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Bassett Head Answers Queries, Opens Up About Challenges

Editor’s Note: Iron String Press hears from readers of “The Freeman’s Journal,” “Hometown Oneonta” and AllOtsego.com on a regular basis, in a variety of ways, be it via e-mail, telephone or text. Folks also stop by to chat and offer their opinions on the news of the day, responding both positively and negatively to various stories and subjects of general interest. One of the topics our readers seem most interested in is Bassett Healthcare Network, and their questions and comments run the gamut—from health concerns, to financial stability, to staffing and housing shortages. New Bassett President and Chief Executive Staci Thompson, MHA, FACMPE, agreed this week to address some of those questions and concerns from our readers. We appreciate her time, and believe these responses will clear up some misconceptions, clarify struggles faced by Bassett administrators and the healthcare industry in general, and illustrate how the network is addressing these challenges.

Question 1. We have had three or four folks just this week reach out, who are suffering from health issues and who are in severe pain, and yet their physicians will not prescribe anything that will give them relief. These are people who have visible difficulty walking, standing, etc. I know the intention is to prevent people from becoming addicted to painkillers, which is a very real and very frightening issue, but is there nothing that can be done to help these folks? What sort of pain management does the hospital provide? What does it entail?

Pain management is a very challenging aspect of medical care, which often requires a multidisciplinary approach for easing the suffering and improving the quality of life of anyone experiencing pain. Its practice requires balancing treatment to preserve quality of life while choosing care approaches that will offer the best long-term outcomes with limited side effects.

One of the most important actions the medical community can take is to support reduced, safe, and appropriate prescribing of pain medication. Although some commonly prescribed medications—like oxycodone, hydrocodone, and tramadol—are useful for controlling pain, they have the potential to cause dangerous side effects, including addiction. Other narcotic medications, like morphine, fentanyl, methadone, oxymorphone, and hydromorphone, while often used for pain management when a patient is hospitalized, are less appropriate for use once the patient goes home.

Bassett Healthcare Network has an interdisciplinary team dedicated to Interventional Pain Management. The program is a subset of what our greater hospital system offers as it relates to managing pain. Many practitioners across our network work with patients to prescribe medications to address pain after considering indications, risks, and benefits (both in the short- and long-term). When pain persists and medication options have not worked well, patients are often referred to Interventional Pain Management.

Interventional Pain Management provides services and support to patients for chronic and subacute pain conditions. The program works with patients and their caregivers to develop the most effective care plans for their needs through lifestyle changes, physical and occupational therapy, and other types of pain management techniques. Other treatments may include smoking cessation services, ergonomics, weight loss and nutrition therapy, exercise therapy, stress management, and more. They will also occasionally suggest medications to use in combination with these other lifestyle therapies that are not opioids. All practitioners in Interventional Pain Management are fellowship-trained physicians with years of specialized training.

This team does not prescribe opioid medications. Although opioids have a role in addressing short-term acute pain or post-surgical pain, in general, these medicines are not useful for chronic issues and may, in fact, make the situation much worse. Patients who may benefit from this service should speak to their primary care provider to receive a referral to our Interventional Pain Management team.

As a reminder to all readers, help is always available for those struggling with addiction. Call toll-free at 1-877-8-HOPE-NY. All calls are free, anonymous and confidential.

Question 2: A woman recently recounted a story to our office regarding being prescribed a medication that should not be taken with her other medications. This woman discovered the issue herself, in reading the literature that came with the new prescription. Don’t physicians check the patients’ charts to make sure they are not prescribing something the patient should not be taking? Another person we heard from was a patient who was prescribed a medication to which she was allergic. Same question as above with regard to checking the patients’ charts. Perhaps these instances are the result of staffing shortages/too much on people’s plates?

Patient safety is always our number one priority. Any time a patient is prescribed a medication, our providers and pharmacists work together to determine the benefits and risks associated with treatment plans. Every patient’s electronic medical record has several layers of safety features, including warnings that pop up for practitioners if they have attempted to put an order in for a medication that may interact with other drugs the patient is taking. Likewise, if a patient has a known medication allergy, an alert will pop up on a clinician’s screen and the prescription process is halted. These electronic database safety features will appear for both the patient’s prescribing provider and the pharmacist, ensuring our teams can uphold the highest quality and safety standards of care.

