Joseph Russell, Chair
Robert Toole, Vice Chair
Norman Snyder, Secretary
Jeanne Snow, Treasurer
Robert C. Tague, DDS
River Hospital Board of Trustees
Trustees Emeritus - Daniel Gregory, MD | Ross Jones | J. Richard Munro | Donald Ceresoli | Laura Coles | Richard Bennett | Patricia Chalk
Mr. Ben Moore, III joined River Hospital as the Chief Executive Officer beginning August 28, 2006. Mr. Moore holds a Masters of Health Administration from Duke University and a Bachelors of Arts degree in Government from Harvard University. Mr. Moore has served on the Board of Directors of the Upstate Medical University Foundation, Hospice of Central New York, the Syracuse Community Health Center and the Hospital Executive Council. Mr. Moore has had a distinguished career as a senior healthcare executive, having led organizations for over twenty-five years through institutional strategic planning and implementation, marketing and business development. Mr. Moore served as Executive Director of University Hospital of SUNY Upstate Medical University from 1993-2005 and as Chief Operating Officer from 1987-1994. Mr. Moore served most recently as the Hospital Management Coordinator prior to his retirement in February 2006, after almost twenty years of service to the hospital.
River Hospital History
||1941 -The first hospital in Alexandria Bay was founded by Dr. Walter G. Robinson. It was housed in the Cornwall House on Market Street. This hospital served the community throughout the 1940s.|
River Hospital is located on the former site of the Thousand Islands House, once a premier resort hotel built in 1872 by Colonel O.G. Staples. The structure was four stories high, and would accommodate 700 guests. Many notable people stayed at the hotel during its heyday, including industrialist Andrew Carnegie, writer Mark Twain, and statesman Henry Cabot Lodge. By the 1930's, during the Great Depression, the hotel was abandoned and the property was sold in 1935 to Mr. Abe Cooper of Syracuse, who razed the structure. The site was sold to the Edward John Noble Foundation Inc. in 1946 for construction of the new hospital.
|1947 - Edward John Noble pledged $125,000, one half the cost of building a hospital, if the people of Alexandria Bay could raise the other half. The Edward John Noble Foundation was founded to promote a cohesive health system for the North Country. (Photo: Edward John Noble)|
|1949 - Through the efforts of the local community and the generosity of Edward John Noble and Abe Cooper, who offered a favorable deal on the riverfront property, ground was broken for the first phase of the hospital. (Photo: Abe Cooper) Ground breaking for the new Noble Foundation Hospital, later to become River Hospital, was held in 1949 after a large public fund-raising campaign. The two-story structure had a capacity of more than 25 beds, including a pediatrics room, maternity section and nursery. There were also doctors' offices, an operating room, emergency room, kitchen and dining room, a laboratory, radiology unit, and fluoroscopic rooms.|
|1950 - July 14, the Edward John Noble Hospital, a 29 bed facility, was dedicated. Mr. Noble and Mr. Royal Garlock, President of the Hospital Board, sealed historical documents in the cornerstone declaring the hospital officially the property of the people. Dr. Charles W. Mayo, of the Mayo Clinic, was the keynote speaker.|
|1970 - The second story was added to the facility and the bed capacity increased to 51 beds, and provided a wider range of services to 20,000 permanent residents and more than 80,000 summer residents and visitors.|
|1991 - As a result of radical changes in the healthcare industry during the 1980s, EJ Noble Hospital filed for Chapter 11 bankruptcy protection and entered into a relationship with Samaritan Medical Center, Watertown, in an effort to maintain quality healthcare services.|
|2000 - Threatened with closure of the hospital, a group of concerned citizens formed a task force to appeal to the New York State Department of Health to become an independent institution.|
|April 15, 2003 - The hospital is 'reborn' as an independent facility and named "River Hospital".|
|In the years that followed the opening of River Hospital in April 2003, until the conclusion of the 2006 fiscal year in December 2006, River Hospital was confronted with many challenges as a start up operation. There were many obstacles to overcome in establishing services in the area such as attracting staff, and physicians, and assuring the community that River Hospital was a viable entity. Fortunately, there was tremendous community support for River Hospital including significant philanthropy which was of great assistance to River Hospital in navigating the difficulties in establishing financial viability. Fortunately, at the end of fiscal year 2006 all the initially planned elements for services at River Hospital were about to be initiated. The final program was an Ambulatory Surgery Program.|
