WITH ITS HISTORY DATING BACK NEARLY A CENTURY AND A HALF, CROUSE HOSPITAL HAS GONE THROUGH COUNTLESS CHANGES.

A SIGNIFICANT MERGER IN THE 1960'S COMBINED CROUSE WITH A NEIGHBORING HOSPITAL WHICH STRENGTHENED THE FACILITY IN THE YEARS TO COME.

BUT THE BUSINESS OF HEALTHCARE HAS CHANGED DRAMATICALLY SINCE THEN AND COVID ONLY WORSENED AN ALREADY TOUGH ENVIRONMENT.

FACED WITH POSSIBLE CLOSURE, CROUSE ELECTED TO MERGE AGAIN - THIS TIME WITH UPSTATE MEDICAL .

BUT THAT MERGER WAS CALLED OFF ABRUPTLY AND WE WONDERED WHY.

ON THE MONEY MET WITH CROUSE'S NEW CEO DR SETH KRONENBERG TO FIND OUT WHAT HAPPENED AND WHAT THE FUTURE OF HEALTHCARE IN CENTRAL NEW YORK MIGHT LOOK LIKE.

WE ALSO VISITED A BRIGHT SPOT: ESSENTIAL FACILITY SERVING MULTIPLE COUNTIES.

IT APPEARS CROUSE IS BACK ON ITS FEET.

>> A LOT OF TALKS, A LOT OF CONVERSATIONSS ANALYSIS, ETC., STUDIES ON A MERGER BETWEEN CROUSE AND UPSTATE.

I MEAN YOU KNOW FULL TRANSPARENCY HERE, I EVEN HOSTED PUBLIC EVENTS TALKING ABOUT THIS.

WE DID A SPOTLIGHT SERIES ON THE SHOW ABOUT THE MERGER.

IT WAS BILLED AS BEING ESSENTIAL AND IT DIDN'T HAPPEN.

WHAT HAPPENED?

>> YOU KNOW, THERE WAS A LOT OF WELL INTENTION TO THE MERGER.

THE CLIMATE JUST WASN'T RIGHT FOR SOMETHING THAT MAGNITUDE.

WE HAVE ACTUALLY COME OUT STRONGER THAN GOING INTO THE MERGER DISCUSSIONS.

STILL HAVE GREAT RELATIONSHIPS WITH UPSTATE.

>> OF COURSE.

>> WORK WITH THEM ON MULTIPLE PROGRAMS.

>> YOU COLLABORATE.

>> BUT WE ARE MUCH STRONGER COMING OUT.

IT GAVE ALL OF US AN APPRECIATION OF WHAT MAKES CROUSE SO SPECIAL.

WE HAVE A CLEAR PATH FORWARD AS AN INDEPENDENT COMMUNITY HOSPITAL LOCALLY GOVERNED AND WE ARE VERY PROUD.

>> I WANT TO TALK TO YOU ABOUT THAT.

IT'S INTERESTING.

YOU KNOW, COMING OUT OR DURING AND COMING OUT OF COVID IT WASN'T JUST CROUSE.

HOSPITALS ACROSS THE COUNTRY WERE HURTING.

IT WAS JUST CRIPPLING, AS YOU KNOW.

YOU ARE TELLING ME YOU ARE GOOD NOW.

FINANCE IS GOOD, GOOD SHAPE.

WE NEED THIS HOSPITAL?

>> WE HAVE A SOLID PHENOMENON PLAN.

ONE OF THE THINGS WE SAW THROUGH COVID IS BEING PART OF A BILLION-DOLLAR SYSTEM DID NOT INSULATE HOSPITALS FROM FINANCIAL CHALLENGES.

THERE ARE FINANCIAL CHALLENGES FOR ALL HOSPITALS IN NEW YORK STATE.

CROUSE SPECIFICALLY WE HAVE A VERY SOLID FINANCIAL PLAN GOING FORWARD AND ARE VERY EXCITED AND OPTIMISTIC OF WHERE WE ARE HEADED.

