Bartlett Regional Hospital in Juneau is looking to cut or downsize six of what it calls "non-core" programs to stabilize its finances. Those include programs to treat drug addiction, autism therapy and hospice. (File photo/Juneau Empire)
Bartlett Regional Hospital in Juneau is looking to cut or downsize six of what it calls “non-core” programs to stabilize its finances. Those include programs to treat drug addiction, autism therapy and hospice. (File photo/Juneau Empire)

Six programs at Bartlett Regional Hospital — including substance abuse, autism, crisis stabilization and hospice care — are being targeted for cuts or elimination by leaders seeking to halt years of operating losses that are threatening to cause the hospital to run out of money during the next few years.

Among the recommendations for closure by hospital administrative leaders are the Rainforest Recovery Center, which provides residential and outpatient substance abuse treatment, and Applied Behavior Analysis (ABA) Therapy, which works with people ages 2-21 diagnosed with autism. Part of the discussion by officials for those and other programs is local alternatives that may be available from public or private entities.

About 40% of the clients at Rainforest Recovery Center are Juneau residents, for instance, who could thus be forced to travel elsewhere for similar care if the facility closes, according to hospital officials. But the facility has suffered operating losses every year since the City and Borough of Juneau transferred management of the facility to the hospital in 2000.

“I would say we need to ask the hard question of CBJ, and it’s ‘Do you guys want to have a dedicated funding stream to make this thing work? Or do you want us to close this thing?’” said Max Mertz, chair of the committee “And I guess there’s maybe an intermediate recommendation, too, which is do we know if there’s any other providers that would potentially want to take this over?”

“If that was an option I think we’d talk,” replied Ian Worden, Bartlett’s interim chief executive officer. “We just haven’t explored it yet.”

Worden said closing the facility appears to be the most practical option, unless the hospital gets additional financial support or another entity takes it over, which some other board members expressed agreement with.

“It’s with reluctance that I say it, but I agree that our only options are to find someone to take it over or to close the facility in order for the core hospital services to remain intact,” said Deb Johnston, the board’s vice president.

A series of meetings and public comment periods are planned during the coming month as specifics of a plan are crafted for “non-core hospital services in light of the hospital’s $10M annual budget deficit,” according to a presentation by Joe Wanner, Bartlett’s chief financial officer. Hospital leaders have stated Bartlett’s fund balance could be depleted in three years without significant steps to stabilize its finances.

Wanner’s presentation featuring an initial evaluation of the six targeted programs was reviewed by administrative leaders and board members during a meeting of Bartlett’s finance committee last week. The viable options presented for the programs include closure, finding a permanent source of revenue to subsidize costs (such as the city allocating a portion of sales taxes), or reducing costs (and thus likely operations).

The full board of directors is scheduled to give initial consideration to the plan at its meeting next Tuesday, followed by a joint meeting with the Juneau Assembly on Wednesday. A proposed schedule calls for the board to approve final recommendations at its June 25 meeting following a “community feedback/engagement period.”

The six programs being evaluated, the reasons why and alternatives proposed in Wanner’s presentation are:

Rainforest Recovery Center, a 16-bed residential and outpatient treatment program that has never been self-sustaining and is expected to lose nearly $800,000 next year. Staffing is considered to be at a minimal level and reductions in services would result in a corresponding loss of income. Subsidizing costs or closure are the only options presented as practical by Wanner.

ABA therapy: Taken over by Bartlett in June of 2021 from a private contractor hired by the Juneau School District because it was “deemed to be a community need.” However, it is expected to lose $536,000 next year due to payroll costs alone exceeding revenues and there appears to be no practical way to make it self-sustainable. However, Wanner noted the two providers in the programs have submitted their resignations effective June 13 and are starting their own company to provide similar services, and the recommendation from committee members is to wind down the program and offer non-monetary support during the transition. There are five other employees in the program who are discussing options within the hospital or elsewhere.

Crisis Observation Services (COS)/Crisis Residential and Stabilization Services (CSS) for Adults and Adolescents: While Wanner’s analysis states “adolescent and adult crisis services are needed in Juneau,” Bartlett has only been able to provide CSS services to adolescents “due to facility layout and staffing concerns.” As with Rainforest Recovery Center, either subsidizing costs or closing the program are the recommended options.

Bartlett Outpatient Psychiatric Services (BOPS): Since the 1990s has provided individual and family psychotherapy, plus medication-assisted treatment for substance abuse. Staffing has grown rapidly in recent years, from the equivalent of 4.12 full-time positions in 2018 to a projected 13.69 positions next year. However, the program is also projected to lose $2.8 million next year. Of the six programs this is the only one where closure was not an option presented by Wanner, who instead listed reducing or subsidizing costs as potential remedies. Committee members agreed they want hospital administrators to present cost-reduction plans to board members by July.

Home Health Services: Taken over by Bartlett, along with hospice services, in mid-2023 after Catholic Community Service halted both programs in the fall of 2022. Numerous financial and operational difficulties are cited by Wanner, who notes “BRH has held initial discussions with a private (home health) and Hospice entity with interest in operating these programs in Juneau.”

Hospice Services: The same fundamental situation and possible private takeover as home health services exist for this program.

Some board members said the latter two programs are vital enough to the community to merit Bartlett continuing to operate them at a loss if necessary.

“These two particular programs are exactly why we need to have Bartlett as a community hospital and to be run by the community, is because this is something that we were able to take over and to provide for our community,” said Kenny Solomon-Gross, the board’s president. Echoing another board member, he said “closing is not an option.”

“So even if we have to take a loss until we’re able to either find another operator or figure out another mechanism I think it’s really important that we put that out to the community and make sure know that they know that home health care and hospice is not going away for our community.”