July 22, 2008

Statewide Plan to Restructure Hospitals Ends With Mixed Reviews

By Henry L. Davis, The Buffalo News, N.Y.

Jul. 22--New York State's grand experiment to close, merge and restructure hospitals is over.

The deadline passed at the end of June to fulfill the mandates of the Commission on Health Care Facilities in the 21st Century, also known as the Berger Commission.

Changes the commission set in motion -- some controversial and others altered -- have begun to play out. Hospitals in Western New York and elsewhere will look different.

But it will take years to judge whether the monumental effort is a success, failure or something in between.

Statewide, the commission originally ordered nine hospitals to close and 48 others to affiliate, downsize or change their mix of services, a plan that would have eliminated 4,200 hospital beds, or about 7 percent of the total statewide.

The state recently reported that it considers most of the commission's recommendations to have been implemented, with the existence of plans to remove almost 1,700 hospital beds by the end of this year and another 1,700 by the end of 2010.

"We took substantial and dramatic actions," said James Clyne, the state's deputy health commissioner. "Now we have to focus more on planning for community health needs."

The commission made Western New York a big target. Among the anticipated changes for the region:

--Close Kaleida Health's Millard Fillmore Hospital at Gates Circle.

--Create a unified governing board over Kaleida Health and Erie County Medical Center that includes the University at Buffalo.

--Build an institute for heart and vascular procedures downtown next to Kaleida's Buffalo General Hospital on the Buffalo Niagara Medical Campus.

--Eliminate the operating license and 203 beds at St. Joseph Hospital and, instead, have Sisters Hospital transfer on paper 125 of its beds to the Cheektowaga facility and operate it.

--Close Nazareth Nursing Home in Buffalo and Mount View Health Facility in Lockport.

The health system statewide will have fewer unneeded hospital beds and potentially improved finances at trimmer facilities. But the commission was supposed to be about more than beds and buildings.

The big question, especially for Buffalo, remains unanswered: Will the changes improve the quality of care and doctor training at the hospitals and, if so, will the better outcomes be reflected in a healthier community?

"It will take 10 years to answer that," said Joseph McDonald, chief executive of the Catholic Health System.

To McDonald and others, the commission at a minimum forced hospitals and their rivals to question the way they do business.

"Berger did facilitate collaborative discussions. That's a good thing," he said. "People found a reason to talk."

But McDonald also characterized the commission as "invasive."

For instance, the commission's order to close St. Joseph Hospital in Cheektowaga was modified to allow the continuation of medical services in the building. The rationale: The Catholic Health System argued successfully that public safety would be threatened if the St. Joseph emergency room closed, on top of the proposed closing of other emergency rooms.

"I don't know if Berger was worth it, especially for us. We had had a reconfiguration strategy," McDonald said.

Others described the commission as flawed but beneficial.

"It was a call to action," said James Kaskie, chief executive of Kaleida Health. "Its report was imperfect. Not everything was accomplished. But it got everyone to focus on what we can change and how we can change it.

"We are certainly different today than we were 24 months ago."

An example: Kaskie said Berger pushed Kaleida Health to examine its patient data more closely, an effort that led to the creation of a chest pain center that will prevent unnecessary hospital admissions.

He and others also said the commission brought with it the promise of unprecedented financial aid for larger projects.

The federal government pledged $1.5 billion contingent on implementation of the recommendations; the state, $1 billion. Kaleida Health was awarded the largest single grant so far -- $65 million -- to help close Millard Fillmore.

"Overall, the commission was a worthy endeavor," said Daniel Sisto, president of the Healthcare Association of New York State. "In the end, the state sorted out the viable recommendations from the ones that needed modification, and it offered extraordinary financial incentives."

However, critics wonder if the alterations to the commission mandates became too politicized.

Berger moved people off of the status quo, but it also was significantly diluted," said Henry Sloma, a Niagara County official and health care consultant who sat on the commission.

The health care system in the state still remains too focused on hospitals and nursing homes, rather than on the types of services that patients and the elderly need, he said.

Said Sloma: "The old buildings are dragging us down."

No other mandate aroused more controversy than the order to achieve greater cooperation between Kaleida Health and ECMC, and, in the process, strengthen the UB Medical School.

To the commission, a medical arms race between ECMC and Kaleida Health had left them struggling to support the medical teams and technology needed to build comprehensive specialty programs noted for their quality, research and educational experience.

"When you looked at what was happening, it was nuts. Someone had to step in and bring some order," said Buford Sears, an M&T Bank executive who served on the commission.

The commission's well-intentioned plan suffered from a lack of clarity but plenty of complexity in its attempt to force a marriage between the public and private institutions.

"If you had ranked the commission's 57 recommendations in terms of degree of difficulty, this one was in a league of its own," said Sears.

Rather than dictating what Kaleida and ECMC should do, the commission ended up creating a framework within which it hoped the hospitals could figure out a solution.

"The agreement the hospitals reached satisfied the spirit of the recommendation," Sears said.

Some of the recommendations remain unresolved, including an order to close Williamsville Suburban nursing home, a facility operated by Legacy Health Care.

Meanwhile, the state is moving ahead with other aspects of the commission's work, including initiatives to encourage regional health planning and to expand basic medical services.

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