MNA Analysis of Consultant’s on the Need for Inpatient Services in North Adams

Following the sudden closure of the 121-bed North Adams Regional Hospital (NARH), which left thousands of residents without access to local healthcare, Berkshire Medical Center (BMC) purchased NARH – now BMC North – and has been operating a satellite emergency room out of the facility, while providing inpatient care only at its Pittsfield campus. Concurrently, the Department of Public Health contracted with Maine-based Stroudwater Associates to evaluate the healthcare market in the Northern Berkshires. What Stroudwater confirmed is that Northern Berkshire residents have asthma, heart disease, and most cancers at higher rates than other communities, and face public health issues including obesity and high rates of alcohol and tobacco consumption.[1] The fastest-growing segment of the population is the elderly, many of whom are disabled. And compounding health problems are barriers to access, like the lack of financial resources and transportation, and all of these factors make North County a “medically vulnerable population.”[2] Stroudwater affirmed the community’s need for the three inpatient services below, but the report attempts to assess the North Adams facility based on its historical condition rather than as a part of BMC – and parent company Berkshire Health System – which has the highest commercial payer rates of any teaching hospital in the state.

1. Inpatient Medical/Surgical Services

Given the various challenges 37,000 Northern Berkshire residents face, Stroudwater determined that there is a need and demand for inpatient care, but simply asserts that the services should not be provided unless BMC North can secure Critical Access Hospital (CAH) designation, which grants rural hospitals higher federal reimbursement for services. With the support of nurses and other community stakeholders, the North Adams hospital has long attempted to secure CAH status, but history shows that it is unlikely, and the significant healthcare needs of North County residents should not be linked to an improbable strategy.                                

In 2012 and 2013, of the more than 39,000 ER visits at NARH, 9,769 visits were considered “high severity,” and nearly 5,000 constituted an “immediate threat to life.”[3] Many of these patients needed access to emergency surgical care, which was available when NARH was a full-service hospital. Today, the safety of those same patients would be jeopardized by a forty-minute ambulance ride, delaying their access to care. And Stroudwater argues that inpatient medical/surgical services must also hinge, not on the need for those services, but on the “viability of physician recruitment” and high volumes of specific procedures to retain them.[4] When NARH was in direct competition with the larger and more profitable BMC, attracting and maintaining physicians was a challenge, and procedure volume suffered. Now that the North Adams hospital is a campus of BMC, BMC physicians can perform surgery and treat their patients at either campus, just as Baystate Health’s Springfield-based physicians travel to the even more remote communities of Franklin County. Stroudwater suggests that transportation to Pittsfield from North County is not too much of a burden for critically ill patients; surely BMC physicians can make the trip in reverse to treat their patients. 

2. Inpatient Psychiatric Care

A 2013 Community Health Needs Assessment conducted by NARH revealed the following data from the Department of Public Health:

Mental health disorders are the seventh leading cause of death for [North County];

Mental health disorders and alcohol abuse are the second and eight leading causes related to hospital discharges;

Both mental health and alcohol abuse exceed the state’s percentage rate for hospital discharges[5]

The DPH data show that demand for inpatient psychiatric care in North County is substantial and the Stroudwater report concurs. But once again, recommending inpatient beds dependent upon BMC North’s unlikely Critical Access designation is not a real response to the need. Absent CAH status, Stroudwater advises that the Brien Center, an outpatient human service agency, build its capacity and expand outreach services despite the fact that, in 2013, the average wait time for outpatient services in the region was between seven and ten weeks.[6] The underfunded human service industry, already struggling to provide supports for individuals whose care can be managed on an outpatient basis, cannot be expected to adequately serve those who need inpatient care. And while outpatient psychiatric care can be an important, complementary service to inpatient treatment, it is no replacement for inpatient, around-the-clock nursing and medical care, which some individuals with severe psychiatric problems need. 

3. Inpatient Obstetrics Services

The Stroudwater report states that obstetrics (OB) services were the most often-cited needs for inpatient care in North County, and the nearly 1,100 babies born in North Adams in the most recently-reviewed years support that claim. The firm recommends focusing the community’s focus to prenatal care and forcing women in North County to deliver their babies at BMC’s Pittsfield campus. Citing physician recruitment as a roadblock to service provision, Stroudwater again forgets that BMC North is no longer NARH, but a campus of Berkshire Medical Center with access to the “largest Mother Baby Unit in the Berkshires” and its many physicians who can easily provide healthcare and to women and their babies in North Adams.[7] Providing OB care at BMC North would eliminate real dangers of a lengthy drive from North County to Pittsfield, especially in emergency situations or for women with high-risk pregnancies, but Stroudwater recommends against inpatient OB care at BMC North.

Stroudwater maintains that in hospitals like BMC North with fewer than 500 deliveries per year, “providing comprehensive care for obstetric patients in these small units is extremely inefficient, not cost-effective, and frequently impossible,” and may also have worse outcomes for mothers and babies.[9] Yet BMC’s other operation, Fairview Hospital, boasts the full-service Family Birthplace, where fewer than 200 babies are born each year. Of course, the data also reveal that in addition to significantly fewer babies born in the more affluent Great Barrington community, less prenatal care is paid for by public payers[10] in Great Barrington than in North Adams, indicating that concerns about providing obstetrics care in North County is less about need and safety, and more about the payment per delivery.

Conclusion

North County is a community dealing with a variety of challenges, beginning with the health of its residents. While the Stroudwater report claims that “hospital-based services do not guarantee a high community health status,” eliminating access to inpatient care to 37,000 people will have real impacts on health and welfare of the community. This report takes the position that Berkshire Medical Center ought to decide which services to provide in North Adams based on NARH’s difficult history and securing Critical Access Hospital status. But a hospital’s mandate is to provide the services that its community needs, and this community has demonstrated again and again that it needs a full-service hospital, equipped to provide inpatient care to individuals with serious mental illness, critically ill patients, and pregnant women and newborns. 

North Adams Regional Hospital was a facility laden with crippling debt and constantly on the losing end of competition with BMC for physician practices, specialists, and procedure volume. The Stroudwater report makes no mention of the North Adams’ hospital’s new membership in Berkshire Health Systems, focusing instead on these historical challenges, which no longer exist. As BMC North, the hospital can now enjoy BMC’s commercial payer price level – the highest among all teaching hospitals in the state – and the purchasing power and efficiencies that being part of a system can offer, in addition to total access to physicians it would have lost to BMC in the past.[11] This community does not need to search for a solution for managing the healthcare needs of North County. BMC North is the solution.

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