The Ties That Bind
Great Lakes Health gives itself good grades despite missing benchmarks
Members of Kaleida Health, ECMC, and the board of Great Lakes Health held an open meeting for half an hour Tuesday morning at the Hyatt Regency. Nine pages of bullet points were offered to illustrate the progress they are making toward implementing the “binding agreement” signed by all the parties last summer.
The agreement was a last-ditch attempt, hammered out in court, to meet the recommendations of the Final Report of the New York Commission on Health Care Facilities in the 21st Century—a.k.a. the Berger Commission—which called for the merger of not-for-profit Kaleida Health with ECMC through the dissolution of the latter public benefit corporation. These two entities were to be brought together under a “single unified governance structure controlled by an entity other than ECMCC, Kaleida or any other public benefit corporation.” The result would be Great Lakes Health, a private, not-for-profit healthcare entity.
At Tuesday’s brief open meeting (before adjourning into various executive sessions), the first claim the group made is that they have lived up to the commitments made last year in the binding agreement. Second, they stated, “We have rarely looked at the agreement over the last year given the trust and relationships that have been built.”
Maybe if they had looked back at the agreement, they would have realized that, in fact, they haven’t lived up to it.
Starting with the second page of the binding agreement, they failed to meet the requirements of section one, which is the basic “Agreement to Merge.” No county or state legislation is out there moving to dissolve ECMC as a public benefit corporation.
Still on page two, they failed to realize Section 2.1, “Step 1: Legislation is Passed Permitting WNYHS (now Great Lakes Health) to Function as the Equivalent of ECMCC’s Sole Member.” See reason stated in the paragraph above. Section 2.2, “Step 2: WNYHS Becomes the Sole Member of Kaleida,” has also not been achieved, since it is also contingent that ECMCC be dissolved as a public benefit corporation before this step can be undertaken.
In short, they have failed to execute the primary mandate of the Berger Commission, which was to dissolve ECMCC through acts of local and state legislatures—including solving such thorny problems as how to handle retirement benefits and post retirement medical insurance benefits to ECMCC employees, and how to manage a labor situation that deals with over six different public and private unions.
Having flunked their primary goal, the spin at the open meeting was to say that the parties are now “working as partners to coordinate activities within the 15 reserved powers” outlined in the binding agreement. Looking ahead, the solution is to redefine the business model. Instead of the merger called for by the Berger Commission and approved by the Department of Health as it was described in the binding agreement, they will be moving in the direction of a “Joint Operating Agreement.” Whatever that finally means.
As for timelines, the binding agreement “outlined key dates to accomplish many steps.” We are told that, having missed those due dates, “the parties mutually agreed to table such deadlines.”
Great. Deadlines, guidelines, what’s the difference as long as we’re both in love?
Looking ahead, they set the bar high for themselves by asking: “What do we need to accomplish over the next 12 months?” Brainstorming or bold leadership: You decide.
Most striking in Tuesday’s public update is the admission the ECMCC and Kaleida Health maintain autonomy. According to the handout, a year ago the boards would “remain independent to include appointment of leadership.” Now, “these provisions are honored but with coordination of Board appointments, selection of leaders, and other bridge-building initiatives.” Looking ahead, they ask, “How autonomous do the parties need to be?”
At the open meeting, you heard a lot of terms like “bridge-building.” Synergy is another popular one. The problem is that the Western New York Health System was not created by the Commissioner of Health to create “synergy” but to dissolve ECMC as a public benefit corporation and consolidate it with Kaleida under a third not-for-profit private entity. Either that, or the health commissioner was to close either ECMC or Buffalo General Hospital. Those fates were avoided thanks to a binding agreement that is now largely ignored.
Remember, just last summer there was a big court case about it. Judge John M. Curran was named a citizen of the year by the Buffalo News for shuttling “from group to group during eight hours of negotiations that involved almost 60 people, including all of the hospitals’ key officials, County Executive Chris Collins, University at Buffalo President John Simpson, the leaders of the UB Medical School, a committee of physicians from ECMC and Kaleida Health and an array of lawyers,” the News wrote. “In the end, the parties resolved key differences and found common ground.”
One year later it should be asked how solid that common ground remains.
In the meantime, I requested the same press release that was given to the Buffalo News and Business First, summarizing the recommendations arrived at Tuesday by the Professional Steering Committee to Great Lakes Health. These recommendations include transferring “all appropriate cardiac care from ECMC to the Global Vascular Institute, while maintaining sufficient services and programs to support Trauma and the high volume of emergency room visits at ECMC.”
Under the recommendations, ECMC would become a center for bone health and kidney and pancreatic transplants. Elective spine surgery would be at Buffalo General Hospital in conjunction with the Global Vascular Institute. Orthopedic programs would be maintained at Kaleida’s Buffalo General, Millard Fillmore Suburban, Women’s and Children’s, DeGraff hospitals, and the Kline Road Ambulatory Surgery Center.
For critical care, the recommendation is to “create a Great Lakes Health transfer center that will allow for the seamless transfers of critical patients from outlying community hospitals.”
So, even though they’ve failed to solve the critical issue of how to dissolve a hospital that is a public benefit corporation created to provide care for all citizens of New York State, regardless of their ability to pay—which is what they were created to accomplish—they have not slowed the process of tinkering with the blueprints of local healthcare for generations to come.
—buck quigleyblog comments powered by Disqus
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