In a city where a man named Daley has occupied the mayor's office for 43 of the past 56 years, it might not seem surprising that some observers think Chicago is a bit slower to adopt change than other major metropolitan areas.
Benn Greenspan says he's seen evidence of the city's cautious approach to change in healthcare, and he believes it has served the city well over the years.
Greenspan—who came to Chicago in 1976 to work at and later run one of the city's safety net providers, Mount Sinai Hospital and the Sinai Health System, until 2004—says he was warned by colleagues in New York that Chicago adapts to changes about five years behind the coasts. “What they weren't saying is that it was a bad thing. They were saying there is something about the Chicago market that waits and watches to see how things go before adopting change,” says Greenspan, who today is the director of the master of healthcare administration program in the School of Public Health at the University of Illinois at Chicago.
By any measure, Chicago is a large healthcare market, encompassing 93 acute-care hospitals in 75 square miles across eight Midwestern counties stretching beyond the Chicago metropolitan statistical area.
But the city was initially resistant to the trend of for-profit ownership, even as investor-owned chains were rapidly expanding operations in other parts of the country. A top executive at Columbia/HCA Healthcare Corp. said in 1996 that Chicago was the chain's most difficult market to acquire in (Nov. 4, 1996, p. 26).
Today, for-profit chains are on a buying spree in Chicago, such as the go-go Vanguard Health Systems, which is now expanding its ownership to six hospitals there in just over a year's time.
Unlike major cities such as New York and Boston, Chicago has also been able to hold on to its not-for-profit Roman Catholic hospitals, though some of the regional players are getting swept into a consolidating trend. Provena Health and Resurrection Health Care have agreed to merge, while large national Catholic systems Ascension Health and Trinity Health are actively acquiring their first hospitals in Chicago.
Kevin Scanlan—president and CEO of regional healthcare provider association Metropolitan Chicago Healthcare Council—didn't say that Chicago follows behind the curve in trends, but he does note that the region has seen an “explosion” of growth in system affiliations in recent years. “Will we get to the point like Boston or Minneapolis, where there are basically three systems and you are a part of one of those three? I don't think so. What is the magic number? Today, there are 20, and it will be less than that, but we don't know” what it will be ultimately.
One area where Chicago isn't waiting to see how a national trend plays out is with its regional health information exchange.
The metropolitan council announced this spring its plans to launch the MetroChicago Health Information Exchange, which has 66 founding members who have agreed to fund ongoing operations of the system. When up and running, the MetroChicago HIE is expected to serve more than 9.4 million people, making it the largest regional HIE in the nation, Scanlan says.
Like all HIEs, it will enable hospitals to share patient data among themselves to improve patient care and enhance public-health reporting systems. Linking emergency department data will be one of the first goals of the program.
No profile of Chicago, however, would be complete without a mention of political corruption. In a state made infamous by having its two most recent governors convicted of political felonies after they left office, healthcare—with all of its jobs and money—has not been left unaffected.
Former Gov. Rod Blagojevich was convicted of attempted extortion and soliciting bribes from a children's hospital executive. The year before, a former fundraiser for Blagojevich and then-Sen. Barack Obama was convicted of using operatives to solicit massive bribes from a suburban hospital seeking certificate-of-need approval.
The Illinois Legislature has since overhauled the CON process with the intention of preventing future extortion.
“Basically, we had a criminal enterprise operating within the (CON) process a couple of years ago,” Greenspan says. “It was too bad, because it shaped not only what was going on a few years ago, but it shaped the planning process.”