>> YEARS AGO I INTERVIEWED A PAST PRESIDENT OF UPSTATE, Dr. DAVID SMITH.

AND I WASN'T BEING SARCASTIC BUT IT WAS A WEIRD QUESTION.

GEE, YOU HAVE PEOPLE LINING UP TO GET IN HERE.

YOU ARE LITERALLY HELICOPTERING PEOPLE IN.

I SAID I WISH I HAD A BUSINESS LIKE THAT.

AND YOU KNOW WHAT HE SAID TO ME?

EVERY TIME THAT HELICOPTER LANDS, WE LOSE MONEY.

I THOUGHT THAT WAS THEN.

IT'S ONLY GOTTEN WORSE.

IS THE BUSINESS MODEL BROKEN FOR HACK FOR HEALTHCARE?

IT'S HARD TO MAKE MONEY IN HEALTHCARE.

>> HEALTHCARE DOES NOT FOLLOW THE SAME SUPPLY AND DEMAND THAT OTHER BUSINESSES DO.

OUR REVENUES ARE CAPPED BY ALL OF THE INSURERS SO WHEN LABOR COSTS GO UP AND COST OF GOODS AND SERVICES GO UP, YOU CAN'T RAISE PRICES BECAUSE THOSE ARE FIXED BY THE INSURANCE.

>> THAT'S THE BUSINESS MODEL, RIGHT?

THAT'S TOUGH.

HOW DO YOU CHANGE THAT?

AND BY THE WAY BEFORE YOU EVEN ANSWER THAT, WHERE IS THE BIGGEST PROBLEM?

IS IT-- LOOK AT DRUG COSTS AND I'M NOT CRITICIZING... R & D DEVELOPMENT COSTS ZILLIONS OF DOLLARS TO MAKE A BILL BUT THAT'S EXPENSIVE.

EQUIPMENT IN THE HOSPITAL HUGELY EXPENSIVE.

WHAT DO YOU DO?

>> SHOE INSURERS ARE ABLE TO MAKE SIGNIFICANT PROFITS, SUPPLIERS ARE ABLE TO MAKE SIGNIFICANT PROFITS.

>> BUT YOU CAN'T.

>> CORRECT.

BECAUSE WE ARE FIXED.

THE CHALLENGE FOR US IS TO MANAGE WORKFORCE AND THOSE ARE OUR BIGGEST VARIABLE COSTS.

>> WHEN I TALK TO DOCTOR FRIENDS, YOU KNOW, THEY DO COMPLAIN A BIT ABOUT THE INSURANCE COMPANIES.

THAT WE HAVE TO NEGOTIATE THESE RATES, WHATEVER FOR SERVICES WITH THE INSURANCE COMPANY THAT DON'T REALLY COVER IT.

IS THAT PART OF THE ISSUE, TOO?

CAN WE BLAME THE INSURANCE COMPANIES IN.

>> YEAH, I MEAN WE ARE ALL IN IT TOGETHER BUT WHEN COSTS GO UP, OUR REVENUES ARE CAPPED, SO WE ARE NOT ABLE TO FLEX UP FROM THAT PERSPECTIVE.

>> SO GETTING BACK THEN, WHAT IS THE SOLUTION BECAUSE IT SEEMS FROM AN OUTSIDER LOOKING IN, IT SEEMS LIKE AN UNSUSTAINABLE BUSINESS AND YET IT'S ESSENTIAL.

SO WHAT DO WE DO?

>> WE NEED BETTER PARTNERSHIP WITH THE PAYERS TO ALIGN INCENTIVES THERE AND WE NEED BETTER STRATEGIES GLOBALLY TO HANDLE WORKFORCE COURSE THAT CONTINUE TO GO UP.

>> I'M TRYING TO FIND BLAME HERE.

IF WE ARE NOT PAYING THE DOCTORS TOO MUCH, DON'T KNOW WHERE WE FIND A SOLUTION WHEN THERE IS SUCH NEED FOR HEALTHCARE LOCALLY ESPECIALLY BUT ACROSS THE COUNTRY.

