during this unification process, the board decided there would be no layoffs.

Last year’s data reports that there were over 2,300 inpatient and 4,300 outpatient surgeries performed at the 300-bed alliance serving roughly 150,000 people in its primary service area of Ulster County, in addition to Eastern Delaware and Southern Green counties. It has the busiest emergency department on the West side of the Hudson River between New York City and Albany. Between all the aligned sites, there were over 14, 780 discharges, which included over 10,500 med-surg discharges.

Validation of the merging campuses into one alliance was recognized during the first fiscal year’s profits growth. At the end of 2008, the system lost almost $6 million but by the close of 2009, it showed an operating profit of $4.8 million.

Lundquist said that the success has influenced “the willingness of the community’s leadership, the hospital’s leadership, and the physicians, to step up and, in effect, bury the differences of the past and come together as one.”

“It positions us very well for the future and our abilities to meet the needs of our community.”

Some of the eliminated duplication of competing services was imaging centers, surgical facilities, behavioral health and maternity units, as well as emergency departments.

Lundquist said that deciding which hospital would be the best for certain services was not easy. An underlying philosophy was adopted to help identify the best location.

To distribute the services between the two hospitals more effectively, it was decided that Kingston would be the emergent acute hospital and accommodate conditions such as cardiac care, stroke and other med-surg illnesses that would typically enter through its emergency department.

Benedictine Hospital was set up to handle elective acute services and the majority of outpatient surgeries. Housed at the campus are the spine and joint center, oncology center, inpatient rehab and behavioral health services along with other medical departments.

A part of what the Berger Commission involved was the application of Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) grant funds to assist hospitals and nursing homes in complying with the mandates of the Commission. At HAHV, $25 million was spent on capital improvements on each of the two facilities. For example, the Benedictine campus created and consolidated two state-of-the-art operating rooms with laparoscopic surgical capabilities at Kingston Hospital money was used to build a new 35-bed expanded emergency department and lobby. Last year between the two campuses, there were over 50,500 emergency room visits. The ER opened in April.

“These funds helped to integrate services not by just consolidation but into brand new spaces so we could enhance the customer experience,” said Josh Ratner, chief strategy officer.

The fastest growth for HAHV is the 55-64 age range, pre-Medicare and Medicare population in addition to patients 65 and older. According to Ratner, HAHV will focus on expanding in areas with continued investment, such as orthopedics, cardiac, imaging and vascular services.

“When we looked at the population we serve, we realized that over the coming years we are going to have double-digit percentage growth in the over 55 population,” said Ratner. “So we are actively looking at services that address the needs of this aging population as well as offering the best customer experience.”

As of May, HAHV has completed all the necessary steps for the alliance. “The construction is done. The integration of staff and services is in place. Now we are able to reach out into the community and really begin as an organization to integrate into the community. We are excited about that opportunity,” said Lundquist.

Already HealthAlliance has earned prestigious accreditations. Mountainside Residential Care Center received a 5-Star rating from Medicare “Nursing Home Compare” and placed it in the top 10% of nursing homes nationwide. Consumer Reports gave Kingston Hospital a perfect rating for preventing central-line infections in the Intensive Care Unit. Kingston’s Family Birth Place received the Certificate of Excellence Award from the NYS Department of Health for their Hepatitis B immunization program.

“This was not an easy venture given the fact that attempts in the past had failed many times. For this alliance to work, it’s been truly an extraordinary event reflecting what can be done when a community accepts the responsibility of protecting its healthcare and making the tough decisions required to make that happen,” he said.

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