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.

Well done!

I’d like to acknowledge with gratitude the work of the Community General Hospital Employee Community Service Fund, which has assisted members of the Community family since 1993.

With Community’s transition to Upstate University Hospital, the CGH Employee Fund completes its exemplary, quiet service.

I say “quiet,” but the Fund could actually be quite noisy once each year during the campaign to aid the United Way of Central New York and the Community General Foundation -- and to resupply its own coffers for the benefit the Community General family members.

Once the annual United Way campaign was finished, the Fund board labored in relative obscurity, inconspicuously providing temporary financial assistance to employees and other “family members” for a “sudden, unplanned economic hardship due to accident, loss or disaster” (in the words of the Fund).

With the transition of Community's employees to Upstate (and to Upstate’s contract services), payroll deductions come to an end, and the Employee Fund completes its work and its lifespan.

Although employee pledges end as of mid-year, Fund directors voted recently to complete payment to the United Way of Fund's full pledge for 2011. Any amount remaining in the Fund goes to the Community General Foundation, which will continue as a fund raising corporation after the Upstate acquisition is completed.

During its existence, the Fund provided some $150,000 to assist CGH family members through hard times.

In addition, United Way contributions from the Employee Fund have been more than $400,000 over that period.

To all who supported the Fund and to the directors who made it work, congratulations and thank you.

Job well done!

Towsley Tourney Turns $150,000

When the sun set on Friday's Towsley Pro-Am Tournament, the Community General Foundation had raised more than $150,000. The photo by Dan Cameron shows the sun as it appeared over the first hole at the Shenedoah Golf Course at the Turning Stone Resort, where the event was held to honor the memory of Bill Towsley, the well-known business manager of IBEW Local 43. Bill died last year, following a battle with cancer.

This was the Foundation's 27th annual pro-amateur golf tournament, but it was the first named for Bill. I had the privilege of meeting with Bill's family when they joined us at the awards dinner at the end of the day. That's Ken (who also played in the tourney), along with Tracy, Jen and Bill in the photo, at left.

IBEW 43/ NECA was the Presenting Sponsor for the tourney, which was supported by IBEW chapters from across the state, including Long Island, Westchester, and Rochester.

My special thanks for the successful to the Central New York PGA and its Executive Director Al Seamans. The character of this tournament day comes in large part from the unique chemistry that results when area golf pros are teamed with foursomes as they play a challenging course.

Thank you, Greg Cohen and Rock Shirtz, the Co-Chairs for the Foundation's golf committee. Thanks also to Scott Matukas, Board Chair, and to the entire Community General Foundation board.

I'd like to acknowledge TK99's Gomez and Dave, who provided MC services (and they play well too).

This was another successful golf tournament due to the thorough preparation and attention to detail by John Zacharek, Community's VP of External Affairs, along with Gillian Ottman, Amy Gulotta, and a host of tourney volunteers. My thanks to all!

"A job well done"

Because of the Department of Health meeting in New York last Friday, I was not able to return to Syracuse in time for the annual Service Recognition Dinner for Community General employees and for recent retirees.

This was, I think, the first Recognition Dinner I have missed for Community. I am sorry to have missed it, it being a poignant evening as the last one under Community’s independent status.

My thanks to Sharon O’Neill, Human Resources Director, and her staff for organizing the event again this year, and thank you too to Vice President Dennis Trepanier and to Medical Staff President Dr. David Halleran who “did the honors” in saluting employees and retirees at this milestone event.

A highlight of the evening was an “ode” by Jan Filsinger, an Emergency Department Coding Data Analyst. Here's what she said:

ODE TO MY ADOPTED FAMILY
Jan Evans-Filsinger

When I was very young you took me in.

You had patience with me and showed me skills.

You watched me grow under your tutelage and there were expectations.

I worked hard over the years and in return you helped me provide for my family.

You paid for some of my education and most of my insurance.

You provided me with the means to save for my children’s education, Christmas club, and even my own separate retirement.

When my children were born, I came to you and you took care of me and the expense.

When I or my family were sick or injured we came to you and again you took care of us and the expense.

Just like any other family, we had our ups and downs but you always stuck by me; even in some really rough patches when I left you in the lurch you were still by me and helped work things out.

Oh sure we have some siblings that have felt you should have done more, given them more, but with the economy changes that got harder to do. Yet year after year you have recognized us, given us gifts, some free lunches and never forgot a Christmas.

But just like any other family member on a fixed income, you began to falter under the weight of the economy.

You made some changes and tightened your belt.

But at the end of the day it proved to be too much and now you need assisted living.

As we move forward I will do all that I can to help you transition with your dignity and self-respect intact.

Tonight we recognize you for 48 years of hard work and a job well done.

I will always look back with fondness and say thank you to Community General Hospital!

The vote to approve

On Friday morning the Upstate Medical University's Certificate of Need (CON) application was the “main event” at a committee of the newly-reconstituted Public Health and Health Planning Council of the Department of Health.

The Establishment and Project Review Committee voted to approve Upstate’s application, a significant step in completing the combination with Community General Hospital.

The CON discussion took the greater part of an hour as committee members reviewed the transaction, considered the financial arrangements, heard about union issues, and considered what was best for the community.

The Department of Health noted that Community General’s services are essential in the area, and it specifically made reference to emergency capacity with Syracuse hospital emergency departments full to overflowing with some frequency.

Apart from the financial issues and policy questions involving the State University of New York (Upstate is part of the SUNY system), a committee member asked about the role and decision-making of Community General’s board of directors.

I explained that Community's board had considered the question of a strategic affiliation for several years, engaging outside consultants and undertaking extensive merger discussions with Crouse Hospital -- before deciding that the community’s interests would be best served by the combination with Upstate.