>> YEAH, SO ONE OF THE ISSUES IS WORKFORCE, SO TRAVELING NURSES MISS AN OPPORTUNITY THAT WE ARE LOOKING STATEWIDE TO SEE IF WE CAN CAP THE COSTS ON TRAVELING NURSES.

WHEN YOU HAVE TO PAY TRAVELING NURSES A PREMIUM, IT'S GREAT FOR THE TRAVELING NURSE COMPANY BUT NOT GREAT FOR THE SYSTEM.

>> IT'S NOT A NEW THING BUT THE SURGERY CENTERS, DOES THAT CUT INTO YOUR REVENUE STREEPS?

>> SO, WHAT WE ARE TRYING DO AS WE MOVE FORWARD IS ALIGN INCENTIVES WITH THE PHYSICIANS.

A LOT OF PRIVATE PHYSICIAN GROUPS HAVE OPENED THEIR OWN AMBULATORY SURGERY CENTERS AND THAT HAS PULLED SOME.

WE ARE TRYING TO LOOK AT THINGS LIKE COMPREHENSIVE STROKE AND THINGS THAT SERVE THE COMMUNITY BUT IT IS A CHALLENGE WHEN YOU HAVE ALL OF THE INDIVIDUALS FRAGMENTS IN THE SYSTEM.

>> EVERY TIME WE'VE TALKED TO SOMEBODY IN BUSINESS, THEY SAY LOOK, WE HAVE GOT-- I'M MAKING THIS UP.

WE HAVE 10 OPENINGS, NO APPLICANTS OR WE WANT TO EXPAND AND CAN'T BRING PEOPLE IN.

ARE YOU SHORT STAFFED HERE AT CROUSE?

>> HEALTHCARE IS SHORT STAFFED EVERYWHERE AND IT'S ALL POSITIONS.

ONE OF THE THINGS WE ARE INVESTING IN HEAVILY IN IS WORKFORCE DEVELOPMENT.

WE WANT TO YOU COME WORK AT CROUSE FOR LIFE.

WE WANT TO HAVE PROGRAMS THERE WHERE YOU START IN AN ENTRY LEVEL AND GROW WITH CROUSE AS YOU PROGRESS ALONG YOUR TRAINING I'M A GOOD EXAMPLE.

I STARTED IN THE PHARMACY IN THE TECH, WENT ON TO BE A DOC.

>> IN YOUR GENERATION MOST PEOPLE GET EDUCATED HERE AND LEAVE.

>> WHAT SEPARATES US IS OUR CULTURE.

IT IS UNIQUE HERE AT CROUSE.

IT FEELS DIFFERENT.

THE WAY WE TREAT EACH OTHER, THE WAY WE TREAT OUR PATIENTS.

>> I'M NOT OBJECTIVE ABOUT THIS ISSUE AT ALL.

BUT YOU KNOW, I HAD TWO DAUGHTERS, 18 MONTHS AARE THE PA, BOTH OF WHICH WERE, WHEN THEY WERE BORN, I'M NOT KIDDING, THEY WERE LITTLE.

THAT NICU UNIT, SECOND TO NONE.

>> IT'S OUR CORE SERVICE.

AS WE MENTIONED, WE STARTED AS A WOMEN AND INFANTS SERVICE.

WE ARE THE REGIONAL PERINATAL CENTER.

>> IT'S NOT SYRACUSE, RIGHT?

>> TO CANADA, PENNSYLVANIA, AND BETWEEN ALBANY AND ROCHESTER.

>> THAT CAN'T BE A MONEY MAKER FOR YOU.

IT WAS SUCH INTENSIVE CARE ROUND THE CLOCK.

IT'S PROBABLY NOT BUSINESS YOU WANT, BUT WE NEED IT.

>> WELL, WE WANT IT ONLY BECAUSE IT'S A SERVICE TO THE COMMUNITY.

LEARNED A LONG TIME AGO, PUT THE PATIENT FIRST AND THE FINANCES WILL FOLLOW.

