Hartford Business Journal

HARTFORDBUSINESS.COM | AUGUST 5, 2024 13 1924.ULBRICH.COM Our company is about the people around us. Our family business is about family. We work hard for each other, for our families, and for the communities we live in. We are connected through our responsibility to produce critical products. By participating in lean, executing our jobs, and ensuring safety is always in the forefront, the hard work of each person impacts the lives of everyone connected to Ulbrich Steel. Improving Lives With More Than Metal — Since 1924 Favorable impact Kramer says the hospital's focus now is on key challenges in the local population, including pulmo- nary and respiratory health, cardiac care, digestive diseases, cancer and orthopedics. He's also committed to keeping the hospital's birthing center, the only one in the northeast of the state, and a key area of controversy after Hartford HealthCare closed the birthing unit at Windham Hospital. There have also been efforts to close rural birthing centers at Sharon and Johnson Memorial hospitals, owned respectively by Nuvance and Trinity Health Of New England. "I think there's just certain things you've got to maintain locally," Kramer said. "And it's important for us to do that." Day Kimball Healthcare is relo- cating and consolidating its cardi- ology team into offices across the street from the hospital, and has recruited the former chief of cardi- ology at St. Francis Hospital, Richard Soucier, to that team. Day Kimball also retooled its orthopedic surgical program, and expanded a collabora- tion with the Connecticut GI group in digestive health. But the hospital also shed some services. Last December, Day Kimball Healthcare sold its homecare divi- sion to a specialist provider based in Cheshire. Kramer says that removed non-clinical homecare responsibili- ties — such as bathing, dressing and meal preparation — but not in-home medical care, which they still provide. Kramer is also facing workforce issues. He says many of his staff spend a working lifetime at the hospital, which provides a lot of continuity, but also some concerns. "When you have a lot of individuals who are exceedingly long tenured, at some point they will make the deci- sion to retire," he said. "We're a small market, so recruiting new people into this market is a bit more challenging." To that end, Day Kimball has been building out partnerships with local high schools to highlight a range of potential healthcare careers. Kramer says all of these changes are beginning to yield a favorable impact on the hospital's financial performance, but the challenges of operating in a small market with a significant Medicaid population and rising labor costs remain. 'Right partner' The message Kramer is sending is that Day Kimball is busy solving its own problems. But he still believes the best end game is a sale or strategic partnership. And that's largely because it's now very expensive to be an independent hospital. The hospital gets some breaks on the cost of buying clin- ical supplies through a community partnership with Yale New Haven, but Kramer says the inequities go beyond that. For instance, routine procedures like an MRI that might be reimbursed at one rate for a big system like Yale or Hartford HealthCare will be reimbursed at a much lower rate for Day Kimball. "An organization that is our size, that's independent, doesn't have the negotiating leverage with an Anthem, an Aetna, a Blue Cross that a large multi-hospital system has," he says. He also sees big expenses ahead, particularly around technology and IT needs. "We are on an electronic health record now, but we need to upgrade that system," he said. "It's the type of investment that if we were to make, would consume our capital budget for probably the next 10 years." Recent research suggests these issues are widespread among rural hospitals nationally. A study of data from 2010 to 2018 showed that financial distress among rural hospi- tals has increased. "In many areas, the population is declining and their case mix is deteriorating, and they have a lot of requirements to invest in capital," said study author Michael Chernew, a professor of healthcare policy at Harvard. "And if they don't — or even sometimes if they do — patients have a tendency to want to sometimes go to bigger centers further away." Chernew says the impulse to look for a merger deal with a large group is understandable. "It's not as if there's some magic solution to this problem," he said. Kramer won't say exactly which systems he's in talks with, but his vision is clearer these days in the wake of the Covenant failure. "You learn a lot," he said. "In these types of relationships, as in life, you want to make sure that you're identifying the right partner." One thing he is focused on is preserving a good range of functions at the Putnam site. "This needs to be a hospital, not an ambulatory setting," he said. "What we know we don't want is a situation where the population is put in a posi- tion where anything that is special- ized gets sent to a mothership." "We're actively involved in conver- sations with larger systems, regard- less of whether there's a relationship potential, because we feel that there is always something that we can learn," he added. "But what we're also making sure that we're doing is telling our story. We're a small community hospital, but we have a lot of good things happening here. We're making a real difference for this population." Day Kimball Hospital in Putnam. CONTRIBUTED PHOTO

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