In The News › Stephanie Grace: Hospitals’ politics have long tradition

Nov 10, 2013

Source: The Advocate

Filed under: Contracting, Hospitals, Jefferson Parish

Stephanie Grace: Hospitals’ politics have long tradition

By Stephanie Grace

The Advocate

November 10, 2013

Once upon a time, the leaders of East Jefferson General Hospital, West Jefferson Medical Center and Ochsner Foundation Hospital got together to talk about merging the three independently run nonprofits into one giant health care behemoth.

The arguments officials made would sound familiar to anyone following the current debate over the future of Jefferson’s two community hospitals, East Jeff and West Jeff. In the face of changing health care economics, the theory went, hospitals needed to join larger systems to achieve efficiencies, negotiate favorable contracts with insurance companies and offer a full range of patient care. If they remained islands, the argument went, independent hospitals would inevitably be swamped.

That was 1995, and the idea went nowhere. Just a couple of months after it was floated, West Jeff leaders walked, and negotiations collapsed.

It wasn’t long before all three hospitals were back at the table. This time the group was broader and the ambition somewhat more limited. National for-profit chains, principally HCA and Tenet, were gobbling up local hospitals and setting up regional networks. The area’s eight major remaining independent nonprofits, a group that included not just East Jeff, West Jeff and Ochsner, but also Children’s Hospital and Touro, explored building a formal alliance that would enable the nonprofits to compete, but also leave each institution’s identity intact. By mid-1996, that idea, too, was dead. First to pull out this time was East Jeff.

So taking the long view, the fact that the two public hospitals again can’t agree on a joint future, this time a combined 30-year lease to either HCA, Children’s or Ochsner, shouldn’t surprise anyone. The two sides are at odds, with West Jeff officials pushing to send both to Children’s, and East Jeff so strongly favoring HCA. Board members there are willing to cut their own deal with or without West Jeff.

Sure, the landscape has changed. Locally, Tenet blew out of town after Hurricane Katrina, leaving a void largely filled by Ochsner, which now runs several of its former outposts. Children’s is a bigger player as well, with Touro and the giant new state teaching hospital in its portfolio. Nationally, the driving force behind change is no longer the spread of HMOs but the mass economic disruption driven by technology, the Affordable Care Act and a movement to rethink the health care system’s overall approach to patient care. Yet in Jefferson, something fundamental has stayed the same and continues to pull the two public hospitals apart. It’s hard to describe exactly what that is, but call it some combination of emotional loyalty, political turf-consciousness, divergent corporate and organizational structures and probably even different demographics.

At first, it looked as if things would be different this time. At the outset of the current drive, parish officials and the two hospital boards appeared sufficiently alarmed by the hospital’s financial prospects that they were ready to put their differences aside. One sign of how seriously parish officials took this was that they lobbied the Legislature to revoke a law mandating a public vote on a lease and overturned a parish ordinance to the same effect — a potentially risky stance for any politician to take.

Both boards, as well as the parish council, also originally agreed to abide by the terms of a secret joint board vote — again, an initial sign that they were prepared to take action.

We all know what happened next. The East Jeff and West Jeff boards deadlocked, the parish council moved in, and the jockeying, maneuvering and accusing began. What began as an overly secretive process has devolved into a public fight over the merits of the two preferred finalists, the benefits of nonprofit versus for-profit operators, the role of the $1.3 million consultant, even the behavior of the people involved. In one blistering exchange, HCA officials complained that Council Chairman Chris Roberts, who supports leasing both hospitals to Children’s, had attacked the company’s corporate integrity. Roberts accused the company of attempting to intimidate a public official and asked District Attorney Paul Connick to intervene. So much for the serious approach.

Last week, the watchdog group Bureau of Governmental Research issued a harsh report declaring the process “overly subjective,” and chalking up problems to the lack of an objective contracting process that identified the most important factors, used a formula to measure those criteria and gave each contestant a final score.

The resulting “disarray,” as BGR put it, looks all too familiar. Once more, the hospitals have pulled apart, rather than finally putting their long-standing issues aside and coming together.

Nov 10, 2013

Source: The Advocate

Filed under: Contracting, Hospitals, Jefferson Parish

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