Clifton-Fine Hospital: Robert P. Kimmes, Chief Executive Officer

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Located in northern New York in the Adirondack Park, Clifton-Fine Hospital is a 20-bed critical-access facility with an attached primary-care clinic.

Being situated in a rural location poses multiple challenges for Clifton-Fine, not the least of which is geography. Clifton-Fine’s service area comprises 700 square miles, and its remoteness makes the hospital the sole healthcare provider in the region with other healthcare entities at least an hour away.

As a popular vacation spot, the area’s population is fairly small year-round, running at approximately 6,500 during the off-season and doubling during the summer with an influx of seasonal residents and travelers.

The nature of being rural

Oftentimes, rural facilities are the lifeblood of the community and the only source from which residents can receive care. Despite this need, being rural doesn’t always pose the most attractive option for hospitals who are trying to recruit outside healthcare professionals to their organization.

Also, providing the necessary primary-care services to a limited patient base is challenging. Robert P. Kimmes, chief executive officer of Clifton-Fine, said it is, in fact, one of the biggest challenges that the hospital is confronting right now.

Furthermore, federal demands can be taxing. As an independent hospital not affiliated or owned by a larger health system, independence has its advantages, but meeting healthcare reform and IT requirements stretches resources. Also, reimbursement cuts affect the organization greatly.

“We have a fairly large Medicare and Medicaid population,” Kimmes said. “And with state and federal cuts toward these programs, that’s been a challenge trying to be proactive and increasing efficiency and looking for other revenue sources and reducing expenses.”

He added, “This is not anything unique to a rural hospital compared to an urban hospital. We’re all facing these challenges right now.”

An abundance of positives

For every challenge that continues to confront Clifton-Fine, Kimmes feels the organization is responding in a successful and meaningful way. For example, the hospital is fully staffed, and in spite of location, the recruitment of medical providers has met with overwhelming success.

This growth has been met with expansion. In late 2010, Clifton-Fine finished construction on a new medical clinic that is attached to the hospital. That project led them to resurrect a dormant foundation and increase the hospital’s fund-development activities, a move that has also proven to be an enormous success.
Currently, the hospital is in the process of converting from public ownership to 501(c)(3) or not-for-profit ownership. According to Kimmes, this will help the hospital save money in the biggest way.

As a public entity in New York, the organization and its employees are required to participate in the state pension plan. The cost to fund pension plans has increased significantly in the last few years in New York, and these costs are passed on to the public agencies and public hospitals who participate in  the program.

By converting to private non-profit, Kimmes said Clifton-Fine will no longer be obligated to participate in the state pension plan, thus saving a large amount in employee-benefit expenses by creating a traditional 403(b) retirement plan for employees.

“We’re not dropping our employee retirement plan,” Kimmes clarified. “We’re just converting it to a different model that will save the organization a lot of money.”

Building a foundation of quality and safety

Apart from the pension plan, Kimmes said New York offers a few state programs that assist Clifton-Fine in benchmarking its quality measures. For example, the hospital participates in a quality and safety program that is funded through the New York Department of Health’s Office of Rural Health. This program has quality indicators that serve as a benchmark for all of the state’s critical-access hospitals.

“Through that, we are given tools that help us set indicators, both quality and patient-safety indicators and also financial and productivity indicators, that we can actually benchmark against ourselves, that we can benchmark against NY State’s other critical-access hospitals and other hospitals around the country,” Kimmes said.

Clifton-Fine also participates in HCAHPS, even though critical-access hospitals are not obligated to do this. However, Kimmes believes that someday critical-access hospitals will be required to participate in HCAHPS and reimbursements will be based off that participation.

“We are consistently above the national average in the HCAHPS’ monitors’ indicators,” he said. “It has been a very good tool for us to use to see how we compare to other hospitals, and we have been doing very well.”

Unlike some of his counterparts, Kimmes views meaningful use with relish. It is because of meaningful use that the hospital has been able to get a new IT system for the entire organization, he explained. And because the incentive payments are given to critical-access hospitals in a lump sum, significant technology investments have also been made.

“It’s allowing us to install a new IT system, where we may not have been able to afford to do that without the incentive payments,” Kimmes said.

All about community

Like most rural administrators, Kimmes views the surrounding community as key to the hospital’s success. He cites a recent capital-fundraising campaign for the construction of the new medical clinic as evidence of this. The total cost of the project was $2.5 million. Clifton-Fine set a capital-campaign goal of $750,000.

Thanks to the generosity of the hospital’s neighbors, the organization surpassed this goal in fewer than eight months.

“I believe that really is a testament to the support the hospital receives from the community,” Kimmes said. “We were amazed at the support we got toward our capital campaign.”

-by Pete Fernbaugh

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