The Hippo


Jul 23, 2019








Rehab facility readies to close
Crotched Mountain winds down its operations

By Ryan Lessard

 On June 5, the Crotched Mountain Specialty Hospital began a 90-day process of winding down operations, discharging patients and ultimately closing for good.

Crotched Mountain CEO and President Michael Coughlin said the problems that led to this decision have been building up for over a decade.
“It was an evolving recognition that something needed to happen as far back as 2000,” Coughlin said.
Money woes
The hospital, which provides long-term rehabilitative services for people with complex medical needs, was bleeding money. Coughlin said that over the past five or six years, the hospital’s reimbursements were not keeping up with its rapidly growing costs, and the organization had to regularly dip into its endowment.
Before that, the board had brought in outside consultants and was approached numerous times with different plans to increase revenue or lower costs. As recently as 2013 and 2014, it tried and failed to strike a deal with larger hospital systems.
“We’re part of a dying breed — organizations that aren’t affiliated with larger hospital systems,” Coughlin said.
While other hospitals joined affiliations, consolidated costs and diversified patients to include better insurers, Crotched Mountain did the opposite. 
Coughlin said the hospital was inordinately dependent on Medicaid reimbursements, which he said is the worst payer source aside from no payer source at all.
“We haven’t had an increase in reimbursements for quite a long time, I want to say since 2010, and meanwhile our costs have just been going up and up and up,” he said. 
Some of those costs were related to equipment and maintenance, but personnel costs were skyrocketing because of the nursing shortage in the state. 
Compared to 2010, he said, the hospital pays “significantly more” for nurses. Crotched Mountain routinely had to hire more outside contract nurses — which costs about 50 percent more than its staff, who are paid about the state average.
“We have to entice people to come from wherever they are up on this mountain in Greenfield, and between the labor costs and the fixed asset costs, it just priced us out of the game, really,” Coughlin said.
Still, Coughlin said, the quality of the work has been top notch.
“This event hasn’t been any reflection of the quality of the work. In fact, all the surveyors who come to us, consultants from around the country come to us and say, ‘You guys are doing amazing work. It’s just that it’s extremely costly,’” he said.
The opioid effect
Another thing that’s changed in just the past year has been a shift in the types of patients referred to the hospital. 
“Historically, we were the place where people would recover from brain injury, stroke and spinal cord injuries,” Coughlin said.
While the hospital is licensed for 62 beds, it pivoted about two and a half years ago to focus on more severe cases, which reduced their number of patients to about 45. More recently, the census has been about 38 to 40.
But just over the past 12 months, a new type of patient started to show up — who were revived from opioid overdoses.
“What happens is people who are revived from Narcan — people who overdosed, somebody calls 911, first responders show up and they would revive the patient with Narcan — if they’ve been out too long, if … their heart stopped for too long a time, they have a significant rehab that may never heal,” Coughlin said.
A year ago, they didn’t have any of these patients. They now make up about 15 percent of the total referrals.
He said the problem, called anoxic brain injury, happens when the brain is starved of oxygen for too long, often causing paralysis of the arms or legs. In severe cases, it can place people in a coma or a vegetative state.
“The other thing about this population that’s so tragic is they’re young. They’re in their 20s and 30s. It’s people who had an active life and then all of a sudden they make a mistake and their life is ruined. It’s an awful situation,” Coughlin said.
After Lakeview Neurorehabilitation Center in Effingham closed in 2015 amid maltreatment lawsuits and a state review, Crotched Mountain was the last to offer the same kind of specialty services, Coughlin said.
Now, many of these patients will either have to stay at traditional hospitals or nursing homes, or find care in a different state.

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