The support from the community-at-large was also well-established. Dr. John McCabe, CEO of Upstate University Hospital, explained that the combination has been endorsed by all local review panels -- the Central New York Health Systems Agency, the Hospital Executive Council, and the Affiliation Council that involves Upstate and Crouse Hospital (formed as a result of the state’s Berger Commission).

The Department of Health noted the support for this arrangement from health insurers, as well.

Last week was the debut meeting of the Council after it has been reorganized by New York State. New Council members were appointed by the Governor in May, and the State Senate moved promptly to approve them in time for a series of meetings this month. The Department of Health digested a voluminous amount of information to get ready for the committee review.

All of us at Community are very grateful for the cooperation and the time and effort devoted to this important project by state officials and by the Council members.

97% voted for the Bridge Agreement

On Thursday Community General employees ratified the Bridge Agreement, as negotiated by 1199SEIU and hospital management.

The Bridge Agreement was supported by 97% of the voters.

Ratification of the new collective bargaining agreement is a notable accomplishment that helps set the stage for Community's employees making the transition to Upstate University Hospital at Community General.

Collective bargaining began on February 11 and continued through the last week of April. There were 12 bargaining sessions, in all. Community's labor agreement expired April 30, and a tentative agreement was reached on May 13.

My sincere thanks to all members of the labor bargaining team who helped reach the agreement, and congratulations to Community's management team for its concerted efforts over the many weeks of discussion.

Onward!

Widespread support

This week we saw an example of union dues at work. 1199SEIU sent over-sized postcards to thousands of Central New York residents, objecting to the "ill-conceived takeover of Community General" by SUNY Upstate Medical University.

Residents are asked to call State Senator John DeFrancisco and Assembly Member Bill Magnarelli. Presumably, they are expected to affirm SEIU's position that Community General Hospital's combination with Upstate is "rushed" and "badly-flawed."

Actually, the combination has been very carefully planned. Upstate has gone to great lengths to assure that vital patient services remain at Community General's campus, and it is taking steps to broaden and deepen patient care here.

Upstate intends to employ most of Community's workforce, and it has made special efforts to transition Community General's employees. The State Legislature even passed a special law allowing Community's employees the option of remaining in Community's pension plan after they join Upstate.

Some people who got the post card told me they called the legislators' offices but with a message the opposite of what SEIU intended. "I support the Upstate plan," one of them told me this week in the cafeteria, "and that's what I told them."

SEIU's post cards do not state the real reason for its opposition. The real reason is that most Community General employees would become public employees. That means they would join the public unions, and SEIU would lose the membership.

SEIU stands pretty much alone in its opposition. The Upstate-Community plan has widespread support.

Elected officials have already endorsed the plan in letters to the Department of Health:

State Senator John DeFrancisco: "I write you in full support of Community General Hospital’s application. . . . (as) essential for continued available services, and assuring uninterrupted employment . . . and providing high levels of care to patients.” (February 22, 2011)

State Senator Dave Valesky: “I believe the merger of the two entities is critical for the continuation of quality health care in Central New York and will benefit the entire region.” (March 21, 2011)

Assembly Member Bill Magnarelli
It is my belief that Upstate Medical University’s acquisition of Community General Hospital is the most reasonable approach . . .and is in the best interest of the community-at-large.” (May 5, 2011)

A number of community health planning organizations have also endorsed the Community-Upstate plan. They are:

▪ Hospital Executive Council
▪ Crouse Hospital/ University Hospital Affiliation Council
▪ Community Health Information Planning Service,and
▪ Central New York Health Systems Agency.

Why 1199SEIU is worried

A recent letter writer to the Post-Standard suggested that Community General’s plans with Upstate University Hospital are somehow part of an “attack” on workers’ rights.

The writer said: “At a time when the rights of workers are under attack, it is important for people concerned with social justice to speak out when management and policy makers display insensitivity to process for the resolution of labor concerns. Such appears to be the case in the plans for the acquisition of Community General Hospital by Upstate Medical University.”

But the letter writer misunderstood what is happening at Community General. When Community becomes part of Upstate University Hospital, employees will continue to be represented by unions.

This is not a question of union vs. non-union. It is simply an issue of how Upstate structures its operations in a way that maximizes community benefit, fosters its mission, and preserves the most jobs for Community employees.

This week 1199SEIU held a rally in downtown Syracuse at which critical comments were made about Upstate for its approach in working to preserve the employment of Community workers. I would think that’s exactly what a union should be working for. But 1199SEIU cannot guarantee anyone's future without a job.

It is Upstate that offers Community workers continued jobs at the Community campus as part of the larger health care system.

To understand what’s behind 1199SEIU’s concerns, look at what’s happening.

In 2009 A.L. Lee Memorial Hospital (with over 200 employees) closed in nearby Fulton, NY. 1199 had a labor contract with Lee Memorial. The former hospital is now an urgent care center operated by Oswego Hospital.

This year Community General (with 1,100 employees) will become part of SUNY Upstate Medical University. 1199 represents about 800 of Community’s workers.

In our region at least two other hospitals with 1199 labor contracts also contemplating mergers with larger hospitals.

No wonder 1199SEIU is worried.

When I was asked about the rally and some of the statements made by 1199SEIU, I told reporter Jim Mulder: “As a business, 1199 is understandably worried about maintaining its client base.”

Jim's news report on the rally was published yesterday.

"The changes we're facing . . . '

Earlier this week the Post-Standard published a letter to the editor from three nurses who work in the ICU at Community General Hospital.

Their letter noted that, among the public comments on Upstate's acquisition of Community, many have been by representatives of a labor union.

Most employees, said the writers, "understand that. . . the changes we’re facing are in the best interest of our patients, the community and the employees."

