The days of hospitals waiting for patients to show up at their door are gone.

Niagara County’s hospitals are branching out and changing in an effort to be more competitive by enhancing the patient’s experience with personalized care while at the same time reducing health care costs by practicing preventive care.

Joseph A. Ruffolo, president and chief executive officer of Niagara Falls Memorial Medical Center, said his hospital has been implementing a number of new strategies since 2009 to turn itself into a community hospital. That includes investing $62 million in the past decade – with more than $8 million in updates and technology in the past year alone.

Ruffolo calls it a “transformation journey.”

In the past, it was a traditional safety net hospital, which serves a large population of underinsured and those with no insurance that typically show up for “episodic care” in the emergency room or with repeated hospitalizations. Now it is becoming a center for community health and wellness.

“If hospitals stay with that type of safety net model, especially in light of health care reform, they wouldn’t be in business today. They simply can’t survive,” Ruffolo said. “If we just waited for people to show up, our costs would far outweigh our revenues.”

Judith A. Maness, president and chief executive officer of Mount St. Mary’s Hospital in Lewiston, agreed, noting her institution has moved away from a model that focused on volume to one that focuses on value, quality, safety and outcome.

Ruffolo said Niagara Falls Memorial’s transformation has been about lowering medical costs.

He said the hospital has assessed health concerns in Niagara County and northern Erie County communities and has found that in this area smoking, obesity, diabetes and high blood pressure are “four indicators that go off the map.”

“We don’t have the resources to do it all, so we have to partner with community agencies, government and other providers to address the main health indicators that are off the map,” Ruffolo said. He said the Falls hospital is designated as a “Health Home” for Niagara County, with more than 50 agency partnerships for care coordination for high-risk individuals. He said the hospital established the county’s first New York State-designated Health Home, which provides care management to hundreds of patients with more complex medical and behavioral health issues. The $2 million Niagara Wellness Connection Center will open this month to provide a “one stop shop.”

“We are not only addressing their health care needs, but we are also addressing their social and community support needs because they are all intertwined,” Ruffolo said of efforts to avoid overuse of medical resources.

Maness said Mount St. Mary’s has restructured its staff in order to provide care coordinators who help to guide patients through the transition from hospital to the office, home or any other place. They also help to follow up and make sure the patient understands what the physician has ordered for them, particularly in chronic cases so they understand their medications, their activity levels and know who they need to call.

She said that in April the hospital implemented an electronic health record system, which helps both patients and the hospital to keep track of what the patient was in the hospital for, what they were treated for in the past and keeps the records all in one place.

All of the county’s hospitals are reaching out into the community and localizing with sites off their main campus that provide basic care in order to avoid the more expensive trips to the hospital emergency room.

The Eastern Niagara Hospital’s Express Care site at 5875 South Transit Road in Lockport opened as an urgent care center last year and offers walk-in, after-hours and weekend care for minor illnesses and injuries. The outpatient facility also offers lab and state-of-the-art radiological services and occupational health. Eastern Niagara Hospital also has begun construction of a $3 million ambulatory surgery center at the South Transit Road site to address the growing need for additional cost-efficient outpatient surgical services, such as orthopedics, reconstructive/plastic surgery, gastroenterology, ophthalmology and general surgery, according to Carolyn Moore, director of community relations for the Lockport hospital.

Mount St. Mary’s Hospital opened a Neighborhood Health Center clinic on Ninth Street in Niagara Falls in 2010 and has a primary care center on its campus in Lewiston. Niagara Falls Memorial has been expanding its primary care sites, which are offered on its campus and in Wheatfield, North Tonawanda, Grand Island and on the Tuscarora Reservation

All of the Niagara County hospitals are offering minimally invasive robotic surgery. Niagara Falls Memorial recently completed its 300th robotic surgical procedure with the $1.7 million da Vinci surgical system, which was put in place in 2012, and spent $2 million to upgrade its surgical suites. Eastern Niagara Hospital in Lockport purchased the da Vinci surgical system last year.

Hospitals also are also offering specialized services:

• Wound care sites with hyperbaric treatment at both Niagara Falls Memorial and Mount St. Mary’s.

• Stroke Care Center and Chest Care Center at Mount St. Mary’s, with the only accredited chest pain center in Niagara County.

• Comprehensive joint replacement program at Niagara Falls Memorial, with the only anterior hip replacement surgical technique in this area and two Jackson tables for back procedures.

• Dr. Muscato Transitions Unit, an inpatient child and adolescent psychiatric services offered in the Eastern Niagara Lockport site.

• Outpatient dialysis unit at Eastern Niagara’s Newfane site was opened in 2011 and has proved to be a much needed and busy service.

• UB OrthoCare, which opened in 2013 in Niagara Falls Memorial’s primary care center in the Summit Healthplex in Wheatfield. The center is a partnership with University of Buffalo Orthopaedics and Sports Medicine.

• David’s Path, a 10-room Niagara Hospice wing in Niagara Falls Memorial. The wing will open at the end of March or beginning of April and is a partnership with Niagara Hospice.

And though maternity services were discontinued in Newfane after the hospital merged with the Eastern Niagara Health Service, Lockport, Niagara Falls and Lewiston have all made updates and enhancements to their maternity services.

The ultimate winners are the patients who are treated to private, comfortable and homelike rooms with trained specialists.

At Niagara Falls Memorial Medical Center, $500,000 was spent in 2013 to upgrade the Mary C. Dyster Women’s Pavilion, which treats patients to homelike rooms with bright colors, all-new furnishings and vivid artwork, while promoting family involvement. The hospital also has Niagara County’s only neonatal trained anesthesiologists.

Maness said Mount St. Mary’s has spent $20 million over the past decade, including many things are not seen, such as infrastructure improvements. But the hospital also has put in a new CT scanner and the Center for Women, a new maternity ward that incorporates physicians’ offices right on the maternity and labor delivery suites, so if a physician is in his office seeing a patient all he has to do is walk down the hall, and the patient is right there.

“It does not look like the traditional maternity ward,” Maness said.

“Everyone is trying to make their hospitals person-centered, not just patient-centered,” she said. “Health care, if anything, has gotten more complex, so we are trying to streamline and standardize so we can reduce that opportunity for error. We are trying to make it work.”

Ruffolo said Niagara Falls Memorial is trying to be the quarterback to keep people out of the emergency room.

“The idea is to be out in front,” he said. “To promote wellness, not episodic care and then connect them to the hospital for very specific reasons.”