Triage At The Hospital

As of this week, Southampton Hospital owes close to $1 million in back payments for employees' medical benefits, pensions, child care costs, and job security insurance.

Nearly two-thirds of the debt is for health insurance premiums and pension contributions covering 275 employees, said Steven Kramer, an executive vice president of Hospital and Health Care Employees Union Local 1199.

According to Mr. Kramer, the hospital could be putting its own workers' medical insurance in jeopardy.

Part of the money owed was paid in October, and the rest, promised Dr. John J. Ferry Jr., the hospital president, will be paid by June 1998. Union officials are watching the situation, said Mr. Kramer.

Late Receivables

"The other side of receiving late payments is making late payments," Dr. Ferry said this week.

There have been widespread reports this year of delayed payments by some managed-care companies, as well as chronic late payments by the Government itself, including both Medicare and Medicaid.

"This is the most severe it's ever gotten at Southampton Hospital," Mr. Kramer said. "It's an astounding amount."

Dr. Ferry was reluctant to divulge details of the hospital's arrangements with the 22 different managed-care companies it does business with because, "the more information I tell you, the more information they will have to use against me" as they negotiate new rates.

But, he said, "I don't hear any hoofbeats of disaster."

Nurses' Union Dues

The hospital has made some late payments on union dues as well, for roughly 160 registered nurses, said Michael Chacon, a representative of the New York State Nurses Association.

Nurses' union dues are deducted from their paychecks - about $40 a month each, or $85,000 annually for the staff. The hospital ran about a month late for four or five months starting in the summer, Mr. Chacon said, but now is considered "current" - about three weeks in arrears.

"It's not a real problem," he said.

"These are unhappy times," commented one longtime R.N., who asked not to be identified. She said she thought the hospital had been "four-square" with its employees.

Developments in recent months have forced hospital officials to adopt a kind of fiscal triage policy, with top priority going to inpatient care and staffing.

Expansion of the plant, "wellness" education, and new outpatient services are having to wait their turn.

Also waiting are several outside contractors who, speaking on condition of anonymity, said the hospital has owed them money for services and materials for months.

One East Hampton vendor said he had been owed $1,200 for more than a year and will no longer work for the hospital.

Closed Doors

Only 18 months ago, new hospital buildings and personnel seemed to be popping up in all directions, with outpatient facilities in nearly every South Fork hamlet.

At least one major project was about to break ground (the Hampton Bays dialysis center); another was at the Planning Board stage (the Pantigo Road, East Hampton, medical arts building), and a third was an approved concept (a cancer center in Hampton Bays).

But now, with 10 percent fewer patients admitted for in-hospital care this year than last, plus the late insurance reimbursements, some hospital doors have swung closed.

Falloff In Patients

The hospital admitted about 6,000 patients in 1995, Dr. Ferry said, 6,500 in 1996, and 6,000 again this year.

The drop this year reflects in some part the nine-month loss of low-income prenatal patients who went to Brookhaven Medical Center in January after Southampton gynecologists demanded improvements in the county clinic where the patients are seen.

Seeing no progress, the doctors refused to renew their contract with the county.

The county has since agreed to renovate the aging clinic and as of Oct. 1 the doctors resumed deliveries in Southampton.

Some say the managed-care system is responsible in large part for the decline in admissions, citing, among other things, better preventive care and a growing emphasis on outpatient services. Some hernia operations, for example, are now done on a same-day-surgery, outpatient basis.

To make up some of the money lost in the downturn - roughly $2.5 to $3 million - the hospital has stepped up its fund-raising, garnering $1 million more this year than last year to date.

Meanwhile, the number of Medicare patients, who generally require more care than younger people, has been rising by about 10 percent a year. It now accounts for about half the patient population.

Consolidating

The hospital has begun belt-tightening. For example, patients and staff from two medical/surgical floors now occupy one. The 45-bed second floor is nearly full most of the time, according to Dr. Ferry, while the third floor, with 49 beds, is not used unless necessary. It can handle 15 patients when needed.

"We can operate better if one floor is busy all the time," he said, "and we keep the other on hold."

Dr. Ferry described the consolidation as part of a "slow and deliberate approach" to avoid reducing the 250-person nursing staff. He acknowledged that some "realignment" and "retraining" was under way, meaning personnel are being reassigned where most needed.

To date, no layoffs have been reported.

Hospital Network

The hospital executive expects to reap savings also through Southampton's new cooperative purchasing arrangements with Central Suffolk and Eastern Long Island Hospitals.

The State Health Department gave the network its long-awaited approval just last month.

The hospital also has consolidated three offices of the Center for Community Health Improvement and Wellness, its educational arm, into one, and slowed the construction of outpatient treatment facilities, including the sports rehabilitation center in East Hampton and the dialysis center.

"We have a dual mission:to break even and serve the community well,"Dr. Ferry added, acknowledging that sometimes the two goals "appear to conflict."

Senior Center Closing

Closing, as of Friday, Dec. 19, will be the three-year-old Senior Center in Hampton Bays, which employed a full-time physician who saw about 1,000 patients a year. Also shut, at least for the off-season, are specialists' offices in Westhampton Beach, near the hospital's primary care offices.

The primary care offices handle 15,000 visits a year and will add the senior population to its patients, Dr. Ferry said.

Dr. Jeremy Halfhide, whom the hospital hired about 18 months ago as its primary care physician in Sag Harbor, has left that office for personal reasons, and is returning to England. Dr. Ferry said he had been unable to attract a replacement of Dr. Halfhide's caliber and has closed that office, in the Malloy Building.