Saturday, December 2, 2006

What the Berger Commission said

The Berger Commission[1] released its report this week after months of confidential deliberations. It calls for the closure of nine hospitals across the state and the conversion, affiliation, or reconfiguration of another 48 hospitals. In all, about one quarter of all New York State hospitals are directly affected by the recommendations – and that includes Community General Hospital.[2]

The report recommends that CGH combine its 50-bed sixth floor, which operates under a skilled nursing facility license, with the 526-bed Van Duyn Home & Hospital.[3] It recommends that the combined entity be controlled by CGH – that is, Van Duyn should be transferred from Onondaga County. And it recommends that the size of a restructured Van Duyn be about 500 beds. Today Van Duyn is licensed for 526 beds, representing about 17% of all nursing home beds in Onondaga County.

The Commission did not recommend any changes in CGH’s licensed capacity of 306 acute care beds.

Van Duyn has been part of Onondaga County for 179 years.[4] In recent years, the County has incurred significant financial losses at Van Duyn. During its budget process last October, the County debated Van Duyn’s role and affirmed it would continue to be part of the government’s responsibility, including its safety net patient services. The Berger Commission wants to see the safety net responsibilities continue at Van Duyn under CGH sponsorship.

The Berger Commission recognizes CGH’s future needs for patient care, including the need for more private rooms. The Commission sees value in “an integrated continuum of care on the campus” involving CGH and Van Duyn and also sees potential reimbursement advantages in such a restructuring. All this, of course, “will require capital (investment) support,” in the Commission’s words.

During the review process, the Commission visited Syracuse several times, meeting with County Executive Nick Pirro and with me. The Commission also visited the campus and toured CGH and Van Duyn. With the encouragement of the Commission, CGH studied options available to the County and to CGH, and these preliminary study results were shared with the Commission and the County.

Onondaga County and CGH work well together. As I said yesterday in testimony for a special hearing of the State Senate Health Care Committee, “Onondaga County is among the best-managed county governments in the state, and its decision-making process is thoughtful and businesslike. Onondaga County has been committed to operating Van Duyn as a public, safety net institution, and Community General has supported that position.”[5]

Because of changes in state law made this year, Van Duyn is expected to return to break-even operations under County sponsorship over the next several years. With an end in sight to its losses, the County wants to keep operating Van Duyn. Both Onondaga County and CGH expected the Commission’s recommendations to require continued work together toward more coordinated care without a change in ownership or control.

However, the Berger Commission recommended changes that would effectively reduce government’s role as a health care provider. For example, it recommended privatizing the hospitals associated with the SUNY medical schools, including University Hospital of SUNY Upstate Medical University. It also recommended that Erie County Medical Center be privatized in Buffalo. In this context, the Commission’s recommendation that Van Duyn become private appears to be part of a philosophical change by state government.

The report raises a lot of questions which no one can answer today. Employees have asked what the report means for the location of sixth floor services, what it will mean if overall nursing home beds shrink by about 75, and what might be the potential impact on employment. It is too early to answer any of these questions, because the planning will take time. First, we have to see if the Commission’s report is rejected by the Legislature.[6] Next, we need to see how soon the state can provide the resources for the necessary business, legal, and financial planning. We also want to know how flexible the state will be in overseeing the complex planning we will have to undertake with Onondaga County and the State Health Department.

With a new Governor in 2007, we can expect many changes in the Health Department, starting with a new Commissioner of Health, yet to be named. It is clear the Governor-elect supports the report of the Berger Commission and has even suggested that the Commission recommendations do not go far enough.[7]

New York State does have funds available to assist institutions like CGH and Van Duyn in making changes. In 2005 New York has established the HEAL-NY program[8] with $1 billion in funds over four years to support hospital and nursing home restructurings, as well as health information technology. Two months ago, the federal government committed an additional $1.5 billion to New York to help close and restructure hospitals and nursing homes. [9]

The Berger Commission represents a significant change in state health care policy. In a short period of 18 months, the Commission studied the entire state, conducted hearings, visited numerous organizations and developed a wide-ranging roadmap for change. We have to give the process time to work, and we have to give the new Administration the opportunity to make changes in state government. For our part, CGH will work forthrightly with Onondaga County and with New York State in doing our best to achieve the ends recommended by the Commission.

As I said yesterday in my Health Committee testimony: “I…respect…the work of the Commission. The Commission members and staff accepted an enormous task. They completed their work in a thoughtful and timely fashion. The report is a positive step towards reform of the State’s health care system.”

[1] Popularly called the Berger Commission after its Chairman, Steven Berger, the Commission on Health Care Facilities in the 21st Century was created in the 2005 state budget process. It began its work in the summer 2005, and a tight deadline called for its final report by December 1, 2006. The report was released on November 28. Patterned after the federal Base Realignment and Closure Commission (BRAC), the state created the Berger Commission so that its recommendations become law unless they are rejected by the Governor before December 5, 2006 or by both houses of the New York State Legislature by December 31, 2006.

[2] Three of Syracuse’s hospitals are affected by the Berger report. In addition to CGH, the report calls for the merger of University Hospital and Crouse Hospital into a single institution in the 500-to-600-bed range. Today Crouse and University Hospitals have a combined total of 942 licensed beds.

[3] The full report of the Berger Commission is available on its website: Click on Download the final report. For the CGH-Van Duyn section, see pages 101-103.

[4] The County Sanitarium, which is now called Van Duyn Home & Hospital, has been part of Onondaga County since 1827. In 1957 Onondaga County deeded 42 acres of the Sanitarium’s property to CGH for the construction of the new hospital, which opened in 1963. In 1979 the Van Duyn Home & Hospital opened as newly constructed 526-bed facility on 65 acres.

[5] For a copy of my testimony before the Senate Health Committee on December 1, 2006, go to Click on CGH Family Letter.

[6]Pataki and Spitzer Back Health Care Consolidation Plan,” New York Times, November 30, 2006: “Gov.
George E. Pataki and Governor-elect Eliot Spitzer yesterday endorsed a plan to close or shrink dozens of hospitals and nursing homes across the state. Their support means that it will be up to the Legislature to decide whether to block the proposed downsizings.”

[7] “Berger, Spitzer see more health care cuts coming,” Journal News, December 1, 2006: “The plan to cut the state's health-care system proposed this week…represents merely a start on reductions that need to be made, the chairman of the commission that recommended the cuts said in an interview yesterday. Later, Gov.-elect Eliot Spitzer disclosed that the savings from the plan to state taxpayers from the proposed closings is likely to be minimal. He reiterated that the ‘bloated system’ needs to be further cut.”

[8] HEAL NY stands for the “Health Care Efficiency and Affordability Law for New Yorkers.”

[9] “In Move to Cut Hospitals, U.S. Will Pay New York $1.5 Billion,” New York Times, October 3, 2006: “The Bush administration has agreed to pay New York $1.5 billion over five years to help stabilize the state’s financially troubled hospital industry, state and federal officials said yesterday. In return, the state will move forward with shrinking that industry, cutting Medicaid costs, and sharply increasing the sums it recovers from Medicaid fraud.”

No comments: