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Money, Employee Morale Put Springfield Hospital’s Health in Question



Valley News Staff Writer
Saturday, December 08, 2018

Springfield, Vt. — Springfield Medical Care Systems is struggling.

For the past few years, the nonprofit health care system — which includes the 25-bed Springfield Hospital, as well as health centers in Charlestown and the Vermont communities of Ludlow, Londonderry, Rockingham and Springfield — has reported losses.

At a budget hearing before the Green Mountain Care Board in August, hospital administrators said they were projecting a $922,000 deficit for the fiscal year that ended Sept. 30, That loss would come following a loss of $3.8 million in 2017. Audited financial statements for 2018 should be available in early 2019.

Now some community members are upset that the hospital has awarded its emergency department contract to a Maine-based company over a Chester, Vt.-based company that had provided the service for 40 years. Others say employee morale is low, some are leaving, the hospital is behind in payments to vendors and they worry about the hospital’s future. And the CFO recently departed.

Springfield, which has about 9,000 residents, has been working on economic development initiatives in an effort to boost the vitality of the former mill town, Springfield Selectboard member Peter MacGillivray said. The median annual income in Springfield is $42,000. The hospital system employs about 770 people.

MacGillivray, a former hospital board member who continues to be involved with fundraising, said he is concerned about the hospital’s management and the board’s oversight of its administrators.

“You can’t have expenditures exceeding income,” he said.

The GMCB, which is responsible with reviewing hospitals’ budgets, is monitoring the challenges in Springfield, said Susan Barrett, the board’s executive director.

“I hope they can figure this out,” she said in a phone interview on Thursday. “We want all of our hospitals to be healthy.”

In a report Springfield Hospital officials provided to the GMCB on Thursday, they outlined the challenges the hospital is facing, including higher-than-expected costs for employee benefits and temporary providers. In addition, they said the hospital is experiencing a delay in Medicare payments.

As a result, hospital officials acknowledged that the hospital’s payments to vendors have been slow. They said the hospital is trying to work out payment plans when possible and is working with its bank to secure a line of credit.

“The important thing is we’re aware of it,” SMCS spokeswoman Anna Smith said. “We’ve got a plan.”

New Emergency Department Contract

Part of the hospital’s cost-reduction plan is a change in the provider of its emergency services.

The Chester-based Emergency Services of New England, or ESNE, which has been providing emergency services at Springfield Hospital for 40 years, will cease operations there on April 8, according to a notice of termination Springfield Medical Care Systems CEO Tim Ford sent to the company in October. In its place, a Brunswick, Maine-based company, BlueWater Emergency Partners, will begin providing the service.

The result will be a “substantial” cost savings for the hospital, Smith said. She and the leaders of the two emergency provider companies declined to provide details about their contracts.

But Smith said it was “prudent” to review contracts in the course of business.

The two companies provided the hospital with bids for the coverage they thought would be required to appropriately treat the patients who arrive at Springfield’s emergency department, she said.

The two services offer different models of coverage. ESNE employs physician assistants only, with medical oversight provided by a physician. BlueWater employs physicians and other advance practice providers such as physician assistants and nurse practitioners.

“We’re able to provide really cost-effective care,” BlueWater CEO Jay Mullen said.

BlueWater focuses on instructing providers in appropriately coding and billing for their services, Mullen said. In addition, he said, using physicians, who are able to care for a greater “depth and breadth” of patient ailments allows his company to be efficient.

ESNE has proposed reducing staffing from 60 hours a day to as low as 43 hours, and currently provides 50 hours of staffing per day, according to ESNE President Cary Stratford.

Reducing the staffing level below 43 hours, Stratford said, would make it more difficult to address the illnesses the company regularly sees in Springfield’s emergency department. Over the years, Stratford — who is 64 and has been working with ESNE for 38 years — said both the severity and complexity of the illnesses his company has seen have increased. He attributed this shift to the increasing age of the population and the survival rate of people with chronic illnesses.

Though ESNE also provides coverage for two of Springfield’s walk-in urgent care clinics in Springfield and Charlestown, and for Mt. Ascutney Hospital’s emergency department in Windsor, Stratford said he expects his company of about 38 employees will see a reduction in staff as a result of the termination of the contract for Springfield’s emergency department.

For his own part, he said it may force him into retirement about five years earlier than planned. Though BlueWater has spoken with several ESNE providers to discuss jobs, Stratford said he is unaware of anyone who has signed on. Both the salaries and the comparably low number of people working at any one time have been deterrents, he said.

“I would not want to work in that environment,” he said.

