EditorialsIt’s painful to watch Three Rivers Hospital struggle with the tough decisions that will be necessary to stay operational and deliver a reasonable level of services to the taxing district that supports it.

Health care – how to get it, what to pay for it, where to find it, who to trust with it – is top of mind for most of us these days, and Three Rivers is in the thick of a survival struggle whose prognosis is murky.

As one of the few medical facilities within reach of the Methow Valley, the hospital in Brewster continues to play an important health care role – albeit a money-losing one in recent years. In the past, Three Rivers has tried to build its business with a variety of offerings – theoretically, not a bad strategy. Now it’s trying to save itself by reducing its offerings – realistically, a necessary strategy.

In fact, just about everything hospital CEO Bud Hufnagel says about what the hospital must do is realistic and practical, and each of his proposals has its consequences. But it is inescapable that Three Rivers must realign its services with the marketplace.

There are no easy choices. Hufnagel has suggested that the hospital should even consider eliminating perhaps the one program that has consistently distinguished it. Three Rivers is certified as a “Baby Friendly” hospital through an international accreditation program. But obstetrics is a “loss leader” for the hospital, Hufnagel says, meaning that it loses money even as it draws positive attention.

Retailers can afford loss leaders to bring in business. It doesn’t necessarily work that way for hospitals. “I don’t have the privilege of looking at that with a lot of emotion,” Hufnagel recently told the Methow Valley News.

Indeed, Hufnagel’s job isn’t to be popular right now. It’s to give the board of directors options. Ultimately it’s the board that will have to risk unpopularity by sorting out the choices.

A key component of Hufnagel’s plan is to keep the hospital’s emergency care services going, but perhaps not as a Level 4 emergency room, which requires having a surgeon on call within 30 minutes of the hospital at all times. Scaling back to Level 5, which doesn’t require an on-call surgeon, could produce substantial savings, Hufnagel said.

Three Rivers’ focus will be to continue operating as a Critical Access Hospital, meaning that it offers emergency care 24 hours a day, seven days a week – while de-emphasizing in-patient care. Also up for discussion are a hospital-owned fitness center, a medical equipment department and a cardiac rehabilitation unit.

Out of this will emerge a Three Rivers Hospital that looks somewhat different. After restructuring, the biggest challenge may be not only redefining the hospital’s core mission but also finding a way to get that message across. What is Three Rivers Hospital, and what can we rely on it for?

The focus will need to be not on what Three Rivers no longer offers, but what it continues to offer and the quality of that care.

–Don Nelson