Despite some unanswered questions, they acknowledged "the management teams of both CGH and Upstate . . . have shown a good faith effort in keeping everybody informed."

These nurses have worked at Community between eight and 21 years, each. I thank them for taking the time to voice their opinion.

From the Board Chairman

This letter from Steven Infanti, Sr., appears today in the Post-Standard.

Much has been written about Upstate Medical University’s planned acquisition of Community General Hospital. This combination will have significant benefits for our community and our region.

Health care is changing — not gradually, but rapidly. Cost pressures, changes in physician practices and progressive changes in Medicare and Medicaid all make it increasingly difficult for smaller, stand-alone hospitals to continue their services.

However, there also exist opportunities for doctors and hospitals to work together in new ways and in new structures to improve health care services and quality.

As part of Upstate, Community General Hospital will be in a larger, better positioned health care system. Upstate has a regional mission, one that becomes more important as health care reforms are realized. Today, Upstate is operating at essentially full capacity, and it needs to expand.

Community General Hospital has available capacity, and it brings to the table a strong reputation, a history of service and a 42-acre health care campus in which our community has already invested.

Upstate’s acquisition of Community General will make the best use of existing health care resources and will provide a cost-effective means for Upstate to grow clinical services and develop its teaching role.

Together the combination will be more than the sum of its parts.

● It solves two problems with one cost-effective stroke. Upstate’s capacity limitations will be solved and increased patient volume at Community General will improve overall financial performance.

● The cost of services at Community General’s campus will be spread over a larger base of operations. This will, over time, achieve efficiencies not possible as a stand-alone hospital.

● Community General’s 1,100 employees will be maintained substantially intact, preserving jobs and providing Upstate with a skilled workforce, already in place.

● Changes in Upstate’s medical staff bylaws accommodate the private medical practices that depend upon, and support, Community General Hospital. And Upstate’s stronger clinical platform will broaden specialty services for patients using the Community General campus.

● The Community General campus will maintain a broad complement of services, including emergency, acute care and outpatient care, continuing access for residents of its primary service area.

● This transaction is right for patients, for doctors and for employees. Most importantly, it is right for residents in and around Central New York.

Community’s board of directors has carefully planned this strategic affiliation. We have used independent consultants, and we have spent countless hours in study and consideration, including the examination of different scenarios about how best to serve the community.

Having analyzed the facts, we feel, unanimously, that the combination of Community General Hospital with Upstate Medical University is the right decision for Syracuse and Central New York.

-- Steven J. Infanti Sr. is chair of Community General Hospital’s board of directors.

Our new name will honor our past

When employees of General Hospital of Greater Syracuse joined the then-new Community Hospital in November 1964, the new hospital changed its name. It became Community-General Hospital of Greater Syracuse.

The name is used today without a hyphen, but the link to General Hospital was important for many. It recognized their association with a caring institution that served the community for 69 years.

Leonard Markert, Sr., a long-time community leader and a past director of Community General Hospital, once spoke earnestly to me about the linkage. "Don't forget," he said, "where we come from."

Upstate has talked about Community General's tradition of caring, even as our campus becomes part of SUNY Upstate University Hospital -- a single hospital with two campuses, as described in the Certificate of Need application.

Upstate has considered several versions of the Community General name. As we anticipate the closing of this transaction on or about July 1, the name "Upstate University Hospital at Community General" recognizes the new role of this campus, as well as "where we come from."

95% have applied

I am pleased to report that Upstate has received applications from more than 95% of those eligible to apply.

Thank you, all!

78% have applied so far

In the first 11 days of sign-up, 78% of Community General Hospital employees have made applications to SUNY Upstate Medical University.

The applications are a necessary step for employees to continue their jobs at the Community General hospital campus once Upstate completes its acquisition of Community in mid-year.

Benefit infomation sessions continue at Community for the next two weeks.

Upstate-Community provides economic boost

Syracuse is poised to build on this robust eds and meds economy, with an opportunity to create a powerhouse academic medical center through Upstate Medical University acquiring Community General Hospital.

So writes Dr. Wlliam Eimicke in today's Post-Standard. You can read the full op-ed article here.

"How excited I am . . . "

Yesterday, the Human Resources staff from Upstate University Hospital began a series of 24 meetings at Community General during April.

They are explaining the Upstate benefits and answering questions about working for Upstate. I attended the first two sessions yesterday and found the Upstate people friendly and very capable. My Community colleagues were engaged and asked good questions.

This morning, one of the employees who attended yesterday’s sessions wrote me:

My e-mail is to state just how excited I am for this new venture for me and to be part of such a large cutting edge Facility with many many opportunities for the staff at CGH.

I moved here . . . (from out-of-state) and worked in a hospital that was purchased four times. None of the owners were really interested in the hospital staff or took the time that Upstate has taken to keep the CGH staff informed.

I very much advocate for this venture and share my opinion as often as opportunity has risen . . .

The advantages Upstate brings to Community are becoming clearer day by day.

Setting the record straight

One day last week I came upon an employee reading intently a poster that displayed a recent newspaper article about the Community General Hospital pension plan.

She looked distressed, and I asked her about it.

She explained that she was very worried and didn’t know what to believe. She said she has read and has heard many things and was concerned.

I explained how, thanks to Upstate's efforts, New York State had changed the law so that, when Community's employees are offered positions with Upstate, they will be able to choose if they want to stay in the Community pension plan or switch to the state retirement plan. She was very relieved.

It's no wonder people are confused. Labor representatives have actively promoted errors and misinformation, and they have ascribed to me and to others the worst of motives.

That's why Community posted Setting the Record Straight last week.

My mother

My mother died on March 29. I have had to attend to a number of matters in addition to my responsibilities at Community. This exlains the absence of recent postings, desite so many things taking place at Community.

