It seems that in the last few days, the only news in Syracuse worthy of publication in the Post-Standard involves Upstate and University Hospital. In the last two days, there are four prominent stories that have something to do with us. Let me provide some observations, insight and comment:
- Pedestrian struck by vehicle in front of Upstate University Hospital: This is an unfortunate incident that happened to occur outside of our hospital. It is not noteworthy for the hospital per say, except that another trauma victim is treated at University Hospital. It does remind us however, that the University Hospital sits in a very congested part of Syracuse. There are many times (Syracuse University events, 5 p.m. on a business day, etc.) when the area around University Hospital is quite congested. The story reminds us all to take extra caution when crossing streets around University Hospital, whether it be Adams Street or the Almond Street underpass of Route 81. We all hope for a speedy recovery for the injured pedestrian in this most unfortunate accident.
- Commentary: Cutting health care in Upstate New York creates more pain than gain: This is a very thoughtful piece by William Eimicke, Director of Executive Education at the Columbia University. Dr. Eimicke is a well respected academician and policy analyst. He holds a PhD from the Maxwell School at Syracuse University. In his commentary he makes the case that there must be healthcare reform and an attention to reducing healthcare costs. At the same time, he points out the regional, business, and economic development value of “eds and meds” in our region. That is educational institutions like Syracuse University, and hospitals like Upstate Medical University really are the only current drivers of economic development and growth in areas like Albany and Syracuse. He points out the importance of an institution like Upstate Medical University as the largest employer in the region, with a significant annual impact on the regional economy. He makes the case for Upstate Medical University growth and levering its resources to generate economic development in the region. His arguments are certainly consistent with our current approach to the acquisition of Community General Hospital.
- Will proposed merger between Upstate University and Community General Hospitals raise costs?: This article, on today’s front page of the Post-Standard asks a very appropriate question. The article compares costs for a number of procedures at University Hospital and Community General Hospital (Medicare costs only). As one might expect, costs are higher at University Hospital. There are a number of obvious reasons for this including:
- higher costs of an educational institution
- Cost of unique services provided at University Hospital such as burn care, and specialized technological services not available elsewhere (i.e. gamma knife)
- University Hospital provides services that other hospitals in the region used to participate in, but no longer do such as trauma care.
- University Hospital bears the cost when other hospitals decline to provide services (for instance other hospitals lack sub-specialty on-call services to their Emergency Department, despite the fact that physicians in that subspecialty have hospital privileges).
- Small niche areas that are not profitable (i.e. spina bifida clinic) used to be offered at other institutions and yet they have stopped caring for these patients.
The cost equation is not a simple exercise. The use of Medicare costs only can be misleading. Medicare payment rates include hospital reimbursement for medical care, but also include payment for teaching activity and payment for our high percentage of uninsured and under-insured patients. Healthcare reimbursements are complex.
It is certainly our intent that the acquisition of Community General Hospital by University Hospital will create a larger platform that will allow us to get the “right patient in the right place” and to restrain the growth of costs overall. This will allow us to spread our “fixed costs” over a larger system, and reduce costs overall. There will certainly be opportunity for efficiency in the care that we provide. Were this merger not to take place, there would be great disruption to the Syracuse health community, certainly with higher costs and poorer care.
Tom Quinn has posted a nice discussion of this issue as well on his recent blog. http://morethanmedicine.blogspot.com/
- Doctor’s lawsuit says Upstate forced him out for blowing the whistle on hospital problems: This article describes a recent lawsuit filed against University Hospital. It is unfortunate that Jim Mulder wants to make news out of baseless allegations, pending lawsuits, and old business. As said in the article by spokesperson Darryl Geddes “In most instances, we would hesitate to comment further, but the baseless claims contained in this suit cannot go unchallenged and we will vigorously defend this case at the appropriate time”.
It is worth reiterating that the quality of care issues raised have been dealt with through both internal and regulatory efforts and review. I continue to have confidence in the quality of care at UH, and with the correct processes to identify and correct quality issues. It is also fair to remind ourselves that faculty generally come and go of their own volition. Dr. Holsapple left Upstate on his own for other career opportunities.