Democrat Photo | Jeanne Sager THE FAMILY HEALTH Center, in the ambulatory services section of the Harris facility, will be consolidated with the clinic run by Hudson River Healthcare in Monticello.

CRMC Doctors Facing Firings?

By Jeanne Sager
HARRIS — October 19, 2007 — Is the new administration of Catskill Regional Medical Center firing doctors?
CEO Steve Ruwoldt says no.
But certified letters sent to at least 10 doctors, signed by the hospital’s chief medical officer, Peter Panzarino, and requesting a renegotiation of their contracts, says they are “notice of your termination.”
“There is no ambiguity in their wording,” said one doctor who asked to remain anonymous.
Ruwoldt said the key is “renegotiation.”
The doctors – all employed by CRMC in physician practices – are being asked to sit down with administration to discuss a new contract.
“It’s not termination,” he said. “What I’m doing is putting the doctors on an incentive plan.
“Currently, they’re on a flat fee – that’s the amount they get whether they work hard or not,” he said.
Ruwoldt said there are doctors who opt not to see patients – but they still get paid.
Under the current contracts, he said the hospital has no recourse.
But when asked if the new contracts would require doctors to bring in new patients to meet that requirement of “working harder,” Ruwoldt was quick to point out anti-kickback laws preclude the hospital from requesting physicians increase the number of people admitted to the hospital or referred to the laboratory.
Almost three years ago, CRMC answered charges from the federal government for a kickback scheme that involved monies paid out to another entity from 1997 to 2000 (when the hospital was operating under the name Community General) in exchange for “administrative services” and patient referrals to its alcohol and substance abuse treatment center in Harris.
The hospital then billed Medicaid for the treatment of the illegally-referred patients.
Opting not to go to court, CRMC signed an agreement to pay the federal government $1.5 million over three years.
At the time, the Office of the Inspector General of the U.S. Department of Health and Human Services also demanded a corporate integrity agreement – which included a contractual review process be put in place to ensure current and future contracts comply with state and federal anti-kickback statutes.
With that in mind, Ruwoldt said new contracts drawn up can have “nothing in regard to productivity.”
So how do they measure if the doctors are working harder?
Ruwoldt couldn’t answer.
But if they’re not – and the hospital loses money on the practices – he said the new contracts would call for the doctors to lose money.
Ruwoldt wants to draw up contracts that he said would give the doctors more power over their futures – they can set their own hours, have more control over their staff.
On the hospital end, Ruwoldt said this would be a loss reduction. Doctors who don’t work don’t get paid.
“The key message in this is it gives the doctor an opportunity to make money if they want to,” he said.
So that wording, “termination of contract?”
“I’ve made it clear I want to renegotiate,” Ruwoldt said.
He blamed rumors floating in the community about doctors being fired on Drs. Donald Roth and David Schwalb, whose office in Liberty is one of four the hospital has pinpointed for “renegotiation.”
The Democrat has heard from patients afraid the rapport they’ve built with their physicians – some over a 30-year period – has all been for naught, patients afraid the oncologist overseeing their cancer treatment won’t be there to follow their path through chemotherapy.
Contacted following Ruwoldt’s claim that they were at fault, Schwalb said he’d rather not have the doctors’ contracts discussed publicly.
“Our contracts and our jobs are very personal and have long-reaching implications to our co-workers and our patients in this community,” Schwalb said. “I would hope these items we are dealing with not be discussed in print.”
Roth and Schwalb have worked for CRMC for the past six years, but their office has been serving patients for decades.
Both are county natives, and Roth once cared for patients alongside Schwalb’s father, the late Dr. Alan Schwalb.
Ruwoldt didn’t put names to the other doctors whose contracts are in flux.
He said those affected include Roth and Schwalb and the hospital’s other clinics including the general surgeons, oncologists and cardiologists.
In all 10 doctors received letters, he estimated, at four different offices.
“We’re supporting a number of these where they’re not breaking even,” he said. “We’re encouraging losses, and we’re paying for that.”
If the doctors decline to renegotiate, Ruwoldt admitted termination is inevitable.
“They’re deciding they don’t want to be employed,” he said simply.

By Jeanne Sager
HARRIS — Consolidation could be the key to saving Catskill Regional Medical Center.
The hospital has decided to renegotiate contracts with its doctors – and put them on notice that a decision not to negotiate would mean termination.
According to CEO Steve Ruwoldt, there’s no current plan to shut down clinics.
But if consolidation is a possibility – if, say, the doctors opt not to renegotiate – the hospital will act.
Already in the works is a plan to consolidate CRMC’s Town of Fallsburg Lion’s Club Family Health Center with the clinic run by Hudson River Healthcare in downtown Monticello.
Under law, the hospital is required to provide a place for patients who originate in the emergency room to receive follow-up care, Ruwoldt explained.
For years, they’ve done that downstairs at the health center, where the hospital has paid a general practice physician and also provided subspecialist care.
The majority of the patients are uninsured or on Medicaid, Ruwoldt said, and unable to receive care from many of the private physicians offices in the community.
But the hospital swallows much of the cost of caring for those patients – subspecialty care alone is costing CRMC $250,000 a year that can’t be recouped from a health insurance company or Medicaid.
Combining with Hudson River – which unlike the hospital receives federal funding to provide the services of a general practitioner to the indigent, will help cut costs for CRMC.
At the office on Lakewood Avenue, just off Broadway in Monticello, patients will be able to follow up with a doctor on the problems that brought them to the CRMC emergency room.
Costs for subspecialty care will now be split between CRMC and Hudson River, reducing the burden for the hospital.
Ruwoldt said the new service should be in effect next month and should provide easier access for patients who live in much of the county because it’s located in the county seat.
The health center, located in the downstairs of the hospital in Harris, is already down a general practitioner who has left the hospital’s employ. When the transition to Hudson River is complete, it will be closed down entirely.
Hudson River Healthcare is located at 23 Lakewood Avenue in Monticello and is open Monday through Friday from 9 a.m. to 5 p.m.
The office accepts most insurances as well as Medicaid, Medicare, Family Health Plus and Child Health Plus and provides service to the uninsured on a sliding fee scale.
For information, call the office at 794-2010.