My mother, Elizabeth, was dear woman, much beloved by her family and all who knew her. I am grateful to all who took the time to remember her and to express their condolences. I was touched by your thoughtfulness.

Honoring their memories

I would like to acknowledge the passing of several wonderful people, whose lives were of service to others, each of whom played a big role at Community General Hospital over many years.

John Morrissey, Jr. passed away on March 23. He was 94 and very much “a gentleman of the old school.” An attorney with the Mackenzie Hughes law firm, Jack practiced law for 70 years. He was a kind and considerate man, whom I admired. Jack joined the Board of Directors at Community General Hospital in 1981, and he served as an officer for most of the 1990s.

One of the original volunteers at Community General, Louis Ketchum died on March 11. Over her decades as a volunteer, Lois gave 9,000 hours of service. She and her husband, Gordon, were mainstays in the volunteer organization. Gordon passed away in 2002. He had a considerable volunteer career himself with 4,700 service hours. A very community-minded couple, Lois and Gordon were a wonderful part of Community General.

William Burke, MD, died on March 11. Bill was a thoracic surgeon who practiced at Community and at other Syracuse hospitals. He worked as a physician into his seventh decade. Bill was well known for his affability and his athleticism. He was a Major in the US Army and was very proud of his service as a MASH surgeon in Vietnam. I will miss his humor and commentary in visits over coffee in the cafeteria.

Finally, I would like to remember Brendan McGrath, our colleague in senior leadership at Community until his untimely death on March 13, 2010. Brendan died in a fierce windstorm in Westchester County while visiting his daughter and his first grand child. We miss his decency and quiet kindness.

The CON has been filed

Upstate Medical University has filed the Certificate of Need (CON) application with the State Department of Health to acquire Community General Hospital. This is an important step as we work to complete the transaction on or about July 1, 2011.

The CON describes the acquisition and how it will benefit Central New York. It includes a discussion of the advantages for Upstate in meeting the existing need for services and in fulfilling its clinical, educational, and research mission in the future. The CON affirms that Upstate seeks to build upon Community's reputation and history and to provide employment opportunities for substantially all of Community employees.

Specifically, the CON states that Upstate’s business plan forecasts growth in the number of discharged patients at the Community campus to some 11,000 by the third year of operation. This is almost 30% more than our 2010 discharges.

In addition, Upstate expects the number of full-time equivalent (FTE) employees at the Community campus to increase to 1,025. That is about 18% above the hospital’s 2010 FTE count.

The CON also identifies efficiencies that are expected. For example, the Community campus will benefit from Upstate’s lower medical malpractice rates, from expanded service lines and from Upstate’s broader complement of specialty physicians.

As we embark on this next chapter of our hospital’s history, we can take pride in knowing that Community will become part of a regional health care system, that employment opportunities will continue, and that our physicians, work force, and our caring campus will continue to provide the quality care for which we are known.

Our caring campus

For several years Community General Hospital and Van Duyn Home & Hospital have discussed the potential in our combined campus infrastructure for a "continuum of care."

Between the two organizations, we have 110 acres of suburban property dedicated to health care services. In the aerial photo, Community is to the left of the tree line.

Thanks to Upstate Medical University, the future of this caring campus has new potential. Upstate and Community General are planning to become a single hospital this year, and Upstate is in talks with Onondaga County, Van Duyn's owner.

Today's report in the Post-Standard offers a look into the caring campus, as envisioned by a grant application prepared last year by Van Duyn, Upstate, and Community.

Thank you, all

Thank you. I want to acknowledge the special efforts made this morning by so many employees who fought the bad weather and, at considerable inconvenience and effort, reported for work at Community General Hospital.

In my 38 winters as a part of the Community family, this morning’s commute was one of the most challenging, if not the most challenging. Thank you for making the effort and following through.

I would also like to acknowledge all who stayed at their jobs after shift-change to assure that care continued for our patients.

The parking lots were “challenging” this morning when we arrived. Plant Operations had been working diligently in a difficult situation, but the weather was unrelenting. Plant Ops has done a great job all year with repeated, major winter storms.

Finally, there were a number of volunteers also made their ways to Community this morning. I thank you all.

I appreciate the commitment and follow-through of so many members of our caring family.

As I look outside at the moment, the sun is shining!

Of sadness, appreciation, and optimisim

I have said it is a huge thing for Community to join the Upstate system.

It is understandable that Community General employees may feel worry or sadness about this. That was how employees of General Hospital of Greater Syracuse felt, back in 1964, when their 79-year old hospital (see photo) merged with the then-new Community Hospital on Onondaga Hill. I worked with employees who made that transition, and I remember their comments about the sadness they felt at the time.

In Upstate, Community has a strong, able, and respectful partner. This puts us in a good position to move beyond worry and sadness to appreciation for the opportunity provided. I am also excited about Community's future with Upstate.

This week's announcement by County Executive Joanie Mahoney that Onondaga County wants to work with Upstate on a plan for Van Duyn Home & Hospital is a positive sign. It offers the promise that the 110-acre campus shared by Community and Van Duyn can be part of a larger, integrated system that provides a continuum of care. The aerial photo shows the campus. The treeline separates the Community side (left) from the Van Duyn side.

Upstate's interest in working with the county and Van Duyn is another indication that Upstate is building the new health care infrastructure that will serve our region well for the coming decades.

I am proud to be a part of that future and optimistic for Community's employees.

Community proposes a bridge agreement

Today I authorized the Community General management team to propose a bridge agreement to the 1199SEIU bargaining group. We are in collective bargaining because the current labor agreement expires on April 30.

