By Ann McCreary

Directors of Three Rivers Hospital in Brewster face the difficult task of laying off staff and eliminating services as they ponder how to keep the community hospital in business.

The board of directors will consider scenarios for the hospital’s future on Dec. 16, after delaying action last week at a meeting attended by more than 50 concerned citizens, hospital staff members and medical providers.

Hospital board members made it clear that they shared concerns about a proposal to discontinue labor and delivery at the hospital, which has prided itself on achieving international “Baby Friendly” designation.

“It was the consensus of the entire board to try to keep labor and delivery,” Rebecca Meadows, director of community relations, said this week.

Bud Hufnagel, chief executive officer, presented the board with six options for the future of Three Rivers Hospital, ranging from restructuring services to closing the hospital. Three Rivers Hospital serves a district that includes the Methow Valley from Mazama to Pateros, as well as the communities of Brewster, Bridgeport and Mansfield.

The hospital has been unable to sustain itself financially for more than a decade, relying on loans from Okanogan County to support operations. Three Rivers has been in debt by as much as $3.2 million, and currently carries about $2.2 million in warrants from the county.

Two years ago the hospital board hired Hufnagel, who has a background in health care consulting, to attempt a “turnaround” of the hospital, which is supported in part by property taxes levied as a special taxing district. At its meeting last week, the board approved increasing the hospital district’s tax levy by 1 percent as allowed by state law. The levy is expected to generate $1.2 million in 2014.


Range of options

The restructuring proposals developed by Hufnagel call for downgrading the hospital’s emergency room from a Level 4 trauma facility, which means a surgeon is on-call within 30 minutes at all times, to a Level 5 facility without an on-call surgeon.

The hospital’s surgical unit would be open Monday through Friday, with no after-hours procedures under those proposals. However, Meadows said, “if there was an emergency surgery that had to take place here, there would be a surgeon available.”

The options also call for eliminating the hospital’s cardiopulmonary rehabilitation unit, selling the hospital’s HealthBeat Fitness center and selling a medical equipment department. Two options propose eliminating total joint replacement surgeries and labor and delivery.

Obstetrics is a “loss leader,” Hufnagel said. “Hospitals simply don’t get paid enough for OB to be profitable. In urban settings the majority of patients have Blue Cross or other commercial insurance so hospitals have an opportunity to cut their losses. If you are in a rural setting with a high Medicaid or self-pay population you don’t have any opportunity to do that.”

Hufnagel also proposed a hospital model focused around an outpatient medical clinic and emergency services.

The different options call for cutting about 20 full-time-equivalent positions from the hospital staff. The hospital’s current 2014 budget calls for approximately 104 full-time-equivalent positions.

Hufnagel cites an on-going loss of physicians as the cause of much of hospital’s financial distress, because doctors are essential to bringing patients into the hospital. Since 2011, he said, six physicians have left the area.

Despite collaborating with Confluence Health in Wenatchee and Family Medical Centers in Brewster to recruit new doctors to practice in the region, only one doctor has been recruited “and we remain below the necessary level needed to support the hospital district,” Hufnagel said.

Meadows said there are currently four family practitioners, one midwife, a surgeon and an orthopedic surgeon with privileges at the hospital.

From 2011-2012, Three Rivers Hospital saw a 23 percent decline in admissions, a 36 percent decline in deliveries of babies, a 16 percent drop in length of hospital stays and a 37 percent drop in total patient days, according to figures prepared for the board.

Outpatient revenues dropped by 13 percent during that period, and surgical revenues fell by 28 percent.

Although they delayed consideration of options for restructuring the hospital, board members directed Hufnagel to take steps to sell the HealthBeat Fitness and the Advantage Durable Medical Equipment facilities, both located on Brewster’s Main Street.

“We were really hoping the board would make a decision and the plans could be implemented … so by mid-January we could be heading a certain direction,” Meadows said. “But I fully understand why the board decided to delay their choice, because this is a huge decision they have to make.”

Meadows said hospital administration is working to refine proposals for the board’s consideration and possible action at its meeting on Dec. 16 at noon in the hospital’s administration building.