|September 2007 - River Hospital opened its Ambulatory Surgery Unit, The Anthony C. "Tony" Malara Operating Suite. This addition to the services provided by River Hospital now offers the option of having minor surgical procedures and colonoscopies performed on an outpatient basis, close to home.|
|The Board of Directors, realizing that River Hospital was about to transition from a start up operation to a stable operating environment, determined that a strategic planning process should be initiated. The hospital operated long term care beds until 2010. It currently has 15 acute care beds and 9 swing beds. The hospital also operates a Primary Care Clinic and has an active Emergency Room. Laboratory, Physical Therapy, Respiratory Therapy, and Radiology services are available. After considerable administrative reorganization, the fiscal environment has improved significantly. River Hospital met its forecast with its first break-even year for fiscal year 2007.|
|July 6, 2008 – River Hospital celebrated its fifth anniversary of operation, the opening of the new modular building housing River Community Clinic and the opening of Jefferson Eye Surgeons Ophthalmology clinic. The movement of River Community Clinic into the new building will allow the Clinic to serve more patients and allow room for new Physicians joining the hospital.|
|Jefferson Eye Surgeons plan to officially open their clinic on August 1, 2008. There will be Ophthalmology services as well as an Optician Shop within the clinic and will be a brand new service at River Hospital. Dr. Ewing-Chow and Dr. Joy plan to begin operating in our Ambulatory Surgery Unit on August 5, 2008.|
|Electronic Medical Records (EMR) were implemented in River Community Clinic in July of 2011 helping to better our goal of delivering the best patient care possible while improving efficiency and enhancing security.|
December 20, 2011, River Community Clinic, in partnership with the Fort Drum Regional Health Planning Organization, announced attainment of a certification as a Patient Centered Medical Home level 3, the highest level of this important new health care model. Scoring 91.25 out of a possible 100 points, among the highest across the North Country Health Information Partnership (N-CHIP) project, this certification puts our small, rural practice at the forefront of the evolution of health care in the country.
"Abide" represents the "life cycle," the continuous movement preserving and protecting lives of patients as well as the facility itself. The three waves rolling together act as a sense of spirituality. The waves which overflow the base stone, acknowledge the community outpouring of concern and caring to keep this hospital alive and functional.
- Water to Native Americans, represents sustenance of life.
- Waves display movement.
- The circle, a continuum as in life cycle.
- Birds in flight represent free spirits.
- Terns classified as an endangered species.
How we became a Critical Access Hospital
River Hospital, a Critical Access Hospital, is here to meet the needs of a Rural Community. In a recent study it was recognized that a considerable number of people do not realize what it means to be a Critical Access Hospital (CAH).
In the 1980s the methodology used to determine reimbursement for hospitals shifted away from “cost based” to “prospective payment based” utilizing Diagnostic Related Groups. For many hospitals this change promoted the expansion of a variety of more specialized services that were financially lucrative. Small rural hospitals, offering predominantly core primary care services suffered as a consequence.
By the mid 1980’s hospitals were closing at an increasing rate. The most common characteristics of the closing facilities included a rural location, less than 100 beds, or they were a specialty hospital. The hospital closures not only resulted in the loss of acute care services but often primary care services that were connected with them were also eliminated. Rural communities across the US were being left with essentially no access to health care.
Responding to the increasing rural health care dilemma the Balance Budget Act of 1997 provided for the creation of the Critical Access Hospital. To be designated as a CAH the facility must be located in an area that meets distance requirements from another hospital, be limited in size to no more than 25 beds, and provide inpatient acute care services with an average length of stay of no more than 96 hours, so as not to ‘compete’ with general acute care facilities.Like other CAHs, River Hospital has developed transfer agreements with a variety of other acute care hospitals for appropriate emergency and non-emergency communications, referrals and transfers when a higher level of care is required.