This agreement is a bridge to the future that proposes to hold intact substantially all of Community's current collective bargaining agreement until SUNY Upstate Medical University acquires the hospital in mid-year.

The bridge agreement is important because it preserves the status quo during the several-month period leading to our hospital’s new life as part of Upstate. The agreement will help Community continue working toward our single, most important goal – securing the future of our services for the community by finalizing the agreement with Upstate.

Working together
At the last meeting of Community's board of directors, I was pleased to hear union officials say they feel management and labor have worked together effectively – for the most part – over the years. The current contract is the result of three separate, comprehensive collective bargaining agreements that have defined (and refined) our relationship since 2001. It is a well-honed agreement, and it will serve well in the remaining months of Community’s independent life.

As I have discussed elsewhere, Upstate sees value in Community and has plans to transition our employees to its organization. Upstate is working within the state system on agreements that we expect to maximize the benefit to Community's employees, our medical staff, and our community.

At the bargaining table, Community has been clear about our financial condition and our prospects as an independent community hospital. Although the 1199SEIU newsletter characterized a presentation to the bargaining committee by Pam Johnson, our CFO, as “unfortunate,” Pam told the truth about Community's prospects for the future without Upstate.

Community is fortunate to have an opportunity to become part of SUNY Upstate's health system. As reported in last week’s Post-Standard, there are a number of other hospitals currently knocking on SUNY’s door. Community and SUNY are far along in our planning process, but we are not yet done. Community's management and labor should do all we can to support the acquisition of Community by Upstate. Nothing will be gained (and potentially, much lost) if the agreement with Upstate is denied, or even unduly delayed.

The bridge agreement
The bridge agreement includes only two modifications from the current contract: one clarifies the severance pay provision, and the other terminates Community's contributions to the downstate Training and Upgrading Fund (TUF), upon expiration of the current contract.

The severance provision, which began as a practice even before 1199SEIU’s first contract with Community, was envisioned for people who lose their jobs because Community needed to adjust its workforce from time to time in the normal course of business – such as occurred during the closure of our sixth floor nursing home, due to the Berger Commission. The planned transition of Community employees to Upstate will not take place “in the normal course of business.” It will end business for Community as a stand-alone hospital, and Community will cease to exist as an employer.

The continuation of jobs has been a fundamental goal since we began planning with Upstate. When a Community employee becomes an Upstate employee, severance pay would not be appropriate because the individual’s employment will continue uninterrupted, albeit with the new employer. Although we believe this is consistent with the intent of the current contract, since it does not clearly address this scenario, we are proposing the clarification.

Upstate is expected to make hire offers to substantially all of Community employees. In some cases, however, an employee may not receive an employment offer (for example, if that employee were to fail the required drug test).

Therefore, to advance the Upstate acquisition and to assist employees who may be impacted, Community has proposed that the severance program continue but only for an employee who does not receive an offer of employment from Upstate. The benefit would provide a minimum of four weeks or one week for each year of service up to a maximum of 12 weeks (three months), plus the employee’s earned PTO (paid time off).

The second change would end Community payments to TUF in order to conserve cash to meet the liabilities Upstate will not be assuming (such as the severance costs, discussed above). Community payments to TUF will total more than $500,000 over the three-year life of the current collective bargaining agreement.

If for some reason Community's acquisition by Upstate were not to occur, the bridge agreement includes a reopener.

A required notice
Finally, Community will be legally required to send a notice to employees in the coming months under the Worker Adjustment and Retraining Notification (WARN) laws. These are federal and state requirements for an employer of significant size that require written notice to employees in advance of “plant closings.”

Because Community will cease as an employer when Upstate takes over, the WARN laws apply to us. Community expects to send a WARN letter to every employee at or near the end of March, anticipating an acquisition date on or about July 1.

Challenges & opportunities
These are truly challenging times. They are precarious times, but they are also rich with opportunity.

Community is working with Upstate in building a bridge to a better health care system for our region as we continue employment opportunities for Community's workers and prepare for the future success of our caring campus.

We appreciate the understanding and support of the Community family and the community-at-larger as we cross this bridge.

Dr. Daines' unexpected death

I learned this morning that Dr. Richard Daines has died. He served as New York State Health Commissioner until last December.

I last saw Dr. Daines on December 13 when he was in Syracuse to address the University Hill Corporation. It may have been his last public address as Commissioner.

A student of history, Dr. Daines gave a thoughtful and insightful lecture. He cited the names of various New York counties through which he traveled as Commissioner, and for each name he recalled a part of New York history involving civil rights, commerce, or technological innovation. He concluded his remarks by advocating that New York, consistent with its remarkable history, has an opportunity to take a leadership role in addressing the needs and challenges of health care.

After the talk, Dr. Daines told me had not yet decided what he would do after leaving the Department of Health. I read last week that he had been named a visiting scholar at the New York Academy of Medicine.

To get a sense of the man, read the New York Times profile that accompanied his appointment as Health Commissioner in 2007. Dr. Daines unexpected passing is such a shock and a sadness.

The Urban League & Syracuse history

A fellow employee asked me last week when I was planning to write "your February letter." She meant, was I going to write about Black History Month? I didn't have a topic, but as we talked, I said, "February is not over yet."

When I checked this blog, I realized I have never written an entry specifically about Black History Month. I have posted comments about civil rights and racial equality but not about Black History Month.

That very day I received a call from an old friend, Leon Modeste, who was President and CEO of the Urban League of Onondaga County for 15 years (1979 to 1994). Now a resident of Albany, GA, Mr. Modeste was a big part of Syracuse -- and of Syracuse black history.

I had found my topic for Black History Month.

I am sorry to say the Urban League no longer exists in Onondaga County. It shut down more than a decade ago, the victim of budget cuts, a leadership gap, and inconsistent community support.

