Saturday, December 9, 2006

I wrote about "rightsizing" before the Berger Commission

In some ways an article I wrote for the Syracuse newspapers three years ago (“Right-Sizing Out Hospitals”) anticipated the work of the Berger Commission. [1]

On November 28 the New York State Commission on Health Care Facilities in the 21st Century, chaired by Steven Berger, recommended the closing of nine hospitals across the state, most of them in New York City – and more significantly, it recommended the restructuring of 48 hospitals – closing about 4,200 staffed hospital beds in all. The Commission also wants to close seven nursing homes and restructure 14 others, leading to a reduction of some 3,100 nursing home beds. All this activity will reportedly save $1.5 billion in health care costs annually.

In our area the Commission wants CGH’s nursing home beds to combine with those of Van Duyn for a total of about 500 nursing home beds. It also wants CGH to assume control of Van Duyn. The Commission did not change CGH’s licensed hospital capacity of 306 beds.

The Commission’s other decision involves Crouse Hospital and SUNY’s University Hospital. The Commission wants them to merge as a private hospital that is not a part of the SUNY system.

As I said in testimony submitted to the State Senate Health Committee on December 1, I support the work of the Commission, and I believe its recommendations are important. However, the devil, as they say, will be in the details of state oversight and assistance. How much money will the state provide and how much flexibility will the state permit as organizations go about implementing the Commission’s decisions? Without adequate funds to plan and invest, the Commission’s recommendations will be impossible to carry out. That is true for CGH and Onondaga County and, I believe, it is true for other institutions affected by the Commission’s decisions.

Most of the local news coverage has centered on the decision to combine Crouse Hospital and University at “approximately 500 to 600 inpatient beds.” [2] Today Crouse and University Hospitals have a combined total of 942 licensed beds, but their combined average daily census is actually 563, according to the CNY Regional Advisory Committee. [3] That is apparently how the Commission determined the 500-600 size.

You may remember that not too many years ago CGH and Crouse Hospital were affiliated under the Health Alliance of CNY. [4] During that time I served as Crouse’s Chief Operating Officer, and as such, I participated in the 2001 discussions regarding a possible merger of Crouse and University Hospitals. I had an opportunity to see first hand the positive potential of a Crouse-University merger, as well as some of the difficulties involved in bringing together these organizations.

After my return to CGH, I wrote an opinion article for the Post-Standard that reminded Syracuse that CGH came into being in the 1960’s as a result of community planning, and I expressed hope that through community planning a Crouse-University medical center might yet be achieved. Headlined “Right-Sizing Our Hospitals,” my article appeared on December 22, 2003.

In that article, I said
The much-discussed and much-delayed affiliation between University Hospital and Crouse Hospital makes sense, and a resumption of their collaborative discussions is to be welcomed. This does not minimize the complexities involved or the understandable interests of stakeholders such as unions, faculty, and private practitioners. But the ultimate stakeholders are the patients of Central New York and those who pay for their care.
I also advocated that
such an academic affiliation [be] in the 500-bed range. That size approximates the combined effective occupancy of the two hospitals as they exist today, it fosters continued efficiency improvements, and it assures the best and highest use of all existing hospital assets.

[1] The report of the Berger Commission is at this web address:
Click on “Final report.”

“Final Report of the Commission on Health Care Facilities of the 21st Century,” p. 91. The Commission’s report, which is 240 pages long, is available at For the section on CGH and Van Duyn, see pages 101-103. To see the Crouse Hospital-SUNY section, go to pages 91-93.

[3] Regional Advisory Committees, or RACs, were established to advise the Commission. The Central New York RAC heard presentations by 123 individuals during February-March this year. The Commission also met with 50 providers in the CNY region, some of them more than once. To see the CNY RAC’s recommendations, go to and click on “Central” under Appendix 2 - Regional Advisory.

[4] The Health Alliance of CNY (1999-2003) was the licensed parent corporation that appointed the boards of both CGH and Crouse Hospitals. Both hospitals shared a single management team, which was expected to bring about a more complete integration of CGH and Crouse over a period of years. The Health Alliance was derailed by several factors, not the least of which was Crouse’s bankruptcy in 2001. CGH officially resumed operations as a separately licensed hospital in May 2003.

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