My very best for the future

At 12:01 this morning, Community General Hospital became Upstate University Hospital at Community General.

Dr. John McCabe, the CEO of Upstate University Hospital, and I completed Upstate's acquisition of Community yesterday afternoon.

Our photo was taken in the New York City offices of Hogan Lovells, the law firm that represented Upstate in the transaction.

Community General was represented by Bond Schoeneck & King.

The files in the foreground are a fraction of the documentation we needed to close the deal. Dr. McCabe and I have been signing thousands of documents since last week in order to accomplish the closing.

That represents the mechanics of the deal. The substance of the combination -- the benefits for the community -- will now follow.

A front page story in today's Post-Standard recaps the history of Community General Hospital as we begin this next chapter of service as part of Upstate. Community's roots go back to Syracuse General Hospital, located on Castle Street in Syracuse. Our progress is shown graphically in the logotypes, pictured below.

This is my final posting for More than Medicine. This began as a weekly letter to employees in the fall of 2002, when I became Community's President & CEO. That weekly letter morphed into More than Medicine in 2006.

Effective today, I am no longer CEO. I have accepted a Senior Vice President position at Upstate, and I will be working in the administrative offices at the main hospital downtown.

Meredith Price is Upstate's new Chief Administrative Officer at the Community General campus. She has already been at work here for several months, leading the transition planning with Community's senior management group.

At the final annual meeting June 15, I told the Board of Directors

". . . the fact of Upstate’s acquisition does not, by itself, make this a successful deal. This deal is going to take hard work. We will have to execute for Meredith Price and for Dr. McCabe. . . .I have asked my managers to give their loyalty and support to Meredith in this important effort," and I am pleased to say that they have done so.

Thank you, Drs. David Smith and John McCabe, and congratulations. To Meredith Price and her team, I wish you the very best for the future.

To CGH employees, volunteers, physicians, and board members: it has been a privilege and an honor to work with you.

Today's milestone for the community

At 4:48 p.m. today, Dr. John McCabe and I signed the final documents, completing the sale of Community General Hospital to SUNY Upstate Medical University, effective 12:01 a.m. tomorrow.

This is a milestone for health care in Central New York. This allows our hospital to continue its service to the community under the aegis of Upstate. This allows the physicians on the medical staff to continue serving their patients at the Community General campus. This keeps most employees in jobs and brings the significant potential of a larger hospital and the academic world.

This helps our hospital prepare for the many changes coming from health care reform, as well as from the challenging demographics and economy.

Achieving this milestone has taken the hard and conscientious work of many, including and especially Dr. David Smith, University's President, Dr. John McCabe, University Hospital's President, and their highly capable staffs.

Community General's board of directors has consistently kept in mind the best interests of patients and the community-at-large, as well as the hospital's stakeholders.

My thanks to Steve Infanti, our board chair, for the past nine years of his leadership (and for many more years, before that). I thank John Hession, Chet Amond, Jim Getman, and all our board members, including the physicians whose participation has been invaluable.

The State Health Department worked diligently to review Upstate's certificate of need application, including the detailed due diligence that was completed within the Department's otherwise demanding agenda from across the state. In fact, all divisions of government, including the Governor's staff, the State University of New York, the Department of Budget, the Attorney General, and the State Controller worked carefully and in a focused way to approve the complex transaction.

I would like to acknowledge the many elected officials who supported the Upstate-community combination, and I specifically reference State Senator John DeFrancisco, whose work was personal and unflagging on behalf of the acquisition. County Executive Joanie Mahoney also was very helpful.

Excellus, the area's largest health insurer, has worked for this moment for more than a dozen years by sponsoring community studies and by encouraging hospitals such as Community General to work toward a well-planned consolidation. My special thanks goes to David Klein, Chairman of the Lifetime Healthcare Companies (the parent company of Excellus) and to Chris Booth, CEO of Excellus BlueCross BlueShield of CNY.

I salute Community's employees who, despite worry, uncertainty, and distractions, always understood our hospital's unique role in the community and the importance of our continued caring. Finally, Community's management team deserves laurels for staying the course, for working hard in support of the combination, and for keeping the focus on patient services and quality throughout the complex process.

As I wrote recently to the board, there have been many instances of heroism and stamina in bringing the Upstate-Community combination to fruition. Too many, in fact, to recount, and so many, I do not know all of them.

In recent weeks many have expressed appreciation to me for Upstate's support and for the honorable way Upstate has worked with Community General and its employees. Such expressions have meant a lot to me, especially the kind words from individual employees and from patients and families.

To all who made this possible, thank you and congratulations. My best wishes to you, to Upstate, and to the community that is the ultimate beneficiary of this milestone.

"Seize this very minute"

Sometime after he succeeded John L. Brown, the founding President & CEO of Community General Hospital, Jerry Harris presented each of his vice presidents with a poem, displayed in small plastic stand for desk or book shelf.

