A hospital health-check

Garnet, Ellenville face challenges

By Zoey McGee | Manor Ink

Harris, NY – As the upcoming election spotlights health-care issues nationwide, rural health care’s unique struggles remain critical, but are often overlooked. In many rural communities, access to health-care services is limited by geography, financial challenges and staffing shortages.

To better understand the realities behind rural health care, Manor Ink spoke with Jerry Dunlavey, chief executive officer of Garnet Health-Catskills and vice president of Operations for the Garnet Health system, and Keith Edwards, director of Human Resources at Ellenville Regional Hospital. Dunlavey and Edwards shared their insights into the challenges their hospitals face, as well as efforts being made to improve those facilities.

Nonprofit vs. for-profit hospitals

Nonprofit hospitals, such as the three campuses of Garnet Health and the one of ERH, operate with a mission-driven focus. All surplus revenue the hospitals earn is reinvested into the hospitals’ operations, improvements, community programs and patient care services. One of the main differences between a nonprofit hospital and a for-profit institution is that they are exempt from federal, state and local taxes. This tax exemption allows nonprofits to allocate more resources toward patient care and community health programs instead of shareholder profits. In return for this benefit, they must accept all patients regardless of ability to pay.

Garnet Health-Catskills is one of several entities in the Garnet Health system. GH-C is made up of two hospital campuses in Sullivan County: the Harris location, a 154-bed, full-service community hospital; and Callicoon campus, a 15-bed critical-access hospital. In addition, there is Garnet Health Doctors, Garnet Health Urgent Care and the Garnet Health Foundation. The hospitals employ over 600 employees, including 300 physicians, and see about 400,000 outpatient visits and 3,700 discharge patients annually.

Garnet Health’s two hospitals provide a comprehensive range of services tailored to a rural setting. They offer two emergency departments, a birthing center, a cardiopulmonary division, inpatient and outpatient surgical services, behavioral health and imaging services, hyperbaric therapy, a comprehensive lab, and physical, occupational, and speech therapy. The Callicoon campus also offers a “bridge-to-home” service for patients who need extra time before being discharged.

In addition, Garnet Health’s Middletown campus is a 383-bed hospital. Patients whose needs can’t be served in the Sullivan County hospitals will be transferred there for care. These specialized services include dialysis and neonatal intensive care, as well as heart catheterization.

A health ‘ecosystem’

Ellenville Regional Hospital is designated as a “critical access hospital,” which defines the services it must offer and those it can’t. The federal Centers for Medicare and Medicaid Services regulate it. It is a 25-bed hospital that provides essential services, such as emergency care, inpatient services, outpatient care, cardiac rehabilitation, physical therapy and imaging services.

While over the Sullivan County border, ERH contributes many services and care to county residents. The hospital also has a strong collaborative relationship with Garnet, and HR Director Edwards says that this partnership and others are crucial, more so in a rural area, where resources can often be limited. “By working together, we ensure patients have a seamless experience when they need services outside our immediate capabilities,” he said.

GH-C CEO Dunlavey likes to refer to the health-care services in the area as an ecosystem. “If you think about it, an ecosystem consists of many vital, important, and interconnected parts,” Dunlavey said. “And I believe that Garnet Health and Garnet Health Doctors, our employed physician group, play an important role in Sullivan County’s health-care ecosystem.”

Like many other hospitals located in rural communities, these hospitals face challenges regarding extensive staff and services shortages. Dunlavey and Edwards both commented on their hospital’s specific challenges.

Challenges facing rural hospitals

Transportation remains a significant issue in rural health care. “If you don’t have the transportation, you can’t get to that doctor’s appointment,” said Dunlavey. “And I think what is important about access to care is disease prevention. What we want to avoid is a situation where you go through the majority of your life not seeing a doctor regularly because of transportation issues, and then you end up in the emergency room because a disease was not diagnosed earlier.”

The other issue mentioned was a shortage of medical professionals attracted to working in rural settings due to the lack of resources and lifestyle amenities that urban areas offer. Medical professionals may also find rural hospitals less appealing because of limited access to professional networking, fewer advanced training opportunities, and concerns about isolation.

“The competitive landscape also plays a role; large healthcare systems can offer more attractive salary packages and benefits, making it difficult for smaller hospitals like ERH to compete,” Edwards said.

To address this issue, ERH partners with medical schools and residency programs to attract people who may pursue a job in rural health. They also invest in cross-training staff to perform multiple roles, ensuring they can continue providing efficient service. “We focus on creating a supportive work environment, professional growth opportunities, community-oriented incentives for our staff, as well as creating a positive workplace culture to encourage long-term retention of our current staff,” said Edwards.

Dunlavey pointed out that recruiting specific types of medical specialists at Garnet has been challenging. Unfortunately, current specialists are retiring faster than they can be replaced. “One specialty that comes to mind is neurology. There is a projection of a 20 to 28 percent shortfall in the number of neurologists across the country over the next 15 years.”

GH-C is actively recruiting for several specialties, including a general surgeon, full-time cardiologist, endocrinologist, psychiatrist, gastroenterologist and primary care and urgent care physicians. “It’s areas where we want to strengthen our presence, and we also want to plan for the future,” Dunlavey said.

Planning for the future

In response to the challenge of recruiting local medical professionals, Garnet has run a residency program since 2014. “We view this as an opportunity for us to not only raise the level of care in our organization, but to create a farm system of potential doctors who might come here for training and then choose to stay.”

Many rural hospitals, such as these, address workforce and transportation shortage issues using the expanding telemedicine program. Congressman Marc Molinaro has contributed to a bipartisan effort to provide federal funding to expand telehealth services. In 2023, a bill called the “Protecting Rural Telehealth Access Act” was introduced to protect, improve and grow this service.

“The ERH facility has been instrumental in serving the community; however, we have outgrown its capacity and are actively working toward building a new, expanded facility,” Edwards reported. “This new structure will allow us to better accommodate our patients and meet the community’s growing needs.” Administrator for Marketing and Corporate Communications Marcy Manheim at Garnet Health also commented on plans for Garnet Health-Catskills. “An important message is that we are not closing. If we’re fortunate to be able to build a modern new hospital, the old hospital won’t close until the new one opens, and it will continue providing all of the inpatient and outpatient services.”