Critical Access Hospitals are hospitals that are certified to receive cost-based reimbursement from Medicare. The reimbursement is intended to improve financial performance and therefore reduce hospital closures. CAHs establish agreements with commercial insurance companies as well. Reimbursement for CAHs from Medicaid is at a much lower rate than the cost of providing care. However, care is not restricted based upon ability or inability to pay. Due to the reimbursement structure, CAHs rely more on grant programs and philanthropic efforts than what would be typical of a general acute care hospital.
Critical Access designation has had a tremendous impact on hospitals across the nation. As of September 2010 there were 1,320 certified Critical Access Hospitals in the United States, with 13 currently in New York State.CAH is a change in provider designation, not a downgrade. Conversion to CAH status does not necessarily mean losing services. In some cases, hospitals that have converted to CAH may even choose to expand their range of services to better meet community needs.
Community Service Plan 2012 Update
It is the mission of River Hospital to provide compassionate, cost effective and accessible, primary health care to the year round and seasonal residents, and visitors of the River Communities. The hospital prides itself on high quality outpatient, inpatient and specialty services to meet individual and community needs through partnerships with our patients and communities we serve.
Hospital Service Area
As in the past reporting year, River Hospital continues to provide health care services to the surrounding communities including the Towns of Alexandria, Orleans, Theresa, Hammond, Clayton, and Cape Vincent, as well as a portion of the Fort Drum military installation. In addition to the full time residents of these communities, River Hospital serves a large population of seasonal residents and visitors as a tourist area.
River Hospital is located in Alexandria Bay, in the northern tier of Jefferson County and New York State, with the general service area reaching a radius of approximately 25 miles. The service area borders Lake Ontario and the St. Lawrence River and into St. Lawrence County, with the county line five miles northeast. Directly to the north, on the opposite shore of the St. Lawrence River is the Province of Ontario, Canada, confining access to the United States health care system to 180 degree radius. Within the range of River Hospital’s service area is the expanding United States Army’s 10th Mountain Light Infantry Division at Fort Drum, bringing along the influx of family members and residual population. The largest nearby United States population center is Syracuse, New York, located 100 miles to the south.
River Hospital is beginning a collaborative consulting process through HEAL 21 and seven regional hospitals to form a clinically integrated health care system. The seven hospitals are:
- River Hospital, Alexandria Bay
- Claxton Hepburn Medical Center, Ogdensburg
- EJ Noble Hospital, Gouverneur
- Clifton Fine Hospital, Star Lake
- Lewis County General, Lowville
- Samaritan Medical Center, Watertown
- Carthage Area Hospital, Carthage
River Hospital was the lead applicant in the HEAL 21 Grant Award with six other hospitals among Jefferson, Lewis and St. Lawrence Counties. This consortium of hospitals will share the funding to collaborate throughout the next two to three years on a plan to keep residents in the tri-county area healthy and to cut costs.
River Hospital actively participates with the New York State Critical Access Hospitals, who work together on quality improvement processes and patient satisfaction outcomes. In addition, River Hospital is very involved with other partners to provide quality healthcare services to this region on Northern New York State, including relationships with Jefferson County Public Health Department, other North Country Hospitals and organizations to share information and work together to educate the public on the availability of services in this region. River Hospital works closely with Fort Drum Regional Health Planning Organization (FDRHPO), which was established to link military families assigned to Fort Drum Military Installation to quality health care services and resources in the surrounding region as there is no on-base hospital.
Prevention Agenda Priorities
Access to Quality Health Care
Mental Health and Substance Abuse
Physical Activity and Nutrition
Specialists: River Hospital is host to Gynecology and Cardiology specialists from outside the hospital’s typical service area to reduce the need for patients to travel to access necessary services. These specialists perform on-campus services on routinely schedules days at River Community Clinic, and when appropriate, in the facility’s Ambulatory Surgical Unit.
