"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.