Six Northern New York hospitals are in a financial crisis, and several may need to consolidate services to survive. But to do so will require communities to be willing to lose some of their hospitals' identity, staff and services. The struggling facilities are facing declining federal reimbursement rates, rising pension costs and service deficiencies, among other issues. "Do I see in the future a more regional approach? Yes," said Denise K. Young, executive director of the Fort Drum Regional Health Planning Organization. "Does everyone need a billing department and all these separate things to run them? I think not."