The Partial Observer by Maureen Dill

On the Crisis in Rural Healthcare…

“If you really want to hear about it, the first thing you will want to know is….” (Holden Caulfield)

Is this about me and the Bassett Primary Care physician who dismissed me from among her patients without any warning, stating in a September letter that she had made a decision to curtail her practice? 

Is this about my community here in the Butternut Valley of Otsego County and the sudden, unexpected closing of the Bassett Healthcare Center in Morris—a valuable and necessary community resource that had served more than 900 residents of the Butternut Valley?

Is this about local volunteer ambulance squads forced to wait lengthy periods of time with patients onboard outside our local hospital ER?

Is this about a family member here in rural Otsego County who drove round-trip to an Albany hospital for eight consecutive days because she was fearful of having a relative treated at one of our area hospitals?   

Is this about the current state of healthcare here in New York State and elsewhere? Why here in Otsego County, when a recent television documentary identified the 10 wealthiest communities in New York State, naming Cooperstown as one of the wealthiest, among such notables as Scarsdale and Skaneateles?

You bet it is! 

In mid-September, when my Primary Care physician at Bassett dismissed me as her patient, without so much as a warning or for a reason one might consider as warranted—I (me) being an octogenarian and a resident of Otsego County for more than 25 years—and when Bassett Hospital unexpectedly closed its healthcare clinic in the Village of Morris—I and others dismissed by this same physician began to take a closer look at rural healthcare, not only here at home but on the state and national level. 

A recent national news report revealed that physicians are quitting nationwide, said to be demoralized by the current state of the healthcare system. In the days and weeks before I wrote this “Partial Observer,” 117,000 physicians reportedly left their professions across the U.S., with projections that one in five will soon be stepping away.

Records from our oft-neglected corner of beautiful Otsego County revealed that among the more than 900 residents of our Butternut Valley corridor of Otsego County served by Bassett’s healthcare center in Morris—men, women, and children from the Town of New Lisbon, the hamlet of Garrattsville, Mt. Vision, the Village and Town of Morris, the Village of Gilbertsville, and the Town of Butternuts—many were frail, elderly or in need of transportation.

We need to be informed as to what had prompted the closing of this important community resource. In recent years, we have all become painfully aware of the lack of resources in this corner of Otsego County, whether it be public transportation, broadband, cellular service, Internet services, or ever-diminishing EMS personnel. Among the services provided by this important community asset were preventative family medicine, flu shots, routine screenings, sick patient exams, nutrition counseling, cancer screenings, depression and anxiety referrals and prescriptions, annual physical exams, family planning, health and wellness, routine blood tests, prescriptions, elder care, and chronic condition care.

Surprisingly, one comprehensive listing, the “Concierge List,” sent to me by Ann Marie, a member of Bassett’s Prime Care Clinic in Cooperstown, revealed that there is still a Bassett healthcare center active in the Edmeston/Burlington area. A phone call to the number listed for this clinic linked me to a young woman who said she was the “call center” for Bassett Prime Care Services. Curious about where this young woman at the other end of the phone line was located, I asked: “Where are you?” To which she replied, “Destin, Florida.” And not too long after answering her two questions that served as identifiers for me, the caller, she revealed information concerning my health status that might only have been gained through access to my database at Bassett.

Who was this young woman so far away down in Florida’s Panhandle who has access to my health records? Following Bassett’s recent reduction of 101 staff members, is she still there? She did tell me that the Edmeston/Burlington clinic operated from Monday through Friday from 8 a.m. to 5 p.m.

Letters published in local print media in recent months have come from residents voicing their concerns regarding their difficulty in identifying replacement physicians—once their primary care provider has either decided to leave the Bassett network, relocate elsewhere, or simply curtail their practice. Some physicians referred by colleagues or family members who have been deemed worthwhile replacements have said they are not taking any more patients—or that they, themselves, are planning to leave the area. Among those searching for new healthcare providers are young mothers with children, older professionals, and elderly women and men. 

The phrase “rural healthcare” is rapidly becoming an oxymoron. Just open any media outlet and you can see scores of reports and comments from the readership concerning the state of healthcare across New York State. Bassett, a rural health system based in Cooperstown, reportedly serves eight counties across 5,600 square miles. But the closing of their healthcare center in Morris has left residents of this rural corner of Otsego County hard-pressed to access quality services.

An article in the local press announced an $82 million grant to Bassett Healthcare by The Scriven Foundation, said to address Bassett’s $80 million shortfall in 2022. There was another report of a similar Bassett shortfall in 2023. Upon receiving the Scriven grant, Bassett announced that, in addition to other needs, this grant would “fund programs to address the challenges rural healthcare operations encounter every day.” And, yet, still no return of the healthcare clinic In Morris. It is incumbent upon us, as representatives of the former patients of the Morris Healthcare Center, to petition for the immediate re-opening of this center, thereby enabling Bassett to live up to its reputation as “a leader in fostering healthy rural communities.”

