It's the height of hypocrisy for Erie Chapman to lecture hospital chief executives about our collective top concerns (Letters, Jan. 23, p. 19). As a former CEO, Chapman offers this sermon from the relative comfort of his self-created foundation position at Baptist Healing Trust, the only remaining independent activity of the formerly independent Baptist Hospital in Nashville.
As I recall, Chapman's concern over financial challenges and, most specifically, the massive debt of Baptist Hospital forced him into a sale to his crosstown rival, St. Thomas Hospital. While he passed the heavy-lifting components of his former job onto someone else and left the hospital CEO field, no one would stoop to accuse him of abandoning concerns relative to quality and safety by selling to St. Thomas.
Yet, Chapman says that not-for-profit hospital CEOs and our boards have done just that. I beg to differ. We have not abandoned our mission. Healthcare CEOs worry about myriad challenges-financial and otherwise. The ACHE survey forced a ranked order of concerns. Yes, I responded to the ACHE survey and yes, financial issues are my No. 1 concern. My board and I have not lost sight of quality and safety, but the old adage "no margin, no mission" rings as true today as ever. I just don't need preaching from the sidelines about my own well-reasoned priorities.
President and chief executive officer
Gateway Health System
... why finances matter
The letters in response to the cover story on the American College of Healthcare Executives' survey of healthcare executives' priorities were very disconcerting to me ("What really matters most," Jan. 9, p. 8; Letters, Jan. 23, p. 19). As CEO of a critical-access hospital and Planetree affiliate, I can well understand why "financial challenges" are indeed on the top of many hospital CEOs' concerns.
I wish to reassure your readers that we have not lost sight of our mission to provide compassionate care in our communities. However, the challenges which daily threaten the very financial viability of our hospitals cause us to continually recall the old adage, "no money, no mission."
Our staff members work extremely hard providing that tender touch, but unless we can afford to give them the proper tools for their jobs, our outcomes are in jeopardy. Most community hospitals will devour their assets before giving up their mission, but once that happens, who will be there at 3 a.m. for your heart attack or auto accident?
President and chief executive officer
Brookville (Pa.) Hospital
An uneven M&A market
I found the annual healthcare mergers and acquisitions special report, by Melanie Evans and Vince Galloro, quite interesting ("Merger ahead," Jan. 23, p. 22.) I certainly agree that things have been active and seem to be off to a very quick start this year. I can't entirely agree, however, that we are in the midst of a seller's market-at least not for all facilities and markets.
Much like the housing market, some areas of the country and communities of a certain size are hot. Other areas are very, very cold even though sellers are present and trying hard to find buyers.
I am working with buyers and sellers encountering both extremes. The appetite very much depends on the location of the hospital or hospitals for sale-whether the community is of a certain size; if it seems to be growing; whether in-market private payers and associated workforce seem stable; whether the Medicaid program at issue is viable; and whether state regulations are strong or weak are all increasingly relevant factors. Also, while the venture money available to startups is truly unprecedented, my sense is that the number of sellers may also be unprecedented-or may soon be as reimbursement rates become less favorable and stable, access to the capital markets continues to be limited to the "haves," the average physical plant becomes older, the costs of providing care skyrocket, etc.
I actually believe that we are in the midst of a market that may not be able to find buyers or partners for the many, many facilities that see a transaction as a way to access much needed capital.
As a healthcare transactional lawyer, these are busy and exciting times. When I put my public-policy hat on, however, I am very concerned about the future of acute-care facilities in all but the most attractive communities.
There is another side to this story.
Waller Lansden Dortch & Davis
What do you think?
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