But then, with the onset of inflation, doing business began to get very expensive, very quickly. Staffing challenges, exacerbated by the pandemic, have forced us to rely much more heavily on costly contract labor — traveling doctors and nurses working on temporary assignment for third-party staffing agencies. At the same time, the cost of necessary supplies — everything from gloves and masks to medications, surgical instruments, and utilities — has gone through the roof. And demand for healthcare services, thrown out of whack by the pandemic, has not returned to pre-COVID levels. To make a long story short, we are spending more money than ever before to provide the same high-quality care to relatively fewer people than ever before. This is a problem, and things are coming to a head.

On Thursday, Oct. 6, Adirondack Health submitted a closure plan for the part-time Lake Placid emergency department to the New York state Department of Health. This action was unanimously supported by the health system’s board of trustees and medical-executive committee.

With Adirondack Health on pace to lose upwards of $10 million this year alone, we are forced to examine every service we provide and see what we can do — or not do — to right the ship. One of our current loss leaders, unfortunately, is the Lake Placid emergency department. Emergency departments are the most expensive care setting in the healthcare industry and, in Lake Placid, we have been averaging fewer than eight emergency department visits per day. We analyzed all Lake Placid emergency department visit types for the first six months of 2022, based on the patients’ presenting concerns, and found that 89% were non-urgent or semi-urgent, 9% were urgent, and 2% were truly emergencies. These low patient volumes translate to a loss of over $2.2 million per year. Put another way, Adirondack Health spends about $8,800 per day to staff and operate the Lake Placid emergency department, while only generating about $2,700 per day in revenue. While we’re not a small business, we’re still a business — a nonprofit business with a legacy and mission we take very seriously. The hard truth is that these numbers are unsustainable, by any measure. We could choose simply to ignore the problem, but that would end up endangering, in short order, the viability of the overall health system.

So here we are, and we’re certainly not alone. Hospitals and health systems across the state — and country — are in the same unenviable position. As the American Hospital Association framed things in an April 2022 report, “these expense increases have been severely detrimental to hospital finances, leading to billions in losses and over 33% of hospitals operating on negative margins.”

We need to make some really tough decisions in order to ensure that access to quality, personalized hospital care remains available in the Adirondacks. In collaboration with our partners in state government and community stakeholders, we intend to reimagine the Lake Placid emergency department and transition it to a model that meets the needs of the community, rather than doubling down on a duplicative service line just because “that’s the way we’ve always done it.” We also want to stress that, at this juncture, no layoffs or elimination of permanent positions are part of the conversation. The Lake Placid emergency department’s full-time and part-time clinicians and staff members will have the opportunity to continue working at Adirondack Health, bolstering capacity where it makes the most clinical and financial sense.

With the 2023 Lake Placid World University Games just around the corner, Adirondack Health is working with the organizing committee, regional emergency medical service providers, and state partners to ensure there are no major disruptions. Regardless of the current financial headwinds, our core philosophy remains unchanged: We honor a mission of excellence, healing, and compassion close to home that goes back more than a century and goes forward just as far. If there’s one thing we’ve learned over the course of these past few years, it’s that you can fear change, or you can manage change. We’re choosing the latter because that’s the only productive option. This is unlikely to be the last hard decision, as we navigate out of this storm and back into calm waters. Nevertheless, we’re committed to getting there with your continued understanding and support.

Change is hard. But change can be good — especially if you manage it carefully and confidently. We promise always to shoot straight with you, because, in addition to being the right thing to do, it is what you expect and what you deserve. We’re making you aware of an acute challenge that poses systemic risk to Adirondack Health because we need you — along with our state partners — to be part of the solution. We need to do things differently in the Lake Placid emergency department space. What we’re currently doing is not working. But something else could, and something else must. Change is coming either way. Adirondack Health has an opportunity to transform the way we care for residents and visitors in and around the global sports capital of Lake Placid. We have made the decision to adapt and overcome, rather than peddle in excuses while access to quality healthcare in the North Country bleeds out.

As we consider the shape this new model takes, we welcome the community’s input and feedback.

(This guest commentary was co-signed by Aaron Kramer, president and CEO, Adirondack Health; Sue Delehanty, chair, Adirondack Health Board of Trustees; Glenn Keet, vice chair, board of trustees; board of trustees members Michael Bettmann, M.D., Elizabeth “Betsy” Buck, M.D., Janet Bliss, Jeannie Cross, Rebecca Leahy, Jon Plehn, M.D., Randall Quayle, Ph.D., Tim Reilly, Harris Semegram, Craig Sheldon, William Smith, M.D., Ernest Stretton, Ph.D., and Kathy Woughter; Irwin Lieb, M.D., president, Adirondack Health Medical Staff; Bartlomiej Szczech, M.D., vice president, Adirondack Health Medical Staff; Daniel Kelleher, chair, Adirondack Health Foundation Board of Trustees; Darci Beiras, M.D., chief medical officer; Dianna Bryan, M.D., medical director, Emergency Department; Medical Executive Committee members Amy Corliss, M.D., Robert “Duncan” Douglas, M.D., Thomas Green, M.D., Michael Hill, M.D., Thomas McBride, PA, David Strauss, M.D., Emily Szczech, D.O., Anthony Tramontano, M.D. and Olga Voronel, M.D.; Elizabeth “Beth” Bartos, M.D., Lake Placid primary care physician; David Garrison, M.D., Lake Placid primary care physician; Michele Mannion, M.D., Lake Placid primary care physician; Howard Reinheimer, M.D., Lake Placid primary care physician and Lindsey Wilhelm, D.O., Keene primary care physician.)