But since we now suspect that Bassett may have abandoned its plan to resume healthcare operations in this corner of our county, there are some who have suggested we instead reach out to United Health Services in Chenango or Delaware counties, whose services are being touted as excellent by residents in our area seeking access to good healthcare services. Bassett Hospital is not part of UHS, so these residents have reportedly turned to UHS in Norwich and Sidney since the closing of the Morris unit.  (Note that there is another entity identified by the letters “UHS” (Universal Health Services), not to be confused with United Health Services.  Universal Health Services is a Fortune 500 for-profit corporation, one of the largest in the U.S.)

While there have been discussions among Butternut Valley residents of the idea of appealing to UHS to establish a healthcare clinic in the Village of Morris, in order to once again provide meaningful healthcare services to the residents of this oft-neglected corner of Otsego County (sorry to feel it necessary to repeat this), when the clinic was abruptly closed in September 2021, it had been with Bassett’s assurance it would be re-opened as soon as a suitable healthcare professional had been identified to staff this clinic. Discussions among residents of the need for this important community resource also turned, recently, to the idea of engaging the leadership of the Butternut Valley Alliance, a local nonprofit that had created an effective task force to address the sudden withdrawal of banking services by Community Bank NA in Morris. The BVA was subsequently instrumental in engaging the banking services of Sidney Federal Credit Union.  As the result of the BVA initiative, SFCU quickly established an outpost in the Morris community, with the promise of more traditional banking services to follow.   

Shown below are some online data reported for 2022 for three area hospitals here in Central New York (www.CHQPR.org). “Total Expenses” are indicative of the relative size of the hospital in terms of both inpatient and outpatient services. The “Patient Service Margin” represents the profit or loss from revenues and costs associated with healthcare services delivered to patients. Many small rural hospitals have a positive total margin despite incurring losses on patient services because they receive local tax revenues or state grants that offset the losses. If these other sources of revenue were to decrease or be terminated, the hospital would no longer have revenues sufficient to cover its costs: Fox Memorial Hospital, Oneonta, Total Expenses $87,041.135, Patient Services Margin -12.8%; Bassett Hospital, Cooperstown, Total Expenses $710,456.136, Patient Services Margin -11.9%; Chenango Memorial, Norwich, Total Expenses $90,444.781, Patient Services Margin -1.3%.

Small rural hospitals are struggling to survive and men, women, and children in rural communities are facing harm. More than 20 percent of all rural hospitals in the country are at risk of closing in the near future. Rural areas face many healthcare issues, not the least of which is access, with rural residents often having less access to quality healthcare than urban residents. This can be due to a lack of doctors and other healthcare professionals in rural areas, or because clinics and hospitals may be far away. Small rural hospitals deliver not only traditional hospital services such as emergency care and inpatient care, but many of them also deliver primary care. The majority of the communities served are at least a half-hour drive from the nearest hospital, and many communities have no alternate sources of health care. The majority of small rural hospitals are losing money delivering patient services. In many instances, the closure of these hospitals meant that residents of the community must now travel much farther when they have an emergency or need healthcare services. This increases the risk of death or disability when accidents or serious medical conditions occur, increasing the risk of health problems going undiagnosed or inadequately treated due to lack of access to care.

It will cost about $4 billion a year to preserve access to rural healthcare services, an amount equal to only 1/10 of 1 percent of total national healthcare spending.  No payment system will sustain rural hospitals and clinics unless the amounts of payment are large enough to cover the cost of delivering high-quality care in small rural communities. Because current payments are below the costs of delivering services, an increase in spending by all payers will be needed to keep rural hospitals solvent, but $4 billion is a tiny amount in comparison to the more than $3.3 trillion spent on all urban and rural hospitals in the country. Moreover, most of the increase in spending will support primary care and emergency care, since these are the services at small rural hospitals where the biggest shortfalls in current payments exist.

Citizens, businesses, local governments, state government, and the federal government must all take action to ensure that every payer provides adequate and appropriate payments for small rural hospitals and clinics. Businesses, state and local governments, and rural residents, must demand that private health insurance companies change the way they pay small rural hospitals. State Medicaid programs and managed care organizations must pay small rural hospitals adequately for their services. Congress must create a patient-centered payment program in Medicare for small rural hospitals.

On the other hand, rural hospitals need to be transparent about their costs, efficiency, and quality, and they should do what they can to control healthcare spending for local residents. And it goes without saying that residents of towns and villages in Otsego County should look to their district representatives for their support, as well as to the county’s Board of Representatives as a whole.

Maureen Dill is a retired social worker and former disaster preparedness and response planner, having served as human services and emergency services director for two international nonprofit charitable organizations.