Partial Hospitalization Program to treat PTSD: River Hospital received an approval letter from New York State Department of Health to provide what is known as a Partial Hospitalization Program, which will serve Active Duty Military suffering from Post-Traumatic Stress Disorder (PTSD). River Hospital received an approval letter from New York State Department of Health to provide what is known as a Partial Hospitalization Program, which will serve Active Duty Military suffering from Post-Traumatic Stress Disorder (PTSD). The program is anticipated to expand to serve the mental health needs of the community.
Observation Unit: In July of this year, River Hospital filed an application with the New York State Department of Health to open an Observation Unit to monitor and diagnose those patients presenting to the Emergency Department to determine if there is a need for inpatient admission. This will also alleviate space constraints in the Emergency Department allowing for improved throughput.
Same Day Appointments: Due to the high demand for primary care services in our outpatient setting, River Hospital has established a “Same Day” service to improve access to care when short –notice follow up is necessary and non-emergent medical attention is requested. This addition is in the initial phase and growth is expected to continue.
Goals/Objectives for the selected priority areas:
River Hospital is a member of Fort Drum Regional Health Planning Organization’s N-CHIP Committee, which strives to improve health information infrastructure.
The North Country Health Information Partnership (N-CHIP) has put in place Electronic Health Records and Patient Centered Medical Home capacity to improve coordination of care for all patients, but particularly focused on adult Chronic Obstructive Pulmonary Disease. The project will connect our community health system to the Statewide Health Information Network through a Regional Health Information Organization. The project is focused on improving coordination of care for COPD patients in a referral zone with unusually high:
- Rates of hospitalizations – 168% of expected
- Mortality for COPD – 65.7%; nearly double the NYS rate
- Physician shortage – Entire region is designated as a Healthcare Provider Shortage Area
(Source: FDRHPO.org N-CHIP Fact Sheet)
National Committee for Quality Assurance (NCQA) developed the Diabetes Recognition Program (DRP) to provide clinicians with tools to support the delivery and recognition of consistent high quality care. This voluntary program is designed to recognize physicians and other clinicians, who use evidence-based measures and provide excellent care to their patients with diabetes, measures as indicated below: include HbA1c control, blood pressure control, LDL control, eye examinations, nephropathy assessment, as well as smoking status and cessation advice or treatment.
River Hospital’s provider, Aaron Huizenga, DO, will be recognized soon for his success in the care for his diabetes patients through his involvement in this program.
River Community Clinic, in partnership with the Fort Drum Regional Health Planning Organization has attained certification as a Patient Centered Medical Home level 3, the highest level of this important new health care model. Scoring 91.25 out of a possible 100 points, among the highest across the North Country Health Information Partnership (N-CHIP) project, this certification puts River Hospital’s small, rural practice at the forefront of the evolution of health care in the country. Patient Centered Medical Homes must meet a variety of nationally-recognized quality standards, including:
- Written standards for patient access and enhanced communications
- Appropriate use of charting tools to track patients and organize clinical information
- Responsive care management techniques with an emphasis on preventive care
- Adaptation to patient’s cultural and linguistic needs
- Use of information technology for prescriptions and care management
- Use of evidence-based guidelines to treat chronic conditions
- Systematic tracking of referrals and test results
- Measurement and reporting of clinical and service performance
This certification is awarded for three years through the National Committee for Quality Assurance (www.NCQA.org).
In the Patient Centered Medical Home model, the patient’s primary care doctor acts as the central hub, or home, for everything going on with that patient. The primary care doctor can find out quickly and efficiently if the patient is admitted to a hospital and can get in touch for follow-up care. Specialists and doctors are linked so test results go right back to the primary care office. The model aims to use the latest advances in information technology to restore some of the values of old-fashioned small-town medicine – knowing your patient better, coordinating their total care back into modern medical practice, and expecting the patient to take some responsibility for their care as well, which includes complying with their medications, following up with specialists’ appointments, and involving them with the discussions so they have a better idea of the whole process, the progress of their disease and why we’re doing what we’re doing.
