Montefiore Investing to Improve Health Care on the Sound

Calling their recent takeover of the Sound Shore Medical Center a “natural opportunity,” Montefiore Health System officials reaffirmed the organization’s commitment to investing in and improving health care on the Sound at The Larchmont-Mamaroneck Local Summit’s monthly meeting at the Nautilus Diner, Tuesday, March 18th.

The packed meeting attracted an unusually large number of residents from the Sound Shore communities interested in learning the fate of the Sound Shore Medical Center of Westchester. In November 2013, Montefiore acquired the Center’s facilities after it lapsed into bankruptcy; facilities included Sound Shore Medical Center, the Dorothea Hopfer School of Nursing and the Schaffer Extended Care Center, all in New Rochelle, as well as Mount Vernon Hospital.

Throughout the discussion, Montefiore representatives - Dr. Andrew Racine, Senior Vice President and Chief Medical Officer of the Montefiore Medical Center and Executive Director of the Montefiore Medical Group; Lynn Richmond, Senior Vice President and Chief of Staff for the President and CEO at Montefiore Medical Center; and Anthony L. Alfano, Executive Director, Vice-President of Montefiore - New Rochelle – sought to reassure the audience of Montefiore’s interest in doing what is best for the community. All three stressed Montefiore’s interest in partnering with the community and local physicians in order to identify what the community needs and invest accordingly.

Montefiore’s Approach to Healthcare and Partnerships in Communities

The panelists began by providing the audience with a sense of Montefiore’s values and approach to health care. Citing Montefiore’s mission statement – “To heal, to teach, to discover and to advance the health of the communities we serve” – Dr. Racine explained that Montefiore differentiates itself by focusing on the question “What can we do to keep people well?” and working very closely with communities to meet their needs.

Ms. Richmond pointed to Montefiore’s experience and successful track record of turning around financially ailing medical centers, including the former Our Lady of Mercy Medical Center in the Bronx, which is now the site of their Wakefield Campus. Using their experience in the Bronx as an example, she also spoke of Montefiore’s interest in establishing integrated regional systems of care that not only provide comprehensive primary and outpatient specialty care, but also include a variety of partnerships with schools, homeless shelters, and more, and provide related health services such as dental care and home health care, thereby addressing a community’s broad range of health care needs.

Montefiore’s Expansion in Westchester

Ms. Richmond explained that Montefiore’s acquisition of the Sound Shore Health System facilities enabled it to build on its existing Westchester footprint, expanding on the twenty Westchester-based practices it already had. She noted that Montefiore recently purchased the former Kraft office building in Tarrytown, where it will be housing the approximately 1600 administrative and back office employees that serve its Bronx and Westchester operations and that it will be consolidating its lab services at a facility in Mt. Vernon.

According to Ms. Richmond, the Mt. Vernon and New Rochelle hospitals will be treated as distinct units, not joint as they were under the Sound Shore organization. In terms of the recently announced partnership with White Plains Hospital, Ms. Richmond commented that it is too early to discuss as the details are still being worked out. Asked about any possible plans for the former United Hospital facility in Port Chester, Ms. Racine said she was not aware of any such discussions.

Status of Montefiore New Rochelle Hospital

According to Anthony Alfono, the new director of Montefiore New Rochelle, their first priority was to “stabilize the workforce,” which had endured a lot of turmoil during the bankruptcy period. Another area that received immediate attention was the emergency department. In addition to getting a facelift, Montefiore enhanced the number of practitioners in the emergency room – physicians, physician extenders, and nursing staff – in order to improve throughput and decrease waiting times. They also introduced a “Fast Track” system aimed at quickly attending to “treat and release” patients. Longer-term, Montefiore is looking to expand the emergency department, which they recognize is a critical service for the community.

Responding to comments from the audience about the poor physical condition of the New Rochelle hospital, Mr. Alfono acknowledged the physical deterioration of the facilities when Montefiore assumed ownership in November. He explained that Montefiore immediately undertook an assessment of the physical plant and has already invested more than $20MM in the facilities, taking care of the most pressing needs including HVAC, security, lighting, painting, flooring and new furniture to give the facility a facelift. He noted that there are many more plant improvements still to come.

In terms of specific services, which several members of the audience inquired about, Alfono explained that Montefiore is still in the process of evaluating service needs of this community. Services that existed under Sound Shore – including palliative care – will be maintained as is for the time being, while the need for services that had not previously been provided – such as psychiatric care – will be evaluated as part of the needs assessment that it underway. He indicated that Montefiore would be investing to enhance or add needed “lines of service” once those had been identified.

Other Questions Raised by Residents

Q:           How can Montefiore afford to acquire and invest in hospital facilities like Sound Shore?

A:            Dr. Racine explained that Montefiore’s financial model is based on contracts with insurance companies, under which Montefiore assumes the full risk for its patients. This “provider-based approach” shifts the financial risk from the insurance companies to Montefiore. According to Dr. Racine, “if we are not beholden to the reimbursement schedule, we can do more for the patient.” By focusing on prevention and keeping people well, and operating very efficiently, Montefiore has been able to save money – money that they are investing in programs and facilities.

Q:           Can Montefiore help deliver health care to our undocumented residents?

A:            The speakers acknowledged that the Affordable Care Act left out the undocumented and that health care providers must keep looking for opportunities to address this issue, but did not offer any solutions.  

Q:           What is the difference between WestMed and Montefiore?

A:            An organization like WestMed provides comprehensive ambulatory care – care that is on an outpatient basis – while Montefiore, with its hospitals, provides integrated health care. Dr. Racine explained that Montefiore is very interested in partnering with health groups such as WestMed.

Q:           How will Montefiore’s takeover of Sound Shore impact local doctors?

A:            According to Dr. Racine, there is “no downside . . . only upside” for local physicians. He indicated that Montefiore would be speaking with private physicians and physician groups about potential partnerships. Private physicians might be invited to partner with the Montefiore Integrated Provider Association (MIPA) to become part of its managed care program.  For a group such as WestMed, Dr. Racine anticipates that there might be ways in which Montefiore could complement its services.

Q:           What can be done about the flight of quality local physicians due to the uncertainty surrounding Sound Shore’s financial woes?

A:            Mr. Alfono explained that by “changing the institution itself” – by making both plant and programmatic changes – good doctors who had left would likely be drawn back by word-of-mouth. “Good doctors want to be where their patients get good care,” something that Montefiore is committed to providing.