>> YOU PROBABLY KNOW THE HEALTHCARE MARKET IN CENTRAL NEW YORK AS WELL AS ANYBODY, HAVING BEEN HERE ALL THIS TIME AND YOUR POSITION, AS YOU LOOK AROUND AT CROUSE AND REALLY AND COMPARE THAT WITH OTHER PARTS OF THE COUNTRY,CAN YOU TELL US THAT CENTRAL NEW YORK IS GETTING THE HIGHEST LEVEL OF HEALTHCARE AVAILABLE?

>> WE ARE BLESSED.

WITH ALL THE CHALLENGES THAT WE TALKED ABOUT, WE REALLY HAVE WORLD CLASS CARE HERE BETWEEN THE THREE SYSTEMS HERE, WE PROVIDE JUST ABOUT EVERY SERVICE THAT IS NEEDED SHORT OF SOME TRANSPLANTS.

>> BUT IS IT UNIVERSAL IN THE SENSE THAT, DEPENDING ON YOUR INCOME, DEPENDING ON YOUR ZIP CODE, IS ACCESS THE SAME FOR EVERYBODY?

>> ACCESS-- THERE ARE DEFINITELY DISPARITIES IN HEALTHCARE.

THERE IS NO QUESTION ABOUT THAT.

THERE IS MATERNAL MORTALITY CONCERNS THAT DEPEND ON ZIP CODES.

THERE IS A LOT MORE WORK TO DO AS A SOCIETY ON GETTING RID OF THOSE HEALTHCARE DISPARITIES.

ACCESS TO CARE IS AN ISSUE FOR ALL OF US.

>> BUT A PATIENT IS GOING TO RECEIVE THE SAME QUALITY OF CARE NO MATTER WHAT.

YOU ARE GOING TO BE ESSENTIALLY BLIND TO WHOMEVER THE PERSON IS ON THE TABLE IF YOU KNOW WHAT I MEAN.

>> WHEN WE SAY WE ARE MISSION DRIVEN AND EVERY MOMENT MATTERS, THAT'S EVERY PATIENT.

>> CROUSE IS THE ONLY INDEPENDENT HOSPITAL THAT'S SORT OF INDEPENDENTLY RUN, GOVERNED, ET CETERA.

SHOULD I CARE ABOUT THAT?

>> WELL, WE SEE THAT SASS A POSITIVE-- WE SEE THAT AS A POSITIVE.

OUR BOARD OF DIRECTORS ARE ALL LOCAL BUSINESS COMMUNITY MEMBERS IT ALLOWS US TO REALLY FOCUS ON WHAT IS GOOD FOR THE COMMUNITY.

WE ARE NOT ANSWERING TO ANYONE ELSE OTHER THAN OUR LOCAL BOARD AND IT ALLOWS TO US ADAPT TO MEET THE DEMAND OF THE POP LAWTION AS QUICKLY AS POSSIBLE-- POPULATION AS POSSIBLE.

>> THAT'S A TWO PARTER.

BUT BASED ON EVERYTHING YOU KNOW TODAY, DO YOU FEEL PRETTY CONFIDENT THAT YOU CAN CONTINUE TO PROVIDE HIGH QUALITY HEALTHCARE TO CENTRAL NEW YORK AND THAT YOU WILL STAY INDEPENDENT?

>> YES TO BOTH.

WE HAVE A VERY SOLID PLAN GOING FORWARD.

OBVIOUSLY THERE IS NO MAGIC WAND OR ABILITY TO SEE THE FUTURE.

AND THE PENDULUM ON MERGERS GOES BACK AND FORTH BUT WE HAVE A SOLID FIVE-YEAR PLAN GOING FORWARD.

WE ARE EXITED TO BE HERE FOR THE COMMUNITY AND WE WILL BE HERE FOR THE COMMUNITY AND WE ARE OPTIMISTIC AS WE MOVE FORWARD INDEPENDENTLY.

>> WE ALL HAVE A VESTED INTERESTED IN YOU.

BEST OF LUCK.

GREAT SPEAKING WITH YOU AND GOOD LUCK TO YOU.