Turning a cruise ship around in a narrow channel is child’s play compared to what’s involved in changing a national healthcare system. Forget that millions of lives are involved in profound organizational change as compared to the matter of a few thousand paltry souls on a pleasure ship. In a systemic turnaround of an entire sector of the economy, the considerations that must be taken into account are infinitely more complex as well as more important. In addition, there’s the politics: the fact that the captain, the crew, the passengers and the owners all seem determined to steer this particular vessel in different directions probably doesn’t help.
Change, once launched, develops a momentum of its own. American healthcare change, which has been happening at an accelerating pace in the Hudson Valley, is now irreversible. The recent burst of merger activity among providers, which has been a long time coming, is a harbinger of even more fundamental change still to come. American healthcare is a system in which all the parts are moving simultaneously.
Hospitals in the region are the most substantial and among the most visible of these institutional parts. In the past year, there’s been a wave of consolidations and mergers of Westchester hospitals with the larger systems to their south.
The wave of consolidations and mergers is spreading ineluctably northward.
“Everybody is looking for a partner,” Kingston-based HealthAlliance of the Hudson Valley CEO David Scarpino is quoted as telling a chamber of commerce audience in Kingston last month. “Any hospital who tells you they’re not, they’re not telling you the truth. We believe the coming world will be hinged on affiliations.”
HealthAlliance has been actively searching for an affiliation partner, Scarpino said. It’s been looking in three directions: within the Hudson Valley, and to its immediate south and north.
Montefiore Medical Center in the Bronx and North Shore-Long Island Jewish Health System are currently HealthAlliance’s southern potential partners.
A month ago Phelps Memorial Hospital Center in Sleepy Hollow said it was negotiating a deal with North Shore-LIJ Health System. Northern Westchester Hospital in Mount Kisco said even more recently that it too was entering into exclusive negotiations with North Shore-LIJ. The latter health system includes 400 physician practices and employs 48,000 people, making it the largest private employer in the state. Its 17 hospitals including ones in Manhattan, Staten Island and Florida. North Shore-LIJ offers a health insurance plan, CareConnect, using its own doctors and hospitals, which is currently offered on the state health insurance exchange to residents of Nassau, Suffolk, Staten Island and Queens.
Meanwhile, White Plains Hospital is in the midst of a partnership agreement with Montefiore Medical Center. Last fall, Montefiore also purchased bankrupt Westchester hospitals in New Rochelle and Mount Vernon.
Lawrence Hospital in Bronxville recently merged with New York-Presbyterian Health System.
Dutchess County based HealthQuest and Westchester Medical Center are HealthAlliance’s two potential partners headquartered in the Hudson Valley. With state and federal regulators ready to block on anti-trust grounds a sale of bankrupt St. Francis Hospital in Poughkeepsie, which has about 2000 employees, to neighboring HealthQuest, St. Francis in February accepted a purchase offer from Westchester Medical.
HealthQuest continue to buy primary-care medical practices. In January Maverick Family Practice, with offices in Boiceville and Zena, in Woodstock, joined HealthQuest Family Practice. HealthQuest now has a dozen primary-care locations.
Mergers and affiliations among medical groups and with other kinds of providers are not uncommon. Relationships that extend well beyond the main mission of hospitals come in all flavors. Some hospitals employ hospitalists, primary-care doctors who generally work within the hospital walls. Many hospitals have been signing contracts for services with groups of specialists.
Finally, Albany Medical Center and St. Peter’s Health Partners to the north occupy the last slots on HealthAlliance’s present potential dance card.
Various local specialty practices in the Hudson Valley have recently been affiliating with each other, with physician medical groups, and with hospital-owned entities such as the two Albany-area hospital systems.
Locally, Albany Medical last October announced an affiliation with EmUrgentCare, a Coxsackie and Saugerties provider of urgent care. The Albany Med Faculty Physician Group, a multi-specialty physician group which includes nearly 400 specialists and subspecialists, offers community-based specialty care. Other hospital-centered systems, including St. Peter’s, have similar relationships in the Hudson Valley.
Electronic records gateway
What we’ve seen so far from the hospitals is just the tip of the iceberg. With government encouragement, healthcare insurers and providers have been increasingly implementing systems that seek to replace the traditional pay-for-service model with paying for and rewarding evidence-based quality improvements. Though an important component, hospital change is only a small part of that overall picture.
Full adoption of electronic health records, a federal mandate in which the Hudson Valley has gained a national reputation for proficiency, is increasingly seen as an essential gateway to facilitating the transformation. Adoption has been progressing for several years. “The moving hand once having writ moves on,” writes Omar Khyayyam. “Nor all thy piety nor wit can lure it back to cancel half a line.”
The argument over whether the chosen path will succeed continues, of course. The nation has adopted a system of electronic health records, all right. But will that adoption lead to the predicted transformation? Or will it prove another burdensome government-imposed impediment?
The early returns are coming in. As it happens, this month a careful study involving more than 300 Hudson Valley medical practices and 140,000 local patients has reported important findings on those very questions.
We’ll explore those findings next week. But let me leave you with a hint. The answer seems not yet as clear as either proponents or opponents would like.