BY JEFF CHUDZINSKINorth Country This Week

CANTON — In an effort to close a $2.7 million budget gap, Clifton-Fine Hospital is transitioning to a rural emergency hospital (REH), a move that will save the hospital from an almost guaranteed closure.

"Frankly we wouldn't survive until 2028," CFH Board Chairman Tom Souter told county legislators Jan. 29.

As part of the restructuring, 12 jobs will be cut but cross-training will be available for a number of employees so they can remain at the hospital.

Transitioning hospital status

Transitioning hospital status’ has been a popular topic in the north country in recent years, with both Massena Hospital and Claxton-Hepburn making the transition to critical access hospitals to restructure while ensuring essential services are maintained for communities. Massena officially became part of the St. Lawrence Health system in 2020 following a hotly contested sale, while Claxton-Hepburn began the process in 2023 in association with Carthage Area Hospital. 

Sauter was on hand during the legislature’s finance committee meeting Jan. 29 to discuss just what the transition means for the Clifton-Fine Hospital and community alike. 

According to Sauter, over 250 rural hospitals, including critical access hospitals, are at immediate risk of closure due to financial losses, inadequate revenue, high cost of staffing and low financial reserves. 

A New York State report showed that 53% of rural hospitals are at risk of closure, as of 2023, officials say. 

Another critical issue facing rural hospitals is a lack of state aid to keep them afloat. 

Officials say losing a hospital will have negative consequences for rural communities and beyond, especially given that 64% of St. Lawrence County residents report having one or more chronic health problems. 

Those statistics alone highlight the need for healthcare access in rural areas and the essential role such hospitals play in their communities, according to officials. 

Recent declines for Clifton-Fine Hospital

Sauter touched on a number of issues at CFH that made the  move to a REH hospital a crucial choice. 

That decision was driven by multiple factors, the largest of which is a population decrease, in particular in Clifton and Fine. 

The decline has also led to fewer students, fewer businesses, reduced revenue and in turn a lower utilization rate. 

“That lessened our ability to support a full-service hospital,” Sauter said. 

As a critical access hospital, Sauter said the hospital had 10 acute care beds and 10 long-term care beds. 

In regards to acute care beds, an average of just one admission per day has played a role in the financial hardships the hospital has experienced. 

Sauter said even during the COVID pandemic the hospital only averaged roughly four acute care admissions, due in large part to taking in other hospital’s patients that were not admitted for COVID. 

“We weren’t treating active COVID patients, they went to other hospitals which were near full capacity,” he said. 

Competition necessitates change

Sauter touched on competition with other health systems, which has proven to be another major issue facing the hospital.

“There’s a lot of competition for healthcare services, for healthcare staff,” he said. 

With hospitals in the St. Lawrence Health system of hospitals, along with Claxton-Hepburn, Carthage Area Hospital and Samaritan, other hospitals are able to provide more services. 

When Clifton-Fine Hospital opened in 1951, it was a full-service hospital, Sauter said. 

But by 1979 the healthcare landscape began to change.  First came the closure of the maternity ward, followed by the closure of the operating room in 1989. In 1996 all dental services were discontinued, while ambulance services were discontinued in 1998. 

Financial downturn 

Sauter said the hospital has been hemorrhaging money for years now, with a net loss of $2.736 million through Nov. 2023. 

The projected margin of -36.6% would continue through 2028 if a change is not made, Sauter said. 

“It was more of an academic exercise but we conducted research that showed there would be no financial improvement unless we changed our designation,” he said. 

But without the change, the hospital would survive through 2025, he said. 

“Frankly, we wouldn’t survive until 2028 anyway. If we don’t change course now, we aren’t making it through 2025. We’ve had structural budget issues we haven’t been able to overcome,” Sauter said. 

In contrast, Sauter said if the hospital were already a REH in 2023, the hospital would have shown a $200,000 profit. Projections show that profit will grow to $264,000 in 2028 due to enhanced Medicare reimbursement rates. 

“On a $100 visit we would receive $105. A 5% increase doesn’t seem like a lot but that really affects our bottom line,” Sauter said. 

Those changes will prevent the closure of the hospital in the short-term and will allow for the project to slowly expand services in the future. 

Sauter said plans are in place to expand outpatient care. 

“That’s the bulk of what we provide today anyway,” Sauter said. 

The hospital will then be able to achieve long-term financial stability through federal subsidization and enhanced payments. 

Job cuts looming

But the move to REH status has come too late for some employees. 

Sauter told trustees that a dozen or so employees are slated to lose their jobs in the status change.

“Another difficult reality is that there will be job losses. About a dozen positions will need to be eliminated due to the closing of the inpatient and swing bed unit,” officials say. 

In some cases, opportunities may arise at Clifton-Fine for employees to stay with the hospital. 

“CFH will offer cross-training to help maintain employment for as many employees as possible,” according to officials. 

Other affected who cannot cross-train will also be offered opportunities with Samaritan Medical Center. 

“Samaritan Medical Center has also agreed to offer employment to any affected staff and will work to keep them on the same shifts for car-pooling options,” according to officials. 

Acute care and long-term care services will also be cut in the status change, which will displace 10 long-term care patients. 

“Samaritan Medical Center is offering to take all of our longer term care patients to Samaritan Keep Home. To ease the transition and make visiting easier for our community, they can all be together on one wing,” officials say. 

“Of course, each individual can choose to explore other locations to move to, based on their wants, needs and availability,” they continued. 

Capital project planned

Along with the REH change, officials are also undertaking a capital project that will see laboratory facilities improved and updated along with an expansion of the emergency room. 

Sauter said if all goes according to plan the REH change would be completed by the third-quarter this year. He said hospital officials hope a state approval by July 1 will prompt a quick and corresponding approval by the federal government as well. 

With the capital project nearing kickoff, Sauter said the project will likely be put out to bid in February with contracts signed off sometime in April. 

By May or June groundbreaking will commence with an end date of Sept. 2025 being the goal to complete work. 

Once complete, the hospital will have expanded mobile mammography services, early intervention services for pediatric rehabilitation, an expanded emergency department, a contract with Upstate Medical for level one trauma assistance, a new radiology suite and observation care beds. 

Sauter said the hospital may also be able to offer mobile dental services, convenient care, tele-psychiatry and substance abuse treatment in the future when the hospital is financially solvent.