It is important to remember that many medications, in combination, may cause minor interactions. When a patient is prescribed a medication, their care team has determined that the treatment will provide the most benefit compared to potential side effects. If patients have questions about their treatment plans, they should reach out to their care teams for more information by calling their clinic’s office or sending a message directly using MyBassett.

Additionally, Bassett’s dedicated Patient Advocacy team works closely with our Quality and Patient Safety experts to investigate and support patients who report concerns to us. Patients are key members of their care teams—and we’re here to make sure they are receiving the right care, in the right place, at the right time.

Question 3: As you probably know, Chip Northrup has submitted a couple letters to the editor taking into question the financial viability of Bassett, based on available financial reports. Can you speak at all to the current financial difficulties being faced and plans to turn things around?

Healthcare is rapidly changing—especially in rural areas—as health systems around the country grapple with a convergence of global and industry factors in a post-COVID-19 environment. Bassett Healthcare Network, like many other healthcare organizations, is working to rapidly address significant operational challenges.

While we have made progress in improving patient access and growing patient volume across the organization, our expenses have escalated at a rate that eclipses our revenue growth. Revenues are simply not offsetting the increasing cost of operations. To best serve our communities, we must find ways to increase services and access while also reducing our costs to provide those necessary health services.

Bassett’s leaders and experts are deeply engaged in critical work related to stabilizing operations and financial performance. We have engaged a leading expert in health system stabilization, who is working with us over the next few months to identify and implement solutions that will best position Bassett for long-term success. It is vital that we work quickly to address financial and operational challenges like rising costs for staffing and supplies, reimbursement changes from government payors, technological advances, and major workforce shifts, among other factors.

At the center of our analysis and planning is patient care. We are focused on creating sustainable models and systems with expertise and guidance from dedicated Bassett leaders and clinicians as we move forward. We have served our Central New York communities for 100 years—and we are committed to remaining an independent, patient-centered system of care for our patients and communities for many more years to come.

Question 4: Are you able/willing to provide any insight into what is impacting the network’s bottom line?

Since the COVID-19 pandemic, all organizations are facing rapidly rising costs. In healthcare specifically, the costs of personnel, supplies, and other things essential to providing care have skyrocketed while reimbursement rates either remain flat or are declining. Think about it—in addition to increased costs of the more medically-oriented resources we require to operate (like machinery and technology, medications, personal protective equipment, tools, many other supplies, and the costs to service them), we also endure increased costs of everyday items like fuel, food, raw materials, office supplies, and more. Combined with swiftly rising costs to recruit and retain personnel, among other complicated operational factors, these expenses are tremendous.

This is especially challenging for hospitals in rural areas. We must find smart and creative ways to be self-sustaining and increase the services we are offering while decreasing expenses. This is extremely complex work.

Question 5: Is lack of physicians and/or other staff resulting in fewer procedures and therefore less income? For instance, I spoke with a patient who was preparing for a necessary surgery, only to learn that their doctor left the system rather abruptly and, as I understand it, there is now only one surgeon remaining who can perform the procedure. That doctor, for whatever reason, does not come highly recommended. When this happens, are patients allowed to go out of network if no doctors are available within the Bassett system?

Access to care is a top priority for our organization as we work to best serve all our patients. Unfortunately, we have seen patients struggling to get timely appointments and services at Bassett, and we are working hard to ensure that this improves. Out-of-network providers are an option for some patients, but for many, pursuing these services can be inconvenient and/or cost-prohibitive. As always, we are working to accommodate the needs of our patients in-network whenever possible.

While the demand for services is high, the tight supply of qualified practitioners and staff due to retirements, turnover, and burnout has driven up staffing costs. Staffing challenges are affecting how quickly and efficiently patients can access the care they need. If people cannot get the care they need in a timely fashion, they may become sicker. In rural areas, where many people travel distances to get care, this becomes an even bigger challenge.

We continue to prioritize recruitment and retention to expand the availability of services to our patients and communities. This is true in all areas, including in inpatient settings, emergency departments, surgery, family medicine, specialty practices, and long-term care facilities. We have already begun to see an increase in the number of practitioners coming to Bassett, which will allow for improved waiting times for appointments. Additionally, we have been successfully adding virtual practitioners to our medical staff who are helping tremendously to reduce wait times for appointments in departments like Primary Care, Endocrinology, Bariatrics, and Surgery.