I worked with Mr. Modeste in the League for many years. He will celebrate his 85th birthday later this year. We reminisced about the people we worked with and issues we encountered in recent Syracuse history. He recalled Andrew Willis, his immediate predecessor as Urban League CEO, who played an active role in desegregating the city schools, something that happened in Syracuse only in the 1970's, despite Brown v. Board of Education, 1954.

We talked about Dennis Dowdell, Sr., who founded the League in Syracuse in the 1960's, working with local employers and civic leaders during a time of black frustration and white worry. Mr. Dowdell was honored with the League's Harriet Tubman Award in 1988.

We remembered other figures from Syracuse's history, such as League Board members Elijah Huling, Jr., Harriet McDowell, the Rt. Rev. Ned Cole, Mary (Mitzie) Cooper, Charles Chappell, Jr., the Rev. Sherman Cummings, Charles Anderson, Larry Harmon, Dr. Bruce Leslie - and so many more. See Charles Anderson's op-ed article in today's Post Standard.

And the issues of the day! The Landmark Theater pepper spray incident. The civilian review board. Fair access to housing. Jobs and training. The importance of family life. Mr. Modeste was outspoken when he perceived injustice or hypocrisy.

The League offered a number of programs, balancing funding among a complex of local and government sources. I remember us calling then-State Senator Tarky Lombardi, Jr., who helped many times to keep state funds flowing during various budget shortfalls and cutbacks for programs the state had contracted with the League to provide.

There were programs in the city schools. One service encouraged students with after-school tutoring, involving parents. The Urban League honored a different family each year at an annual awards ceremony, respecting the decency and determination of family accomplishments.

The League helped educate and assist first-time mortgage applicants. And it was part of the community's cultural life with fashion shows and fundraisers. The photo, above, is from the Urban League's 25th anniversary dinner in 1989. That's an embarrassingly youthful me, next to Mr. Modeste.

Two years ago Mr. Modeste and Mr. Willis donated pictures, papers and other documents from the old Urban League to the Onondaga County Public Library.

Thanks to the prompt from a co-worker -- and a fortuitous call from Mr. Modeste -- I am able to post this commentary during Black History Month, just barely.

More support for Community & Upstate

In a post on Thursday, I wrote:

Last week Community General's board of directors approved a resolution that accepted Upstate’s offer to acquire our hospital and its affiliated companies . . .

You read it here first. Today the Post-Standard reported on the Board's decision, based on my memo to employees, which you can read by clicking here.

The combination of Community with Upstate University Hospital has also been supported by the Auxiliary to Community General Hospital. Click here to see the Auxiliary's endorsement.

Are stand-alones an endangered species?

Today we read in the Post Standard that Auburn Memorial Hospital, Oneida Healthcare Center and probably "every hospital within 100 miles" is interested in some form of stronger affiliation with a larger health system.

In a very public way Community General Hospital has been pursuing its strategy of affiliating with another, stronger hospital since 2009.

The newspaper quotes Gary Fitzgerald, President of the Iroquois Healthcare Association:

Our region has a lot of . . . stand-alone hospitals. They just can’t afford to stay completely independent without exploring other options . . .

Last week Community General's board of directors approved a resolution that accepted Upstate’s offer to acquire our hospital and its affiliated companies. This represents progress in defining Community's future role in Central New York.

The board action is good news for the community that we serve, as well as our medical staff and hospital employees.

We are fortunate to have the opportunity to become part of SUNY Upstate's health system.

Upstate's important "eds and meds" role

In the discussion about the economic benefit of SUNY Upstate Medical University, an executive from Columbia University weighed in yesterday in the opinion pages of the Post-Standard.

Willaim Eimecke, Director of Executive Education at Columbia University’s School of International and Public Affairs, noted the "Brookings Institution recently concluded that the best strategy for stimulating the Central New York economy is investment in its educational and medical institutions; Upstate Medical (University) is both."

Dr. Eimecke urged that elected officials who seek to balance budget cuts with job creation should see SUNY Upstate and other teaching centers "as an investment, not just a cost."

Click here to read the full text of "Cutting health care in Upstate New York creates more pain than gain."

Scale and efficiency

At the CNYHSA meeting last month, there was one comment by a physician. Dr. Douglas Tucker works for MVP health plan so he was actually speaking as an insurer, rather than as a physician.

Dr. Tucker said that the acquisition of Community by Upstate would be “a catastrophe” because patient services at Upstate cost more than at Community. As a result, he asserted, the combined hospital would be more expensive for the community-at-large.

He wasn't speaking about hospital costs. He was talking about what insurers pay hospitals for care given to their beneficiaries. (Hospitals aren't able to disclose what we are paid by insurance companies. To do so would violate antitrust laws.)

Is Dr. Tucker's concern a valid one? Will the combination of Community and Upstate help or hurt the cost of care over the next five or ten or 15 years?

First, let's be clear about Community's prospects as an independent community hospital. They are not great, as has been widely reported, unless we become part of a larger hospital system.

So why are Community's prospects "not great" as a stand-alone, community hospital? There are several reasons. A loss of cases in profit-making services. A limited ability to cost-shift to private insurers when there is underpayment from government payers. The ever rising costs of the hospital business. And fewer physicians who replace themselves when they leave practice.

Community has lost profitable cases to free-standing ambulatory surgery centers. This profit-making volume helps a hospital like ours subsidize the money-losing services, such as medicine, psychiatry, and 24/7 emergency services.

Over the years some ambulatory surgery cases have migrated away from the hospital in favor of free-standing ambulatory surgery centers, which are typically owned by physicians. Why do physicians need the additional revenue? Because their incomes have been frozen or otherwise restricted for a number of years.

