Unintended Consequences – Northumberland Hills CEO says replacing ALC patients comes at a cost

Reducing the number of “alternative level of care” (ALC) patients in a hospital may have unintended consequences.

Robert Biron, CEO of the Cobourg’s Northumberland Hills Hospital, told the Central East LHIN yesterday that his current operating deficit may be partially linked to the hospital’s success in reducing the number of ALC patients from a high of 36.8 per cent in December 2010 to a low of 2 per cent in June of this year.

Alternate level of care patients are those who have completed their acute care treatment at the hospital but are not well enough to return home. Wait lists for long-term care beds and home care services have left many hospitals without an ability to responsibly discharge these patients.

Biron says filling the former ALC beds with high acuity patients requires more resources, not less, including advanced nursing care. These are additional costs to the hospital in a year when base budgets are frozen.

The NHH CEO said key financial pressures include increased usage of both the emergency department and the intensive care unit at the hospital. NHH experienced an 11 per cent increase in admissions through the ED, whereas patient days have increased by 14 per cent in the intensive care unit.

The hospital is also feeling the effects of a sour economy as fewer patients arrive with insurance to cover preferred accommodation. That’s less revenue to apply against the hospital’s bottom line.

The worst case scenario for Biron will be finishing the fiscal year at the end of March with a $607,000 deficit. The most optimistic forecast is for a balanced budget. Much will depend on the impact of this year’s flu season on admissions to the hospital. This will be the first time since 2009/10 that NHH has faced an operating deficit.

Biron told the LHIN that he has nothing left to cut – all he has left are essential core services after divestment and closure in recent years. The hospital has recently lost 34 acute, interim long-term care and complex continuing care beds as well as an outpatient diabetes education program and outpatient rehab services. All were the subject of community demonstrations in 2010 and some say contributed to the defeat of Liberal incumbent Lou Rinaldi in the 2011 Ontario election.

Northumberland Hills Hospital spends less than 8 per cent of its budget on administrative costs — among the lowest in the province.

That doesn’t mean the hospital is not undertaking other measures to reduce costs, including reducing their reliance on agency supplied emergency room physicians by recruiting their own staff.

If there is a small silver lining for Biron, the CE LHIN did approve reallocation of $340,000 in funding towards inpatient therapy services at the hospital. The hospital is trying to secure permanent funding for these services. CE LHIN Senior Director Paul Barker calls such reallocations “recurring one-time funding.” The bad news is this funding must be used up by March 31, 2013.

Reallocations are an opportunity for the LHIN to take forecasts of unused funding and direct it towards priority services in the third quarter of each year.

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