Most St. Lawrence County hospitals are struggling financially but are not laying off employees or imposing a hiring freeze yet as Massena Memorial Hospital has done.

“We’re scrambling. I don’t think anyone is flush,” said Charles P. Conole, administrator at Edward John Noble Hospital, Gouverneur. “So far, we have not had layoffs, but I’m not going to be hiring anyone this summer unless it’s some kind of unique situation. I’m going to play it very cautiously.”

The hospital is adjusting to reimbursement reductions and increased denials from insurers while trying to improve revenue from patients using the services in its recently opened addition.

Like E.J. Noble, Claxton-Hepburn Medical Center, Ogdensburg, is dealing with a drop in reimbursements.

“They continue to decline, especially with Medicaid,” spokeswoman Laura C. Shea said. “It’s difficult to find that balance. It’s difficult to cover cost.”

There have been no layoffs and the hospital is not instituting a hiring freeze, but it is working on a leaner strategy.

“That is a strategic focus,” Mrs. Shea said. “We know the cuts are going to continue, so it’s imperative we become as efficient as possible.”

As a critical-access hospital, Clifton-Fine Hospital in Star Lake is less affected by changing reimbursements in Medicare and Medicaid, Administrator Robert P. Kimmes said.

But it has noticed insurers in general readier to deny claims in a push to make more services outpatient.

“Then we have to appeal for our reimbursement,” he said. “That is a challenge.”

Massena Memorial announced Monday it was laying off two people, reducing hours for some part-timers and not filling vacant positions for a work-force reduction of 13.1 full-time positions to help with a troubled financial picture.

Only Canton-Potsdam Hospital said it was actively trying to fill more than 50 vacancies.

While the need for fiscal responsibility is present, the hospital is on strong financial footing, spokesman Randy K. Ferguson said.

“We’re in more of a growth mode than anything,” he said.

The effect of the Affordable Care Act, ruled constitutional by the U.S. Supreme Court, remains to be seen, hospital officials said.

Claxton-Hepburn, for example, could see $800,000 less next year because of cuts to Medicare, Mrs. Shea said.

On the other hand, the legislation could help more people have insurance, leaving hospitals with less uncompensated care, Mr. Kimmes said.

Staff writer Jacob Tierney contributed to this story.

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