A broader look at affiliation

On May 19, I sent the following announcement to Community General family:

Yesterday, the CGH board of directors decided it was in the best interests of the community to examine more than one option for hospital affiliation. Accordingly, the board did not proceed to the next step of the merger planning process with Crouse Hospital. CGH remains interested in continuing strategic planning with Crouse, but not on an exclusive basis. Therefore, the board exercised its right to dissolve the Memorandum of Understanding (MOU), which required exclusive joint planning.

Upstate University Hospital has recently provided CGH with an alternative strategic proposal, which is well-developed and comprehensive. The CGH board believes it is in the best interests of the community to examine all options when considering the community’s long-term needs for health care quality, service and access to care.

As details of this become clearer, I will, of course, provide additional information to the CGH family about these important issues.

We have much to be proud of - our medical staff, our employees, our facilities and the support of the community-at-large. We have demonstrated excellence in many areas. We continue to plan the best way to improve upon these assets as we prepare for the many changes to come in health care delivery, technology and finance.

I thank you for your continued hard work and dedication to CGH.

If you missed it . . .

Several employees have asked for copies of the presentation I gave at 'round-the-clock employee meetings earlier this month.

Thanks to brainshark, I am able to do so here. Click on the presentation, below, to see the slides and hear my narration.

Appreciation day

Yesterday Community saluted its employees, physicians, volunteers, and associates with an Appreciation Day picnic in the cafeteria.

Buffet servings were free for all shifts, and management topped off the meal by serving ice cream sundaes.

Employees received a Community General Hospital coffee mug as a token of appreciation.

The annual festivity acknowledges and thanks health care workers for their 24/ 7 service to patients and community. Thank you!

Our employee meetings

As I do from time to time, I held ’round-the clock meetings for employees on May 6. Naturally, a lot of the discussion focused on the impact of the federal health care reform legislation as it affects hospitals, as well as on the status of Community General Hospital's merger discussions with Crouse Hospital.

Health care reform legislation

I summarized the effects of the health care reform legislation – admittedly, at a very high level – on consumers, hospitals, and other organizations. For consumers, health care coverage will become more available, and an estimated 30 million individuals could be added to insurance rolls. Individuals will not be excluded from purchasing health insurance because of pre-existing health conditions, nor will there be any lifetime caps on what insurance pays for care and treatment. Adult children, up to the age of 26, will be able to have coverage under their parents’ insurance plans. This information has been generally well-covered in the news media.

I also talked about the impact of health care reform legislation on hospitals, specifically about the $196 billion reduction in Medicare and Medicaid payments to hospitals over the next ten years. There will be new taxes on medical devices and on brand-name pharmaceuticals ($31 billion over ten years), as well as the new taxes on health insurance coverage itself ($57 billion during the period). These are examples of increased costs hospitals will have to pay for the goods and services they buy.

The hospital association has translated the $196 billion nationwide reduction into the impact on each hospital in New York State. Because of the new legislation, the four hospitals in Syracuse, NY, will receive $424 million less from Medicare and Medicaid over ten years. These are huge numbers, and they are hard to imagine in the current context.

These reductions in revenue are expected to be offset to some extent by revenue from individuals who will have health coverage, thanks to the legislation. It is very unlikely, however, that the revenue from the newly insured will come close to offsetting the reduced hospital payments that are forecast.

Overall the health care reform law will be a transformative force affecting the way health care is provided in our society.

Our merger talks

In this context I discussed the merger talks currently underway between Community General and Crouse Hospitals. I compared the forces acting on Community (such as, higher state taxes, the needs of physicians and medical groups, and pension costs) with some of the forces affecting Central New York generally (such as, flat population growth, an aging population, and Medicaid cutbacks). Recognizing these forces and anticipating the impact of federal health reform legislation, last January Community and Crouse entered an agreement to plan a merger, if feasible.

Moody’s, the financial analysis company, recently predicted that, as a result of federal legislation, non-for-profit hospitals will find it more difficult to borrow funds and that more hospitals will look for opportunities to consolidate.

Community and Crouse are, in fact, considering the advantages of creating a larger hospital that operates two campuses. The advantages could include the better ability to work with physicians, potentially better access to capital, more efficiency, and the ability to avoid duplicate investments. In interviews with consultants earlier this year, physicians from both hospitals suggested various ideas, and the consultants have been considering these. The consultants are getting close to a recommendation for both hospitals to consider.

Assuming both hospital boards adopt a structure recommended by the consultants, there will still be a number of steps remaining before the merger process is done. These include implementation planning with clinicians, filing a Hart Scott Rodino document with the Federal Trade Commission, and preparing a Certificate of Need (CON) application for New York State. In addition, both hospitals would have to complete “due diligence,” a process in which each hospital examines the other’s business in detail, considering such things as financial performance, business contracts, tax issues, pension obligations, property ownership, etc. The time frame for these activities could be another year or so.

Our financial performance

I also reviewed Community's financial performance through the first quarter of 2010.

I was pleased to report that through March, Community is operating in the black and on-budget (see the chart below). This is significantly better financial performance than we experienced in 2009 in the first quarter.

Patient satisfaction

I discussed patient satisfaction and showed how Community's most recent HCAHPS scores – as self-reported by Medicare patients – have improved in every category.

The HCAHPS survey measures the percentage of Medicare patients who report that nurses and doctors “always” communicate well, that their pain is “always” well-controlled, and that their rooms are “always” well-cleaned. Community does well in comparison with other Syracuse hospitals – we have the highest scores in three of ten categories and the second highest scores in another five categories. And . . . Community's HCAHPS scores improved in the most recent 12-month period (see the chart, below).

Improvements to come

I talked about improvements being made to patient rooms on several units. The sixth floor renovation (orthopedics) has been completed, and room improvements are underway on Three West. Furthermore, we have begun to update rooms on Four West and, when finished in late summer, the patients and staff from Two West will relocate to Four West to take advantage of the updated and larger rooms. Following that, we will make improvements to the GYN rooms on Two East.

The new health information exchange

Community will become the first hospital in Syracuse this year to link to the health information exchange (HIE) being developed by the Health Advancement Collaborative of Central New York (HAC-CNY).

The HIE will initially link all four Syracuse hospitals, through the Internet, with five primary care physician groups, representing several hundred physicians. By next year doctors and hospitals on this fledgling network will be able to exchange patient-specific data with the consent of the patients themselves. As more physician practices join the exchange, HAC-CNY will link to other networks through the State Health Information Network of New York (SHIN-NY). The idea is to make individual patient information readily available to any of that individual’s caregivers. Naturally, there are demanding security and patient privacy requirements for this to function.

Employees had a number of questions and suggestions during the meetings, and I appreciated the opportunity to speak with so many of you.

Our nurses: pride in professionalism

Community celebrates Nurse’s Week, starting today.

Festivities throughout the week acknowledge and thank our Nursing Division, consider the history of professional nursing, and honor our dedicated professionals and support staff.

Mon May 3 Florence Nightingale Birthday Celebration

Tue May 4 Nursing Thank You Celebration

Wed May 5 Nurses’ Day Celebration

Thu May 6 Nursing Awards Presentations

Fri May 7 Ancillary Departments Thank You Celebration

Congratulations, nurses, and thank you!

Green thanks!

Staff members from Community General Hospital participated in a grounds clean-up on Earth Day, April 22.

The volunteers helped pick up debris from the 42-acre campus, following the winter months.

This was the fourth annual Earth Day clean-up. Many thanks to the green volunteers for their big help!