Being certified at level 3 as a Patient Centered Medical Home means River Community Clinic meets the highest standards of health care coordination under this cutting-edge health care model. We are using electronic medical records and are the only Critical Access Hospital tied into the new regional health information exchange, namedHealtheConnections, which allows electronic patient histories to be shared online across health care providers with patient consent.
River Community Clinic decided to pursue Patient Centered Medical Home certification in part because of some of the chronic health issues we see among our patients. Chronic obstructive pulmonary disease, diabetes, hypertension and asthma are the top four diagnoses at our clinic. With chronic conditions especially, better coordinating patient care and improving patient education can go a long way toward preventing relapses and repeat inpatient hospital stays, and widening the time between acute episodes of illness.
Because the clinic is a part of River Hospital, the same clinicians care for patients through the clinic as well as at the hospital during inpatient stays. That means River Hospital patients, too, benefit from these improvements to care.
In working together with Holliswood Hospital to provide the Partial Hospitalization Program (PHP) to treat Post Traumatic Stress Disorder (PTSD) for military personnel, Holliswood Hospital is developing two assessment tools to measure patient change while in the program. The first assessment tool, which is the military version of the PTSD checklist, measures changes in active PTSD symptoms. The second assessment tool is the Quick Inventory of Depressive Symptomatology, which measures changes in current depressive symptoms. All military patients complete both assessments at the beginning of their treatment stay, in the middle of their stay and then again at the end of their stay. Scores are compared to evaluate change.
It is the expectation to use this research protocol with River Hospital’s PHP to follow patients clinical progress from Holliswood to River PHP and conversely to monitor a patients clinical progress, which gets initiated at the River PHP program level and to Holliswood and then back to River. The overall expectation is to prove the integrity of the continuum of care between Holliswood Hospitals program and the River Hospital Partial Hospitalization Program.
Implementation Action Plan Summary:
River Hospital is always seeking methods and working with other organizations to improve access to health care and activities as outlined in the New York State’s Prevention Agenda. Quality health care is consistently monitored at River Hospital to ensure the care provided is delivered with the utmost quality and compassion. Health promotion and disease prevention in our primary care services, as well as our outreach activities with local schools, businesses, employers and surrounding communities in our service are outlined as follows:
- Access to quality careis important in order to alleviate the incidents of health disparities and increase the quality and years of healthy life for all New Yorkers. As indicated in prior Community Service Plan updates, River Hospital conducted a community survey November and December 2010 to examine the community attitudes toward River Hospital relative to other facilities in this area, service available at River Hospital and address key community leader concerns. In the latter part of 2011 River Hospital Administration and Board of Trustees performed reports to the various communities in civic group and town meeting settings to share the results of the survey and obtain feedback.
A key component of a well-functioning health care system to ensure access to quality health care includes availability of appropriate preventive and primary care services, which lend to improved overall health. Results of this survey, as well as vigilant monitoring of the health needs of the community, continue to drive the assessment of potential new service lines, evidenced by the new priorities listed earlier in this report.
River Hospital remains actively involved in quarterly meetings with Cancer Services Program to increase patient awareness for their program offerings and assist with connecting them to obtain services through outreach, and remains involved in other regional meetings to maintain an active role in providing quality healthcare services to the North Country Region.
- On the matter of Mental Health and Substance Abuse, mental disorders continue to be common, widespread and disabling. Moreover, in this region of New York State, with the proximity to Fort Drum Military Installation, mental health, more specifically Post Traumatic Stress Disorder, is very prevalent among the soldier population. Fort Drum is home to the 110thMountain Light Infantry Division, ranking among the most deployed solders in the United States Army. The mental health services for the returning active duty soldiers, is very limited, with waiting lists in excess of one year out. As described previously, River Hospital’s Partial Hospitalization Program will aid in meeting the mental health needs of soldiers and civilians. Administration anticipates the opening of the first phase of this program in the Fall of this year.
- Chronic diseases cause major limitations in daily living and lead to high costs of health care. Proper education and awareness can lead to improved quality of life and better health. One of our outpatient primary care Registered Nurses has participated in diabetes education and has successfully passed the Certified Diabetes Educator (CDE) exam. In her capacity she will continue be a valuable resource for diabetes patients, as well as those at risk for diabetes, in our primary care practice.