Josh Rosenblum, a South Londonderry, Vt., resident who joined ESNE as a physician assistant in 2012, said he is one who won’t be working for the new company.

“I couldn’t imagine going to work one day making the money I make now — which I think is commensurate with what I do — (and then) go to work (in the) same emergency department with the same issues (and) make 30 percent less the next day,” he said.

As an ESNE employee, Rosenblum said he has been making about $185,000, including his base salary, longevity bonus, overtime and shift differential, annually. At BlueWater, Rosenblum said he could earn a maximum of $130,000.

Mullen said all ESNE employees have been invited to apply for positions at BlueWater. His company aims to offer salaries that are at or above the 50th percentile of salaries nationwide, he said. In addition, BlueWater pays 100 percent of premium costs for employees and their families. It also fully funds their health savings accounts, he said. To qualify for benefits, Mullen said employees need to work just 1,440 hours per year, which works out to about 28 hours per week.

Rosenblum expects that when the Springfield contract ends he will work full time at Mt. Ascutney, which is an hour’s drive from his home. To get there, he’ll drive by Springfield Hospital.

This change is hitting Rosenblum hard, he said. He has two daughters, ages 5 and 7, and his wife has been staying home to care for them. This change, which he said will reduce their income, may force her to get a job.

Though change can be difficult, both ESNE and BlueWater say that they are committed to a smooth transition for patients.

Mullen, an emergency physician, and his chief medical director will both be working shifts at the beginning, he said.

“We want to make sure the culture really works from the start,” he said.

Morale

Though her husband is an ESNE employee, Dr. Sabina Morissette, a geriatric specialist, said her decision to leave the Springfield health system came before the hospital terminated ESNE’s contract.

Morissette, who plans to leave in February, announced her decision to leave last spring. That decision, she said, is due to not feeling welcomed or supported by the hospital’s leaders. She would have liked more opportunity to provide care in long-term care settings and to provide office and hospital consults throughout the system.

“For me, I think the goal of a hospital should be to maximize their care and support the clinicians,” she said. “I simply didn’t find that being there I was able to give care the way that I wanted.”

The stress of trying to work in what she described as an unsupportive environment took a physical toll on Morissette, she said. She lost her hair.

So after almost three years with the Springfield system, Morissette is now setting off on her own to work in long-term care settings.

“For my own well-being, I really have to leave,” she said.

Smith said that some unhappiness is to be expected in any workplace.

“We do employee surveys and we’ve gotten pretty good results,” she said.

The most recent survey, administered in May and June with a 62 percent response rate, showed slight decreases in the categories of commitment, job satisfaction and manager investment and an increase in the category of peer relationships.

Smith said “all four categories fell within 3 percentage points of peer averages.”

The hospital system, like many organizations, is working to improve communication, she said.

“We are building teams, engaging employees and reinforcing our commitment to a culture that is effective, efficient and solution-focused on fulfilling our mission to provide high-quality patient care,” she said.

Signs of Change

There are some recent signs of change in the hospital’s financial management. Last Monday, Ford announced the departure of Chief Financial Officer Scott Whittemore in a memo to employees. Ford did not cite a reason for Whittemore’s departure, and Smith, the system’s spokeswoman, said she could not discuss a personnel issue.

Ford wrote that he expects to appoint an interim CFO soon and will begin a search for a permanent replacement. He also addressed the broader challenges facing the system.

“2018 has been a challenging year in many respects,” he wrote. “We missed several of our financial targets, primarily due to declining revenues and increasing benefit and locum expenses. We are certainly not alone in these struggles as many small hospitals in Vermont and across the nation are confronting similar issues. Yet, while the environment remains difficult, the situation requires our focused attention and commitment to improvement.”

The system has contracted with Quorum Health Resources to conduct a review of its operations, which is expected to be completed in February or March, Smith said.

Smith said she did not anticipate any further changes in leadership or changes in services, such as a closure of obstetric services, which a number of other small hospitals in the Upper Valley and beyond have opted for in the face of low birth numbers and high costs. But she wasn’t ruling anything out completely.

“We’re open-minded,” she said. “We’re going to wait and see what the review process presents.”

In August, when the Green Mountain Care Board pressed Ford about the hospital’s recent losses and what might be done to stabilize finances, he said they would have to take a look at programs and consider cuts. At the time, he pointed to obstetrics. Springfield and Gifford Medical Center in Randolph — which also has seen losses in recent years — are currently the only Upper Valley hospitals other than Dartmouth-Hitchcock Medical Center in Lebanon where women can deliver babies.

“Hopefully we don’t have to get into that difficult conversation on what programs do we have to cut,” Ford told the board in August.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.