Question 6: Another example of a patient who will probably have to seek assistance elsewhere is a woman recently referred to outpatient mental health. The PA said she would refer her, but that there is a backlog of about six months. That woman will probably have to find a doctor out of the Bassett system as well.

Psychiatry and Behavioral Health are critical services that are highly needed across the nation. In Bassett’s service area, this is no exception. Our care teams in this area are working diligently to serve the patients seeking our services while we work to recruit practitioners.

We have been embracing both short- and long-term solutions that connect patients with needed care, including with emergency and inpatient telehealth psychiatric services in partnership with Iris Telehealth, a national organization dedicated to offering expert services in psychiatry and clinical social work. We also work closely with county mental health services for local referrals.

Mental healthcare is a fundamental part of overall healthcare. Bassett is dedicated to finding solutions and continuing to find the most expedient ways to serve our patients and communities with these critical services.

Question 7: Housing has become a very controversial subject here in Otsego County of late, with the pushback against both the Templeton Foundation Averill Road here in Cooperstown as well as the RSS-proposed housing unit in Oneonta. Are you able to talk about what impact the lack of housing has had on Bassett? One hospital administrator quoted in an article published in Rural Health Information Hub said she loses 1-2 prospective employees each month due to housing issues. Does this hold true for Bassett as well? Are prospective doctors, etc., being lost due to Cooperstown’s rural location and/or lack of housing?

Lack of housing across Bassett Healthcare Network’s service area is closely related to problems with recruitment and retention of caregivers to our facilities. Housing is vital to the health of our communities in many ways. Our ability to present adequate housing options to prospective employees will influence the success of our recruitment efforts—especially when prospective employees are moving to our rural area from urban locations. This includes housing options that are convenient to our facilities—whether in Cooperstown or Oneonta—and investing in our communities with a forward-thinking strategy to boost the quality of life for our population.

Question 8. We consistently hear reports of patients who find a physician they like, only to have to choose another prime care doctor because that physician has left or is leaving. I personally know of two Bassett patients who have had multiple prime care doctors over a short span because their doctors keep leaving. What is the average number of years a physician/surgeon/doctor stays once hired? What is the average for the past 10 years in particular?

Practitioners are departing healthcare organizations (and the healthcare industry in general) at an unprecedented rate nationally. We predicted years ago the widespread effects retirements would have when clinicians in the baby boomer generation approached retirement age. What we could not have predicted was that this natural generational shift would occur at the same time as a devastating global pandemic. According to projections from the Association of American Medical Colleges, the United States will face a physician shortage of up to 86,000 doctors by 2036. Between a large volume of retirements nationally and post-pandemic burnout and turnover, pools of caregiver staffing—particularly with practitioners—is more challenging now than in recent memory.

Bassett Healthcare Network’s leadership has made recruitment of practitioners a top priority. Our goal is to increase signed contracts for new practitioners by at least 30 percent over the most recent historical average by the end of 2024. Much of this has been made possible by an $82 million grant we received from The Scriven Foundation in 2022, which was awarded to Bassett for initiatives related to recruitment and retention.

In addition to prioritizing recruitment, we have also significantly bolstered our strategic approaches to retaining medical staff by building a new retention program that is dedicated to long-term onboarding and engagement. We have hired practitioner retention specialists who are dedicated to overseeing this program, acting as partners with individual practitioners and groups to ensure that both new and existing medical staff are engaged, connected, and continuing a path to building their careers here.

Between January 1, 2024 and April 15, 2024, we hired more than 30 physicians and advanced practice clinicians (nurse practitioners or physician assistants) in a variety of disciplines, including Anesthesiology, Cardiovascular Services and Cardiac Surgery, General Surgery, Nephrology, Urology, Endocrinology, Psychiatry, Family Medicine, Digestive Diseases, Emergency and Trauma Services, Cancer Care, and Women’s Health. In 2023, we hired more than 70 practitioners across the network. We are working as quickly as we can to bring more providers on to our medical staff.

We are making progress with hiring practitioners. Our Medical Staff Recruitment team works closely with clinical leadership to carry out national outreach to recruit talented practitioners to our organization. We are offering competitive sign-on bonuses for clinicians. Additionally, virtual practitioners are rapidly becoming a critical component of our medical staff, serving in disciplines like Primary Care, Endocrinology, Bariatrics, and Surgery.

Question 9: Are you planning any big organizational changes in the coming months that might address some of the challenges currently faced?

