Nobody said healthcare reform is easy. The question is how much is your hospital and community willing to sacrifice in the name of efficiency and cost.
Regardless of the answer, the urge to merge among hospitals continues unabated. A recent survey of not-for-profit hospital chief financial officers, for example, shows that 68% have consolidated or affiliated their facilities with other acute-care providers or plan to do so. Just last month, two of Houston's powerhouse hospitals-Methodist and St. Luke's Episcopal-signed a letter of intent to merge.
The hurdles to achieving a successful merger are well documented. The problem of leadership comes to mind. In the Houston deal, the boards of St. Luke's and Methodist indicate they may go outside to find a new chief executive officer. Antitrust concerns can be another barrier. In Louisville, Ky., Alliant Health System and Baptist Healthcare System say they'll need legal clearance to proceed with a joint venture that ultimately would create a statewide healthcare network. But Alliant and Baptist also are careful not to characterize their deal as a merger. Both organizations will remain autonomous with separate assets and finances. Such are the sensitivities faced when forming partnerships.
But in Skagit County, Wash., the flip side of the coin bears watching. Two hospitals that merged into Affiliated Health Services in 1991 are considering a corporate divorce. The saga involves two proud communities that are having difficulty sharing resources and sacrificing local control. The situation will come to a head Nov. 8, when voters will be asked in an advisory referendum whether the tax district's hospitals should dissolve their affiliation.
When politicians attempt to sell healthcare reform they rarely emphasize the impact of cost containment, community health planning and squeezing excess capacity. In Sedro Woolley, Wash., it hit home when United General Hospital was converted by Affiliated Health from an acute-care hospital to an outpatient diagnostic center with a 12-hour urgent-care center. Meanwhile, the system's acute-care services were consolidated at Skagit Valley Hospital in nearby Mount Vernon.
New federal guidelines will make mergers easier and clearer. But when it comes to accepting the realities of consolidation, nothing is easy or clear.