A.O. Fox Hospital Transformation: A Conversation with Fox President Jeff Joyner

A.O. Fox Hospital

April 22, 2016

Q. Why is a transformation plan necessary for Fox Hospital?

A.  Fox Hospital, like many community hospitals, is struggling financially.  In order to assure Fox Hospital’s long-term viability, we need to make changes that will better position Fox for the future. The transformation plan is designed to do that.  Critical to this work is the $21.4 million in essential health care provider support funding that New York State awarded Fox Hospital earlier this year. That funding will allow us to clean up our debt and invest in a growth strategy for Fox – one designed to help us adapt to the changing health care environment and continue to meet the needs of the population we serve for decades to come.


Q. What does the transformation plan entail?

A.  The plan responds to a trend we’re seeing locally, as well as in similar rural regions across the country. Fewer people are giving birth. At the same time, we’re getting older and our shoulders, hips, knees and spines are wearing out. The transformation plan is designed to help address this by growing the orthopedic program in Oneonta and establishing an orthopedic center of excellence at Fox Hospital. In contrast, the birthing program at Fox has experienced a significant decline in deliveries and given the high set of costs associated with maintaining an obstetrics program, it operates at a significant loss. For these reasons, the transformation plan also calls for consolidating labor and delivery services at Fox with the program at the Bassett Birthing Center in Cooperstown.


Q. When would labor & delivery services end at Fox, and what about general maternity care?

A. Fox has submitted a certificate of need (CON) to the New York State Department of Health to consolidate Fox Hospital’s labor and delivery services into a single program at Bassett Medical Center by January 1, 2017. This timeline, if approved by the state, gives us several months to smoothly transition services. It is important to note that under this proposal, prenatal and post pregnancy care would still be available at Fox and Bassett facilities. So women would still be able to receive all of their outpatient maternity care at Fox and Bassett locations in Oneonta and Cooperstown, as well as at other locations where these services are offered in the Bassett Network.


Q. What is the volume of births at Fox Hospital?

A. Deliveries at Fox over the past few years have consistently declined with less than 250 births at Fox Hospital in 2015 and less than 50 as of mid-April. We’re operating the program at a significant loss, which is not sustainable. For this reason, we feel it is in the best interest of our patients to combine our program with the one in place at the Bassett Birthing Center, which handles approximately 900 deliveries annually. In fact, January of 2016 was a record month with 104 babies born at the birthing center in that month alone.


Q. If the state approves of the plan to end labor and delivery services at Fox Hospital, what happens if an expectant mother in labor comes to the Fox ED or other hospital ED in the Bassett Healthcare Network?

A. Emergency departments (ED) are prepared to handle this situation. Mom would be assessed and the ED provider would determine next steps. This could mean an onsite delivery or transferring the patient to a hospital with an OB unit to optimize the outcome for mom and baby.


Q. How does the L&D closure plan factor in where women throughout the region served by Bassett Healthcare Network are delivering their babies?

A. Fox, in partnership with Bassett Medical Center, looked very closely at where families are coming from throughout the eight counties served by the network. An equal number of people go to Bassett in Cooperstown from Delaware County as those that choose to come to Fox Hospital.  There are also many women who come from the northern reaches of the network to deliver in Cooperstown. If we relocated everything to Fox, we’d be creating a parallel or worse transportation problem for a significant number of families. In the end, the best decision for patients and the long-term viability of Fox Hospital is to combine the programs into one at the Bassett Birthing Center.


Q. Can Bassett’s Birthing Center accommodate another 100 or more deliveries a year?

A. Because of the uncertainty associated with when deliveries actually occur, Bassett already has developed the ability to flex its labor and delivery capacity to meet variable needs. So in the short term, we have processes in place to handle the increase. Longer term, there is a plan being reviewed to renovate and expand the Bassett Birthing Center to accommodate further growth. 


Q. What about orthopedics at Bassett in Cooperstown and Oneonta Specialty Services, as well as around the network. Will these services be affected by the plan to create a center of excellence at Fox?

A. Any expansion of programs at Fox would not replace services at Bassett Medical Center. Orthopedics across the Bassett Network is an area of significant patient demand. The scope of services under a center of excellence program will be determined with the help of an implementation team made up of leadership from Fox Hospital, Bassett Medical Center, and the Bassett Medical Group.


Q. When would these changes to orthopedics and labor and delivery start occurring?

A. Some of it is dependent on the state’s approval. However, we are putting together transition teams comprised of the appropriate professional staff from both hospitals to begin the work of determining the best way to accomplish the proposed changes. This includes determining a timeline for exactly when the changes would occur.


Q. When will DOH make a decision on the proposed labor and delivery consolidation?

A. DOH has not given us a definitive date, but we hope to have a response within the next couple of months.


Q. What is Fox Hospital’s financial status?

A.  Fox received a $21.4 million dollar state grant earlier this year, the bulk of which will be used for debt restructuring. Having regained its financial footing, Fox, in conjunction with Bassett Healthcare Network, can focus on repositioning itself for the future. The challenge for Fox and the entire Network is to adapt to the current climate where we are still operating in a fee-for-service (driven by volume) world, but transitioning at the same time to preventive health, population health management, and new payment systems – all while attempting to become more efficient at what we do and lower health care costs. 


Q. You have characterized theses latest changes as the next level of integration. What other integration efforts have occurred since Bassett and Fox signed an affiliation agreement six years ago?

A.  Just last year, Bassett consolidated its cataract surgery and urology programs in Oneonta to Fox locations. Prior to that, Fox and Bassett were already cooperating in the areas of cardiology and cancer care, orthopedics, and general surgery. One of the most significant areas of investment underway now is the planned upgrade of Fox Hospital’s electronic medical record and integration of information technology services so that Fox will have the same electronic medical record platform available at all other network hospitals by the spring of 2017. This means that patients’ medical information will be available in real time no matter where they are seen within the network for their care.

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