By Jeanne Sager
HARRIS June 27, 2006 A change in federal government reimbursements spelled the end of the Upstate Rehabilitation Unit in Harris.
As of June 20, the 10-bed unit at Catskill Regional Medical Center (CRMC) has closed its doors.
Hospital CEO Art Brien says its because the unit isnt being used and the federal governments adjustment in how it dispenses Medicare reimbursements to rehab units made it impossible to afford.
But Medical Director Dr. Barry Scheinfeld, a physiatrist with a private practice right up the road, tells a different story.
Some 20 years ago, Scheinfeld joined the Catskill Regional Medical Center (then Community General Hospital) and at the behest of then-Administrator Martin Richman, petitioned the state to open a hospital-based rehab unit.
The idea, he said, was to keep people in need of rehabilitation from having to travel to Helen Hayes Hospital in West Haverstraw or farther for care.
We had an agreement with Helen Hayes that if there were really tertiary care cases like head trauma . . . wed send it to Helen Hayes, Scheinfeld explained.
But the more frequent cases that appear in a rural community strokes, amputations, rheumatoid arthritis, hip replacements, etc. would be treated right in Harris.
What opened in 1986 was a well respected and successful unit, Scheinfeld said.
But since Richman left the hospitals employ, Scheinfeld said his successors have failed to nurture the unit.
You have to put money back into the unit, he said, comparing the care of a hospital unit to that of a flower.
If you have a beautiful plant and you dont water it, and you dont change fertilizer and you dont move it around so it gets sunlight, it cant thrive, Scheinfeld said.
Scheinfeld called the federal governments announcement two years ago the coup de grace.
Hospitals with rehab units were informed that they would have to phase in a program that would ensure 75 percent of the patients on the unit at any one time fit into a 13-category list of diagnoses.
The other 25 percent being treated could have any range of problems.
Scheinfeld said he asked the hospital to immediately appoint a point person to make sure CRMC was on track in phasing in the new requirements.
Nothing was ever done until it was too late, he said.
That point person was brought on only in the past year, and administration never made some of the beds on the Skilled Nursing Unit into sub-acute rehab beds as Scheinfeld had requested.
During a four-month period earlier this year, CRMC didnt meet the federal percentage requirements.
They were informed that the hospital would be losing its enhanced reimbursement status.
And with a shortage of patients on the unit and funding shortfalls, Brien said the decision was made to shut down.
The staff was moved to other parts of the hospital.
But thats part of the problem, Scheinfeld said.
Once they knew the rehab unit was closing, they treated it like it wasnt important, he explained. They started taking the experienced rehab unit nurses and floating them on medical floors.
Scheinfeld surmised the federal governments move was aimed at rural hospitals with rehabilitation units.
But he said this didnt have to be the end for Upstate Rehabilitation.
I dont think our hospital did due diligence on an administrative level to keep this rehab unit, he said. We had this service.
How can you justify giving that up in the face of an aging population? he asked. They didnt have an outreach program, they didnt know how to market the place . . . they just wanted it to make money.
Were a community hospital, Scheinfeld said. We should be serving the community that should be the priority.
I think were going backward with this administration by giving this up, he continued. This is a serious matter to the people of Sullivan County.
Sure, I had a personal interest, but I think we really filled a need.
Scheinfeld will continue his private practice in Harris, but he foresees CRMC having to again petition the state for a rehab unit.
I dont see anyone getting younger, he said.