What’s Ailing Glens Falls Hospital is What’s Ailing Our Community
March 7, 2019
Glens Falls Hospital’s financial plight is a wake-up call for our community. The hospital is a reflection of the people and communities it serves; its problems are rooted in the decline of the Upstate New York economy, the shrinking population of local communities, and the graying of our neighbors and ourselves.
The challenges, for the most part, are not of the hospital’s creation. They are the product of Glens Falls Hospital doing what it is expected to do and does well: Taking care of the sick and injured, the aging, the impoverished, the uninsured, people with disabilities — and any other patient who arrives at its door day or night.
Most Glens Falls Hospital patients do not carry commercial health insurance provided by their employers.
They are eligible for the federal and state government insurance programs, Medicare and Medicaid. These programs are vital social safety nets. Medicare provides health-care security for our seniors, younger people with disabilities, and those who suffer from certain diseases. Our Greatest Generation, our moms and dads, our leaders, mentors and teachers earned the right to take full advantage of those benefits and should do so. Medicaid, meanwhile, supports people who struggle economically as well as pregnant women, infants, parents and caretaker relatives.
But as socially beneficial as these programs are, both systematically under-reimburse hospitals, physicians and other providers for the care they provide. This is why some providers decline to accept government insurance. A community hospital like Glens Falls Hospital does not do that.
In 2018, 69 percent of all patients seen at Glens Falls Hospital were either Medicare- or Medicaid-insured. Inpatients tend be the sickest people requiring the greatest care. At Glens Falls Hospital, 82% of them were Medicare- or Medicaid-insured last year. Nationally, Medicare reimbursement falls 13 percent below the actual cost of care. In real dollars, that means when Glens Falls Hospital cares for a patient with pneumonia it receives an average of $12,400 from commercial insurers. Medicare pays only $4,760 for the same care in the same setting. The hospital provides the same high level of care no matter how much it is reimbursed.
Insufficient reimbursement from government insurance programs is not new – historically, private commercial insurers like MVP, CDPHP and Blue Cross Blue Shield made up the difference. That approach works if most patients have commercial insurance, as is the case at Saratoga Hospital, reflecting the prosperous and growing Saratoga County economy. But this cost-shifting approach does not work in areas where most patients are government-insured.
There are other factors, too: More people are getting very good primary care and staying out of hospitals or are getting health care in settings outside hospitals. Both are good things, generally. Some folks are delaying care because of high deductibles in their private insurance. Not a good thing.
Regardless of how many patients arrive needing care, Glens Falls Hospital and other hospitals must operate, equip and staff emergency rooms, intensive care units and operating rooms, with all of the attendant technology, 24 hours a day.
Nationwide, health care is undergoing radical change. But the challenges in Upstate New York are especially pronounced because of demographic trends particular to the region:
* Upstate New York’s population is declining. Younger people are moving out and fewer people are moving in.
* Forty-two of 50 upstate counties lost population between 2010 and 2017, according to the Census Bureau. During the same period, New York City’s population grew, as did the number of jobs there.
* The proportion of elderly people to the overall Upstate population is increasing quickly as the elderly live longer and younger people leave the state to find opportunities elsewhere. And a greater percentage of elderly people in Upstate counties are living in poverty.
* As younger working people leave Upstate New York, there are fewer working-age adults to pay taxes to support their elders at the very time when their need for support — health care, social services, residential support — is increasing.
Statewide, the number of New Yorkers aged 65 and older increased 26 percent in the last 10 years. In the same period, the population aged 65+ increased 28 percent in Warren and Washington counties and 21 percent in Clinton, Essex, Franklin and Hamilton counties. Notably, Saratoga County’s retirement-age population increased 55 percent in 10 years.
The problems now facing Glens Falls Hospital will face many others shortly unless there are short-term and long-term solutions.
The long-term federal and state policy fix is to replace the system of under-reimbursement with one that adequately reimburses health care providers. The U.S. spends more on health care than any other nation, and there are appropriate calls for greater efficiencies. But the answer is not to shortchange hospitals and physicians, especially those in small communities serving large and growing populations of older, poorer and often sicker people. No hospital can long afford to accept less-than-full reimbursement of its legitimate costs, assuming they are within the range of their peers. And accepting insufficient reimbursement is irresponsible because it imperils health care for the entire community. Public policy that shortchanges hospitals and providers unfairly shifts the cost to others and ultimately means services for the most vulnerable people in our society may cease to exist.
On a state level, the long-term fix is rebuilding the economy of Upstate New York and creating jobs that will keep more young people here. This starts with supporting primary, secondary and higher education, providing creative economic incentives to retain existing and attract new private-sector employers, lowering the cost of doing business over time, and offering a predictable and sane regulatory environment. New York State has made progress on Upstate economic development in recent years, but the region is at a critical turning point and there is more to do.
In the short-term, the state and federal governments may need to step up with greater financial support for comprehensive community hospitals that are penalized by Medicare and Medicaid for doing the right thing. Unfortunately, our state legislators, facing a $2 billion state budget deficit this year, are actually considering measures that would exacerbate the problem, including denying hospitals a promised increase in Medicaid fees. This would cost Glens Falls Hospital another $2 million in 2020.
What can we as individuals do? Get in the game. Make your voice heard:
1. Spread the word about the positive experiences you and your family and friends have had at Glens Falls Hospital. And if the hospital happens to fall short of your expectations, let hospital representatives know right away so the problem can be addressed.
2. Communicate your gratitude and encouragement to the hospital’s dedicated employees.
3. Support Glens Falls Hospital, as a patient using their services, as a contributor to their fundraising, and as a voter and citizen pressing for public policies that will keep Glens Falls and other community hospitals healthy.
4. Hold our elected representatives accountable for campaigning for and getting enacted the critical and significant policy changes that will benefit Glens Falls Hospital and other similarly situated community hospitals.
5. Energetically support and speak up for local economic development efforts to attract business, retain business and create jobs.
6. Cheer in grateful appreciation for our local employers. Defend them when they are under unfair attack. Remember it’s the Finch Papers, Lehigh Cements, SCAs, Irving Tissues, Barton Internationals, CR Bards, Angiodynamics, SUNY Adirondacks, Skidmore Colleges, Glens Falls National Banks, CWIs, Adirondack Studios, Sagamore Resorts, Tribune Medias, JUST Waters, Price Choppers, local school districts and others that help sustain our community’s economy and keep Glens Falls Hospital in business.
7. Patronize and encourage local farmers, retailers, restauranteurs, publishers, artisans, professionals and small businesses, the people who provide necessary services and products, pay big taxes, invest in our community every day, and help sustain our economy.
Since 1897, Glens Falls Hospital has helped local people in their hours of desperate need. It is our community’s single most important health care institution and its largest employer. The hospital and the community are inextricably linked.
The chips are down for Glens Falls Hospital. It’s time to help the home team … and ourselves.
Mark Behan is a longtime member of the Board of Governors of Glens Falls Hospital. The views expressed here are his own.
 “The Aging of New York: How the Population is Growing Older at a Remarkable Pace,” Rochester Democrat and Chronicle, February 28, 2019; “Upstate New York Population Continues to Drop,” Rochester Democrat and Chronicle, March 22, 2018; “The Graying of Upstate New York,” The Empire Center, August 16, 2012;
 “The Aging of Upstate New York,” Federal Reserve Bank of New York, July 2006.
 Christian González-Rivera, Jonathan Bowles, and Eli Dvorkin, “New York’s Older Adult Population is Booming Statewide,” Center for an Urban Future, February 2019 (Report prepared with the support of the AARP and other groups).