My intense focus through 2024 is on stability and operational efficiency. Our top organizational priorities include recruitment and retention of caregivers, providing exceptional patient care and experiences, improving access by embracing virtual health and innovation, continued network integration, and financial viability. Everything we do around these initiatives is directly related to what matters most—providing excellent and safe patient care, and maintaining a deep commitment to remaining an independent, community-based organization. This work is well underway and involves direct input from medical staff, leaders, and caregivers around the network. They are critical to our success.

Much of this work is not visible to our patients and communities day-to-day—our experts are always optimizing processes and operations across the organization to strengthen how we function. This means everything from supply ordering and costs, to

scheduling procedures, to revenue management and collections, to workforce management. As always, it is our goal to provide safe and excellent care to every patient with seamless experiences. Every decision we make is centered on this goal.

Question 10: Since COVID is on the wane, are there any plans on re-opening the “walk-in” Convenient Care in the clinic in Cooperstown?

We are always looking at our services and facilities to see where we can best allocate resources to meet patient needs. Right now, we have Convenient Care open seven days per week in Oneonta and Herkimer. Same-day appointments are available at both locations.

While we do not have any plans immediately to re-open Convenient Care in Cooperstown, I would ultimately like to see this service reestablished in Cooperstown to aid in providing access for our community. Along with this, we have been working to rapidly expand virtual care options—including for on-demand virtual visits. These quick appointments, which do not require appointments at all, are available with a few taps on your mobile phone or computer. Patients can receive care from the comfort of their homes or offices for things like colds and flu, ear and sinus infections, headaches, rashes, minor scrapes and bruises, pink eye, allergies, and many other symptoms and conditions that someone might otherwise visit an urgent care clinic for. Visit bassett.org/GetCareNow to get started.

Question 11: Why are COVID patients having elective surgery? It seems if it’s elective, surgery could wait until the patient is healthy, thus not submitting staff to the virus.

COVID-19-positive patients are not eligible to receive elective surgery. Per guidelines outlined by both the Centers for Disease Control & Prevention (CDC) and New York State Department of Health, all patients are properly screened for symptoms prior to any appointments, and we test all patients who are scheduled for elective procedures for COVID-19 as part of their pre-surgical screening process. If a patient becomes COVID-19-positive ahead of a scheduled procedure, they will be re-scheduled at a later time.

Question 12: Would you be able/willing to give me a few specific examples of stumbling blocks you have come up against since joining the Bassett team, both before you became interim head up to the present? (E.g., promising new hires who backed out when they realized how rural Otsego County actually is, or who may have experienced culture shock or difficulty finding appropriate housing). I think if the public had some specifics they might really begin to understand the difficulties the hospital faces despite its best efforts.

Having served at Guthrie Health, a rural healthcare system that spans more than 10,000 square miles in New York and Pennsylvania, I have a thorough understanding of the unique needs and challenges of rural populations. Recruiting and retaining talented people to rural areas is always challenging. Lack of resources, like housing, transportation, and broadband access, also pose daily obstacles for patients, caregivers, and others that are not necessarily barriers in urban areas. These are all things rural healthcare leaders analyze daily.

But in addition to these operational and social obstacles are the challenges posed by some of the more deeply rooted cultural considerations I’ve come to understand in my 28 years in rural healthcare. Namely, learning how to embrace an organization’s history, independence, and community presence while also finding efficient and meaningful ways to keep the business viable and relevant. Even more important is helping the organization’s caregivers and communities understand this balance and necessity.

I am dedicated to honoring Bassett’s rich history and preserving our health system as a local, independent, community-centered network of care. We also must make critical decisions to ensure this organization is here well into the future. Bassett Healthcare Network today does not look the same as it did 10, five, or even two years ago. In order to thrive and position the organization for long-term success, we must evolve. Change is not only good—it’s necessary.

I am optimistic about Bassett’s future because of the strength and commitment of our caregivers. Their devotion to our patients and organization is deeply appreciated. Since my arrival at Bassett in May 2023 (when I was then in the role of chief operating officer), I have felt at home. Bassett Healthcare Network is an extraordinary health system filled with people who are compassionate, talented, and fiercely dedicated to our patients and communities. I could not be prouder to work alongside these outstanding caregivers.

Staci Thompson is president and chief executive officer of Bassett Healthcare Network.