Adirondack Medical Center in Saranac Lake (Photo provided by Adirondack Health)

SARANAC LAKE — Before the coronavirus pandemic, many rural North Country hospitals were operating on razor-thin margins. Now, hospitals are facing revenue losses that could force this area’s health care providers to rethink how they deliver care.

Three hospitals that serve residents of Franklin and Essex counties — Adirondack Medical Center in Saranac Lake, Alice Hyde Medical Center in Malone and Elizabethtown Community Hospital — all canceled elective surgeries last month in an effort to conserve supplies and free up space for an anticipated influx of COVID-19 patients.

But many rural health care providers rely on elective surgeries — and the testing and imaging services that go along with them — to shore up enough revenue to break even.

Before the coronavirus outbreak reached the North Country, rural hospitals were already facing financial difficulties, many of them merging or downsizing. Canceling services that gave them needed revenue could prove to be a significant challenge for an industry that is among this region’s largest employers. Adirondack Health, for instance, the local network that includes AMC, is the largest private employer in the Tri-Lakes area.

Some upstate New York hospitals and community health networks have already begun furloughing staff.

Glens Falls Hospital on Monday announced the indefinite furlough of 337 employees not involved in essential care or the care of COVID-19 patients. The Hudson Headwaters Network, which runs community health centers mostly in Warren and southern Essex counties, furloughed 85 non-clinical employees last week. As a result of a loss of revenue from the canceling of elective procedures, Oswego Health on Monday temporarily laid off roughly 300 employees — approximately 25% of its total workforce, according to the Watertown Daily Times. Some of those laid-off employees were medical staff.

At ECH, 25 employees have been temporarily furloughed, according to Rogers. She said those people are expected to be brought back as soon as it’s safe.

“We also reassigned staff wherever possible; 19 have been redeployed to roles supporting our COVID-19 response,” Rogers said.

There has been no involuntary layoffs or furloughs at AMC — though employees were offered voluntary furlough options, and a few people did take them, according to spokesman Matt Scollin.

“We are doing everything else we can to safely rein expenses in before turning to furloughs or layoffs,” Scollin said Monday. “(Adirondack Health CEO Sylvia Getman) says all the time that our employees are our most valuable assets. And they are.”

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Hospitals face losses

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When elective surgeries were suspended at local hospitals last month, the decline in revenue was severe.

“When non-urgent elective encounters were suspended to help slow the spread of the virus, our revenue was reduced by about 50%,” ECH spokeswoman Elizabeth Rogers said Monday.

Adirondack Health’s surgical volume has plummeted by 70% since March 23, according to Scollin. In tandem with the decline in surgeries, the hospital has seen a decline in imaging services of roughly 50%.

That puts significant financial strain on the hospital.

If the virus continues to spread and surgeries and other services remain canceled for the next few months, Adirondack Health is facing losses in the millions of dollars, according to Scollin.

But as hospitals face losses, administrators are also looking at different ways to continue providing care to patients who don’t have COVID-19. Tele-health visitation between doctors and patients is emerging as a common solution.

“In a matter of days, we launched a tele-health program, allowing patients to visit their providers virtually on a secure platform,” Rogers said.

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“It’s going to take a long time”

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The decline in revenue as a result of changes to surgical services comes after Adirondack Health and its donors have invested heavily in elective surgeries and imaging services at its facilities in recent years.

The new Lake Placid Health and Medical Fitness Center building on Old Military Road, Lake Placid, which opened last year, cost more than $22 million to build. The hospital raised about $16 million of that through its Future of Care campaign, which also helped fund the Surgical Services Department for AMC in Saranac Lake. A $2 million state grant was received through the North Country Regional Economic Development Council.

“That is the future for us,” Scollin said, of elective surgeries.

Still, Scollin stressed that canceling surgeries to conserve supplies and space was, and is, the right thing to do.

“It is the right call to conserve (personal protective equipment) and keep everybody as safe as we can,” he said.

To elected officials and others who may be able to help, Scollin said, “It is going to take a long time to dig out of this hole, and we can take all the help we can get.”