Our thanks this year

The Thanksgiving quilt is being displayed throughout Community General Hospital. This is a graphic tapestry displaying expressions of gratitude by employees, volunteers, and other members of the Community family.

Leading the things for which we are thankful, as in past years, are the love of family and friends (almost one-half of all comments), our jobs and coworkers (about one-fifth), and our faith, life, and health (about one-fifth).

Others are thankful for men and women in military service, for our doctors, for Community's partnership with Upstate Medical University, for the Syracuse University football team's bowl prospects -- as well as for baseball, for ice cream, for doe permits, and for the copier machines!

There are three Thanksgiving quilts posted throughout the hospital so be sure to see them all. You can read the individual comments by clicking on each of the three displayed here.

This is the fourth year we've displayed the quilts at Community General, and we borrowed the idea from Peter McGinn, past President of UHS in Binghamton, NY.

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.

It's official

Community General Hospital has been officially re-accredited by the Joint Commission.

This means our hospital operates in conformance with policies and procedures that meet accreditation standards.

As previously reported, the accreditation survey identified areas where Community could improve. Community's staff addressed each and every area within the time frames required, and the Joint Commission issued its certificate this week, dating from the time of our site survey.

Their good work in Tela

It's a wonderful thing that Dr. Tom Haher and Physician Assistant Steve Keib did recently. They both returned from a week of humanitarian work in Tela, Honduras.

Before they left, they stocked up on supplies and materials from Community, which were put to good use in helping care for children at Hospital Tela. The family income in Tela is only a few hundred dollars a month, and Dr. Haher has been part of a voluntary program to bring medical care to Tela for 15 years.

That's Dr. Haher kneeling in front of Community's logo with Steve Keib third from left. Both are part of Syracuse Orthopedic Specialists in Syracuse, NY.

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.

Buying medical practices

Today's Post-Standard carries a story about St. Joseph's Hospital buying a primary care practice. This comes on the heels of a story in September about Crouse Hospital's practice acquisition.

So the question is: "Will Community General Hospital be buying practices too?"

The issue is not practice acquisition per se. The issue is developing alignment strategies to help hospitals and doctors work more effectively in the future.

Many changes are expected in health care, and Community's strategy is to seek a merger partner - Upstate University Hospital - to help meet those changes.

▪ New York hospitals, with physical plants that are among the oldest in the country, need to make investments as they replace aging infrastructures, purchase medical technology, and develop electronic medical records. To be economical, such investments need to be spread over a large base of operations. Preparing for the future is largely a question of having sufficient scale to undertake such investments. This means being larger than a stand-alone hospital.

▪ Hospitals in New York generally have weaker financial operations than most of the country. And Medicare payments will be reduced dramatically in the coming years so hospitals have to become more efficient. Syracuse hospitals are already among the most efficient statewide so, again, hospitals face issues of scale, of spreading their fixed costs over operations that are sufficiently large.

▪ Hospitals and doctors will need to better coordinate care, not just hospital care but wellness care and prevention, access to primary care and specialty doctors, and transitions among outpatient, hospital, and post-hospital services – in other words, we will need more integrated delivery systems.

Through Community's merger planning, we expect to enhance the ability of private practitioners to care for patients. But we realize not all physicians will remain in private practice in the future, nor will all doctors coming from residency training want to join private practices. Our affiliation with Upstate will bring Community more options for doctors.

Employing many physicians is a huge task, a huge investment, and a huge risk for a stand-alone hospital. Hospitals in Syracuse and elsewhere have failed at this before.

That’s why Community is developing the initiative with Upstate, with its larger base, its broader specialty panel, and its established employment opportunities – at the same time we continue to work with private practitioners.