What about insurers, such as Dr. Tucker represents? Arguably, insurers have been paying more than their fair share to hospitals, given the increasing statutory and regulatory controls on Medicare and Medicaid. Like other hospitals, Community relies on private insurers to make up the difference. But private payers do not make up all the difference, and there is a limit to this cost-shift. Dave Oliker, MVP’s President, recently called the cost-shift a hidden tax.

With this pressure on hospital revenues, we have also seen hospital fixed costs going up. Hospitals shoulder the added cost of services no longer provided by private doctors (such as 24/7 hospitalist service). We've seen higher costs due to federally-mandated electronic medical records (EMRs). And there are greater capital costs as hospitals construct private rooms (the emerging standard) and update medical technology.

Add to that the problems of doctor practices. Many older physicians do not replace themselves when they leave practice. A shrinking supply of doctors means hospitals scramble to buy medical practices as a way of replenishing physicians (and not incidentally, as a way to avoid competing with doctors for ambulatory surgery cases).

Community has been clear about what it wants from its affiliation with a larger hospital system: we seek to spread the fixed costs over a bigger base of operations, we seek to avoid duplicate and costly capital investment, we seek an integrated delivery system, and we seek better access to capital. Upstate provides these things.

The question about hospital system efficiency cannot be answered by looking at the hospital payment rates negotiated last year by the health insurers. Those rates represent the embedded costs of the old system. We are talking about future costs of a reconfigured system. Scale and efficiency are everything in the future system – only the larger, more efficient, and well integrated health care organizations will weather the storm.

Community General Hospital cannot build such a system. So we will join one.

We believe that Upstate’s investment in Community is a cost-effective way to best use the expensive assets in which this community has already invested.

We believe the combination with Upstate will foster a more efficient hospital system in the coming years -- and for decades.

LICH implications for Community?

A report in today's New York Times suggests that a takeover of Long Island College Hospital (LICH) by SUNY Downstate Medical Center might not happen. New York State is reportedly reconsidering its award of HEAL grant funds that were expected to be part of the overall financial transaction.

The Downstate-LICH transaction has some similarities to the proposed acquisition of Community General Hospital by SUNY Upstate Medical University. So a logical question is: does today's report about LICH have implications for Community?

Community recently finished a project involving a HEAL grant. Among other things, the grant funds made possible the Center for Orthopedics. The funds were awarded as part of the Berger Commission's recommendations for Community and Van Duyn Home & Hospital. They were not part of the proposed transaction with Upstate. The funds have mostly been expended (and reimbursed).

The Community-Upstate transaction is far smaller, as I understand it, and not as financially complex as Downstate-LICH.

Yesterday Dr. David Smith, President of Upstate Medical University, addressed the Upstate community on the overall subject of state budget cuts, university finances, and plans with Community General.

Dr. Smith reiterated Upstate plans for its acquisition of Community because doing so will help Upstate build capacity and will help “put the right patient in the right bed.”

Doctor and poet

Poetry may not be among today's most prominent art forms (except in popular music). However, poetry is such a part of the human condition, I suspect there are as many people writing today as there ever were, including physician poets.

You may know some of the famous physician poets, such as William Carlos Willaims (Complaint) or John Keats (Ode on a Grecian Urn).

Here is a physician you may know (he practices in Camillus, NY), but you may be surprised to learn about his passion for poetry. Dr. Dave Manfredi is primary care physician with Preventive Medicine Associates, PLLC. His poems have been published in literary and medical journals. One of his poems ("I Come Down in the Morning") was set to music by composer Carter Pann for the Skaneateles Festival (2009).

In “For Zizi” (Voices in Italian Americana), he writes with poignancy about an aged seamstress whose story is implied by the distance between youthful wine making in Sicily and her "life's fulfillment" serving “Dandelion salad to a whole generation of Americans.”

Not surprisingly, Dr. Manfredi writes about health, as well as life and death. He considers personal exercise in “Running” (Rattle) and the experience of disease in “Alzheimer’s” and “Tumor” (both in the Healing Muse).

“Doctor Patient” (Healing Muse) is an affectionate dialogue between the physician and noncompliant patient, “a man comfortable with himself” who kindly refuses to modify lifestyle to reduce health risks.

"Cut back on bread, rice, and pasta,” I say.
His eyebrows raise to unimaginable heights.
“How can that be. . . the staff of life?”

The poem “July” opens with this arresting image . . .

It’s 5 PM, late July on my deck
I sit with my brain in my lap . . .

. . . and concludes with an acceptance of mortality:

The greenery stares at me
Like the transient curio that I am
and I wait patiently to decompose

The existential question is important in Dr. Manfredi's poetry. Here is another example, from “The Grave” (Journal of the American Medical Association), where he sees in the beauty of nature a place of repose:

The grass is comforting and soft,
The green in me is oozing forth
Though I lay resting in my clothes
To its embrace I decompose.

Dr. Smith goes to Community

This morning I was meeting with Dr. David Smith, President of Upstate Medical University. He asked if we could spend a few minutes walking around Community General Hospital, just to see the facility and to meet people.

It was a great suggestion.

On our impromptu walk Dr. Smith had the opportunity to meet and speak with perhaps 80 or 90 people.

He thanked everyone for the work they do and said our work at Community will continue to be important after we join with Upstate.

Dr. Smith commented several times about the good care a member of his family received at Community during a hospitalization two years ago. He spoke about Upstate's teaching mission, about changes in the medical staff bylaws to support the ongoing private practice of medicine here, and about respecting Community's identity within the Upstate system.

There were a number of questions, mostly about jobs but also about the mission of the hospital.

Dr. Smith said that different employment models are under consideration, and he acknowledged the concerns of employees, saying Upstate is working to address the concerns.