- River Hospital has participated in Community Preparedness actions. The Disaster Preparedness Coordinator participates in the necessary grant work plan activities as outlines by New York State, as well as, participation in the Village of Alexandria Bay’s one day work shop for first responders and healthcare personnel entitled “Crisis Management for School Event” earlier this year.
Through a New York State Department of Health grant funding opportunity, again this past year River Hospital has been able to continue to enhance networking efforts with the regions Emergency Medical Service affiliates. The benefits of this grant were shared with a broad spectrum of volunteer and professional Emergency Medicals Services (EMS) departments. “Battlefield Emergency Care: What can combat medicine teach us from the scene to the ER?” was a training day held at the Fort Drum Simulation Center. With coordinating participation from the Fort Drum Regional Health Planning Organization, Fort Drum Medical Simulation Training Center (MSTC) and Jefferson County EMS, a hands-on training was well attended by Emergency Medical Technicians (EMTs) from the Jefferson, Lewis, St. Lawrence, and Madison County areas, active duty military personnel at Fort Drum, as well as Jefferson Community College Paramedic students.
- Tobacco Use: The Tobacco Cessation Center began working with the River Community Clinic in 2007 to assist them in the implementation of the US Public Health Service Guidelines for tobacco dependence treatment. In January of this year the Tobacco Cessation Center of Northern New York (TCC of NNY) recognized River Community Clinic, River Hospital’s primary care health practice, for their diligent efforts over the past several years in the treatment of tobacco dependence. River Community Clinic has achieved the highest level of partnership with the TCC of NNY and was recognized for their efforts.
The Clinical Practice guidelines are the Standard of Care in tobacco cessation treatment in health care settings and River Community Clinic was among the first in their area to implement them. The staff and providers continue to provide excellent tobacco cessation services to the community.
Data analysis will begin with HEAL 21 Collaboration.
Other Non-Prevention Agenda Priorities:
River Hospital Board of Directors and Administrative Staff continue to work together closely and diligently to be vigilant in the appropriate health care service offerings to the communities served by this facility. With the volatility in the reimbursement structure for services, especially as a Critical Access Hospital in a very seasonal community, the management team is very watchful of the financial margins of current services as well as new services under consideration. Through the development and tracking of goals and constant analysis, measurable progress has been made in the past twenty four months in an effort to stabilize in unpredictable times when availability of affordable health care is at the forefront of concerns in America.
Successes and Challenges Regarding Provision of Financial Aid and General Overview of Accomplishments, Process Improvements Related to Financial Aid Program:
A key element of a well-functioning health care system to safeguard access to quality health care includes assisting with available health insurance alternatives. River Hospital is host to a Facilitated Enroller on a weekly basis to assist with medical insurance coverage options.
River Hospital staff is dedicated to providing quality care to our patients with financial assistance to those who may need help paying for their healthcare. Financial aid is available to patients with no insurance or whose health care benefits have been exhausted. River Hospital does not provide additional assistance with copays and deductibles after insurance payments. Patients are offered a packet which provides the
tools needed to apply for financial assistance with hospital bills. Patients are expected, however, to contribute to their healthcare costs based on their ability to pay by completing a River Care application in and supply necessary documentation for this assistance.
The primary challenge that accompanies this provision refers to the accounts that cannot be fully collected, despite the patient’s best efforts to pay. With lack of health insurance and limited income to pay accruing patient charges, the facility often is unable to collect for services rendered, resulting in lost reimbursement.
River Hospital is a unique institution. The uniqueness is replicated in this web site. Our staff cares deeply about quality patient care and personal attention. We are focused on expanding our current services to the area communities, and visitors of this area. The staff's attitude is summed up in the description of the hospital logo. Our staff is committed to serving you and your family in the most compassionate, competent, and efficient manner. Some photos of the campus can be viewed by accessing our Video Library and Photo Gallery below.