ARLINGTON — According to Cascade Valley Hospital and Clinics CEO Clark Jones, smaller hospitals such as Cascade Valley are facing an uphill battle to stay in business if they don’t affiliate themselves with larger health care systems.

“Like fire departments and districts, affiliation could offer us cost savings to counteract decreased income and reimbursements, as well as increased expenses,” Jones said. “An additional concern for hospitals is that our whole system is changing. Firefighting isn’t going through a sea change right now, but health care is. We’ve been told that the costs are unsustainable and that Medicare’s insolvency is pending, but no one has done anything but talk so far.”

While Jones declined to offer an opinion on the Affordable Care Act, he nonetheless predicted that it would result in Cascade Valley and other hospitals caring for more patients than ever before, “but with no more money for it.” Likewise, while Jones identified three cost-cutting alternatives under the ACA — results-based reimbursements, electronic health records and accountable care organizations — he noted that each one comes with its own set of expenses, from the system of results reporting required by the result-based reimbursements to the maintenance of even existing electronic health records systems, such as those that have already been established at Cascade Valley.

“As for accountable care organizations, they’re larger networks of medical care providers and facilities offering whole spectrums of services,” Jones said. “What’s driving a potential affiliation is that Cascade Valley provides a relatively narrow band of services, and by affiliating with the Island and Skagit Valley hospitals as part of a much larger organization, we could achieve economies of scale and offer services that have never been available to our communities.”

The three public hospitals serve contiguous geographic areas in Snohomish and Skagit counties, and have been conducting community forums to hear from the public what they think about proposals to affiliate with either the Providence-Swedish organization, PeaceHealth, the University of Washington Medical Center, Virginia Mason or MultiCare Health of Pierce County. The Rainier Conference Room at Cascade Valley Hospital served as the site for one such forum on April 10.

“Before any such affiliation occurs, we need to make sure that our visions fit together,” said Jones, who noted that a number of attendees of the April 10 public forum, including a few Cascade Valley Hospital employees, expressed reservations about the fact that two of the potential affiliation partners are Catholic health systems that restrict certain services according to church doctrine. “These are credible citizens with very legitimate concerns. One of our nurses even said that we should be about science and not faith-healing.”

The tentative deadline for these potential affiliation partners to submit their request proposals is April 26, although Jones deemed that a flexible date. Jones likewise emphasized that the nature of any potential affiliation has yet to be determined, and could range from “a loose handshake agreement” to one organization buying out the others, although he conceded that any such arrangement would likely result in the loss of a certain measure of local control.

“If none of those organizations meets our needs, then we’ll have to go with a Plan B, which we don’t have right now,” Jones said. If only one or two of them look attractive, it’ll still take at least a few months to sort things about. If they all look attractive, we’ll talk to each one. The bottom line is, it would almost take a miracle for this to get resolved in 2013. It’s more likely going to happen in 2014 or 2015, and yes, as the process progresses, we’ll be soliciting additional public input. People will have lots of questions, and we can’t answer of a lot of them right now.”