Jerry became President & CEO in 1982, and it was probably several years later when he handed out the short verse by Johann van Goethe. Here is a translation by John Anster:

Lose this day loitering - 'twill be the same story
To-morrow - and the next more dilatory;
Each indecision brings its own delays,
And days are lost lamenting o'er lost days,
Are you in earnest? Seize this very minute -
Boldness has genius, power and magic in it.
Only engage, and then the mind grows heated -
Begin it, and then the work will be completed!

Jerry Harris was a key figure in my career. He promoted me to vice president and helped me return to college for an MBA degree. He also freely shared his hospital stories and his sayings about management. Among them was this challenge: "Sooner or later, somebody's gotta do the work!" That was an echo of Goethe's "Lose this day" eloquence.

One of the most impressive things about the leadership of SUNY Upstate Medical University is its action-oriented management team. Dr. David Smith, University President, and Dr. John McCabe, Hospital President, look for and expect results.

At a senior management retreat last fall, Dr. Smith passed out coffee mugs to his Upstate leadership team. "Get-r-done!" the cups read, referring to Upstate's acquisition of Community General Hospital.

To this day, I display in my office the Goethe poem Jerry Harris gave me. It is good to know that Community's work ethic will fit comfortably with Upstate's bias toward action.

You read it here first

Yesterday I made the case for Community joining Upstate at an evening meeting of the Board of the Central New York Health Systems Agency (HSA). The HSA is a health planning agency for the region.

The HSA heard from Community and from Dr. John McCabe, Upstate University Hospital's CEO, as well as from the public. Among those speaking were members of Community's Board of Directors, employees from Community, and officials from 1199SEIU.

You can view the PowerPoint presentations from Dr. McCabe and me by going to the combined Community-Upstate website.

Also addressing the meeting was Ron Lagoe, Executive Director of the Hospital Executive Council (HEC). For almost 30 years the HEC has been the cooperative arm of the four Syracuse hospitals, working together to improve the health care system. The HEC members are Community General Hospital, Crouse Hospital, St. Joseph's Hospital Health Center, and Upstate University Hospital. Last evening the HEC said "the acquisition of Community General Hospital by University Hospital is consistent with the Hospital Executive Council objectives of improving efficiency and outcomes for regional health services..."

Following the public discussion, the HSA Board of Directors voted unanimously in support of a resolution that supports "the process and development of the proposed affiliation and acquisition of Community General Hospital by Upstate Medical University." The resolution is predicated on continuing services at Community's campus, enhancing the role and mission of Upstate, integrating private practice and teaching responsibilities, considering the suggestions of the public, and continuing to engage the HSA.

Last evening's public discussion was covered by the Post-Standard, YNN, WSYR, and CNY Central, but the news media left before the HSA Board voted -- so you read about it here first.

Earlier this week, I participated in a half-hour discussion about the CGH-Upstate combination with George Kilpatrick, along with Dr. David Duggan, Upstate's Chief Medical Officer. You can see that discussion on WCNY's Central Issues.

Our new website with Upstate

Community General Hospital and Upstate Medical University have started a combined website, a joint project to help keep everyone informed as we plan to combine the two hospitals in 2011.

Happy new year!

Dr. McCabe and I meet at Community

Dr. John McCabe and I held a series of meetings with Community General Hospital employees last week. Our thanks to all who attended, asked questions and offered comments.

Each meeting began with my introduction of Dr. McCabe, who is not known to most employees. Dr. McCabe briefly reviewed his background, and he talked about his philosophy of hospital management: to employ capable people and to provide the resources to help them do their jobs. He acknowledged the technical and professional expertise of hospital employees. He said he understands and appreciates that patient care depends on each individual’s competence and caring.

I told employees who attended the meetings that Dr. McCabe and I have worked closely together throughout the summer and fall, and we have developed mutual confidence and respect.

I briefly reviewed the reasons why Community is interested in combining with Upstate University Hospital as referenced in comments about discussions with Upstate and buying medical practices.

I reviewed some of changes that are expected to affect hospitals and doctors, and I reminded employees about the areas our Board of Directors has determined to be important: the need for future investment in facilities and medical technology, the need for more options and opportunities to work with physicians, and the need for larger scale operations to achieve greater efficiencies and access to resources.

I said that Community's Board is interested in the future role of the hospital in providing quality care to the populations we have traditionally served through emergency, inpatient and outpatient services. Community’s goal is to build upon the traditional assets developed over decades, namely, the private medical staff, the skilled work force, and the property, plant, and equipment.

Dr. McCabe said that Upstate has similar and complementary goals. Upstate has a very high occupancy rate, upwards of 90% -- and Upstate is growing. As a result, Upstate needs more acute care beds, and Community has acute care capacity. The ways in which Community’s physical infrastructure and its licensed capacity can help address Upstate’s growing needs are being actively explored. He said the goal is to have a single hospital with two campuses.

Upstate’s educational role will expand in the future as more physicians, midlevel practitioners, and allied health professionals are needed. The Community campus would maintain a separate identity within the Upstate system and would participate in Upstate’s academic role. The extent of educational involvement would vary, depending on the clinical service and the interest of private practice physicians and health practitioners.

