Saturday, January 20, 2007

Q&A on CGH & Van Duyn

I have written two recent posts about the Berger Commission,[1] and I thought that was enough on the subject, at least for a while. But I am often asked about the Commission so here are my answers to frequent questions.

Is the Berger Commission really “the law?”
Yes. Its recommendations became law on January 1, 2007 because there was no vote to overturn them by the State Legislature in 2006.

What exactly did the Commission say about CGH?
The Commission had two requirements for CGH. The first was that the Van Duyn Home & Hospital (526 beds) and CGH's sixth floor skilled nursing facility (50 beds) should be “joined under a single unified governance structure under the control of Community General."[2] That means that CGH will become legally responsible for all long term care beds on this campus. The second requirement is that the size of the combined CGH-Van Duyn nursing facility become smaller by “approximately 75"[3] beds. In other words, the total number of nursing home beds on campus would go from 576 to about 500.

When does all this happen?
I don’t know. The Commission report says only that Onondaga County[4] and CGH have to develop an agreement by the end of 2007. And, as yet, there are no specific plans about how to accomplish it, how long it make take to do so, or how much it might cost to do so. What the Commission asked for is quite complicated and will require time and funds to accomplish.

Does the Berger Commission want CGH to become a nursing home?
No. The Commission recommended that we “create an integrated continuum of care on campus.”[5] That means developing a health care campus that encompasses various care alternatives – acute hospital care, nursing home care, and perhaps other care levels as well. The Berger Commission did not take away any or CGH’s certified hospital beds. It effectively added 500 nursing home beds to our 306 hospital beds.

How will this affect employees?
The Berger Commission gave us one year to develop a plan with Onondaga County, subject to the state’s approval. After the plan is developed, it will take some time to implement it. I believe that at the end of this process there will be more opportunities for CGH employees, not fewer opportunities.

Do you believe the Commission’s decisions will be implemented?
I believe they will be implemented, yes, but I am not sure how or when – and I don’t know if the state will permit changes in some of the Commission decisions.

At least seven hospitals have started lawsuits against the state to stop it from implementing the Commission’s decisions. The lawsuits object to the absence of Department of Health hearings on Commission decisions and to the Commission’s alleged failure to comply with the state’s open meeting law.

Also, we do not know exactly how the new Administration in Albany is going to implement the Commission’s decisions. The Administration has been busy filling top positions in the health department – these are the positions that will oversee implementation of the Berger report. A new Commissioner of Health was appointed by Governor Spitzer only two days ago.[6]

The state has identified funding sources for the institutional changes that are expected as a result of the Commission. These are HEAL funds, which come from the state, and FSHRP (“f-sharp”) funds, which come from the federal government. It is not known how or when these funds will become available for the organizations that need to make changes.

So the timing and ability to comply with the report’s recommendations may depend on the outcome of court cases, on Administration decisions yet-to-be-made, and on the future availability of funds.

So what is CGH doing about all this?
CGH and Onondaga County had met about ways to work together even before the Commission report. We met together with the Berger Commission last summer when it was considering its recommendations. Although we did not expect the changes that the Commission ultimately recommended, both CGH and Onondaga County support the goal of an integrated continuum of care campus. Since the Commission’s report, CGH and Onondaga County have prepared for discussions with the state. We hope to learn more about the timing and flexibility we have to achieve the goals of the Berger Commission. And we need to answer a very important question: how do we obtain the funding necessary to achieve these goals?

[1] The New York State Commission on Health Care Facilities in the 21st Century was chaired by Steven Berger – so it was called the “Berger Commission” as shorthand. On November 28, 2006, the Commission recommended the closing of nine hospitals across the state, most of them in New York City. It recommended the restructuring of 48 hospitals, closing about 4,200 staffed hospital beds in all. The Commission also proposed to close seven nursing homes and to restructure 14 others, leading to a reduction of some 3,100 nursing home beds statewide. The 2005 law that established the Commission was crafted so that its recommendation became law unless they were entirely reversed by the State Assembly and the State Senate before December 31, 2006.
[2] Commission on Health Care Facilities in the 21st Century, p. 101. To see the full report, go to
[3] Commission, p. 101
[4] Onondaga County owns and operates Van Duyn, which has been a part of the County for 180 years. It began as the County Sanitarium 1827. In 1979 the Van Duyn Home & Hospital opened as newly-constructed 526-bed facility.
[5] Commission, p. 102.
[6] Richard F. Daines, M.D. was named to serve as State Commissioner of Health on January 18, 2006. Dr. Daines is the President and CEO of St. Luke's-Roosevelt Hospital Center in New York City.

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