One nurse observed that Upstate must be interested in Community's available square footage. Dr. Smith said, "We're interested in the workers. What you do is important. We're interested in keeping 1,100 jobs and in continuing the high quality care you are known for."

Since his walk-through, several employees told me they were impressed with Dr. Smith's friendliness and his uplifting words.

There have been several questions about Upstate's organization, specifically how does Dr. Smith relate to Dr. John McCabe? Many employees have met Dr. McCabe in my employee meetings last year.

Upstate Medical University (UMU) is a large organization, a university, not just a hospital. Part of the State University of New York (SUNY) system, UMU has four colleges, plus University Hospital.

Dr. Smith is the President of SUNY UMU, the entire university. Dr. McCabe is the head of University Hospital. Dr. McCabe's official title is CEO at Upstate University Hospital and Senior Vice President of Hospital Affairs at Upstate Medical University.

Last week, when I met with the Auxiliary to Community General Hospital, one of the Auxiliary board members told me of the time she met Dr. Smith. It was several years ago when he was President of Texas Tech University. She saw him throw out the puck at a hockey game and asked him where he learned to skate. Dr. Smith told her he spent his early childhood in Toronto and learned to skate there. Later, as a student at Cornell University, he was a member of its hockey team.

Dr. Smith is a man of accomplishment. A pediatrician, he is also an avid outdoorsman. And he is a past Commissioner of Health for the State of Texas.

"A huge thing"

A recent comment on this blog observed that Community's intention to join with Upstate "is a huge thing" and employees "have every right to be scared."

It is a big deal, and not only for employees, but for the medical staff and for the community-at-large. It's a big deal in response to the big changes affecting all health care providers. There is an ongoing, significant consolidation in health care.

Look at what has happened to doctors in our community. A number of medical practices have merged, some doctors have left practice, and some groups have been acquired by hospitals. These changes over a number of years have consequences on services available at hospitals and on how much it costs hospitals to provide the services.

Add to that the higher costs of running a hospital (hospitalists, for example); the higher cost of mandates (such as electronic medical records); the cost of new technology; the restrictions, rules, the cost containment we have seen (and will continue to see) in Medicare and Medicaid, (and the limited ability of insurers and employers to make up the difference) -- these forces are inexorable, and they make the financial situations of stand-alone, community hospitals very difficult indeed.

We have seen this coming for a number of years. As I pointed out in my remarks before the Central New York Health Systems Agency (CNYHSA), the Syracuse hospitals have been considering mergers and consolidations since the 1990's.

I used the slide (above) to remind the CNYHSA about the various studies and reports that have recommended that Syracuse hospitals consolidate. You can find my full presentation here (click on "Tom Quinn's PowerPoint").

Community General Hospital is part of this industry-wide consolidation, and I expect such consolidation to continue, even increase, among New York's hospitals in coming years.

The question is not whether we can avoid such consolidation. The question is, given the massive changes in health care, what is best for our community and for the health care people caring for our community?

That’s why Community has sought a merger partner, first with Crouse Hospital and ultimately with Upstate Medical University. That is our Board’s responsibility – to assess the situation and, given the changes and the realities, to determine how Community General should best serve the community-at-large in the future.

There are and will be many technical and legal issues affecting the Community General combination with Upstate. All these issues have not yet been resolved. I believe our path with Upstate makes the most sense for our community, for Community’s employees, and for the medical staff.

We are working with Upstate to assure that Community’s mission, services and jobs continue as part of Upstate's larger organization and purpose. Let me call attention to the guiding principles, developed by Community and Upstate (available here), in which the importance of the existing workforces is recognized at both organizations. Upstate is a fair and honorable partner for Community, and I have confidence that the combination will ultimately be in the best interests of Community's employees.

For the most up-to-date information regarding affiliation and workforce issues, please see the Q&A section of the Community-Upstate website.

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.

"A smart move"

Yesterday's Post-Standard published an editorial supportive of the proposed combination of Community General Hospital with Upstate University Hospital.

Here's the link to the editorial.

There is also a joint Community-Upstate website on this topic, and you can find that here.

A lot has been written about this already -- and no doubt there will be a lot more.

Our opportunity with Upstate

Today's Post-Standard has a story about Community's financial condition, based on a recent report by Moody’s Investor Services.

The Moody's report considers the flat population in Central New York, Community's smallest market share, and the cost of competing in the four-hospital Syracuse market. Moody’s concludes, correctly, that it will be difficult for Community to invest properly in the hospital in the future.

These are among the factors the Board of Directors considered in 2009 when it decided that -- as a strategy to better serve patients and our community -- Community should become part of a larger hospital system. And in a somewhat public way, we have been seeking the right hospital partner ever since.

Our discussions with Crouse Hospital were announced in the fall, 2009. They did not work out, but our planning with Upstate is going well.

We have largely completed many of the legal and financial reviews (“due diligence” process) that are necessary, and we have been able to add to Community's medical staff a number of physicians from Upstate, even in advance of a formal combination. These are good signs of progress.

Community has a strong medical staff and workforce and an excellent physical plant. We operate on a 42-acre suburban site. Our patient services are strong. Today's newspaper notes that Community has "the lowest rate in inpatient complications of any hospital in the city." Last year, Consumer Reports acknowledged us for low infection rates. HealthGrades recently awarded us for the sixth straight year, its overall excellence award in New York State for orthopedics care. Yes, that's in New York State.

And . . .Community was recently re-accreditated by the Joint Commission.

These advantages bring value to Upstate as it meets its academic, clinical and research missions in the broader Central New York region.

Remember, there is an old saw about risk and opportunity. The Moody’s report identifies risk for Community. Community and Upstate see the opportunity in doing something important for our community.