Dr. McCabe said Upstate recognizes the role and importance of the private, voluntary medical staff at Community and seeks to foster such private practice. In areas where services can be improved by a combination of private staff and university physicians, Upstate is willing to cooperate – examples include the current hospitalist service and cardiology coverage. If private practice is not able to provide a service, Upstate would do so (for example, intensivist services).

How to bring together the two medical staffs has not yet been determined, and initial meetings have been held with Community physicians to begin considering the issues. More work will be done in this area over the next several months.

Upstate has made significant progress in conducting due diligence on Community General. “Due diligence” is the process of investigation and discovery that two parties undertake before they enter a transaction, such as a merger, acquisition, or joint venture. Over the summer months Community and Upstate shared various documents with each other, allowing attorneys, accountants, and other experts to understand and evaluate business practice, finances, legal contracts, property conditions, etc. Dr. McCabe estimated that Upstate has reviewed more than one quarter million pages of Community's documents and has not found obstacles to the planned combination.

Research and analysis continue in the areas of clinical services and workforce. There are various models for consideration, and Upstate is actively examining them. Dr. McCabe and I met with representatives of 1199SEIU earlier this month to hear their interests and concerns, and Dr. McCabe said that he has had a similar meeting recently with the representatives of the unions active at Upstate.

Dr. McCabe said the timeframe for combining the hospitals is next year, possibly by mid-year. This is, of course, subject to the extensive review and approval process involving various government regulatory departments. This would include Certificate of Need (CON) approval by the state Department of Health. When the project is approved in 2011, the process of combining hospitals would begin. This process would likely take place over a period of years.

There were a number of questions from employees. These ranged from “What will happen to my position if the two hospitals come together?” to “Would you continue to be interested in a consolidation if the federal government slows down or stops health care reform?”

In the first case, it is too early to say how positions might be organized. This relates to the study of clinical services and workforce needs that remains to be completed. In general, the combination is likely to make the Community campus more busy, not less busy -- and that would be good for jobs.

To the second question, the answer is “Yes, even without federal health reform, the hospitals’ combination makes sense.” The economic forces facing hospitals and doctors are well underway and are likely to continue, despite what the next Congress may or may not do in the next year or two.

Dr. McCabe and I heard many encouraging comments about preparing for the future challenges and opportunities. I appreciate the good attendance and the constructive comments from employees.

The Community family made Dr. McCabe feel welcome, and he was pleased to hear good comments about the Upstate-affiliated physicians who have joined Community's medical staff this year.

Employee meetings tomorrow

Since the poster appeared last week, several have asked me,"What's the big announcement?"

No big announcement -- just a progress report on the journey Community General and Upstate University Hospitals are making to become a combined hospital.

This round of meetings gives employees the opportunity to meet Dr. John McCabe, the President and CEO of University Hospital, and to hear him discuss our progress.

NOTE: Because of a conflict, Dr. McCabe will not be able to attend the 2 p.m. meeting, as planned. The other meetings will proceed as scheduled.

Dr. McCabe was appointed President & CEO at University Hospital and Senior Vice President for Hospital Affairs at Upstate Medical University in August 2009. He has been at Upstate for more than two decades and developed its Emergency Medicine residency training program. Dr. McCabe served as Dean at Upstate Medical University for six years in the 1990s. His national leadership positions include serving as Chair of the Board of Directors of the American Board of Medical Specialties, the organization that oversees the certification of physician specialists in the United States.

Dr. McCabe has served as editor of the journal, Resuscitation. He is a Past President of the American College of Emergency Physicians. He has served as a member of the American Board of Emergency Medicine since 1996 and is on its Board of Directors.

Dr. McCabe attended medical school at the SUNY Upstate Medical University, completed his internship at the Charles F. Kettering Medical Center in Kettering, Ohio, completed his residency in Emergency Medicine at Wright State University School of Medicine in Dayton, Ohio.

For those who cannot attend the meetings, I will provide a recap in several days.

Congratulations, Doctors!

Congratulations to the physicians listed in last month’s CNY Magazine as “best doctors.” I want to acknowledge and congratulate all who practice at Community General Hospital, starting with our Medical Staff President, David Halleran, MD (photo, at left) of Colon Rectal Surgeons of Central New York, along with his partner John Nicholson, MD.

Others from the list include our intensivists Russell Acevedo, MD and Daniel Polacek, both of Critical Care Associates; John McCabe, MD, leader of the emergency medical group that provides services at Community General; James Tifft, MD, of Associated Gastroenterologists of Central New York; and John Gullo, MD, and Anthony Scalzo, MD, both of Hematology Oncology Associates of Central New York, which operates a cancer care and hematology center on the campus of Community General.

Congratulations, as well, to Francisco Gomez, MD, (photo, at right) of CNY Neurology; Leonard Levy, MD, Chair of the Department of Pediatrics; Robert Weber, MD, Medical Director of our Physical Medicine and Rehabilitation Service; Mark Levinsohn and David Thompson, MD, of the radiology group that provides services at Community General; as well as surgeon Robert Schwartz, MD, of Vascular Care.

It is a tribute, indeed, to be recognized by your peers!