Columbia Memorial Health (1) Careers

EDITORIAL: Hospitals get hitched

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COLUMBIA MEMORIAL HEALTH and Albany Medical Center officially got married last week–kind of. The new couple celebrated with that most intimate of ceremonies, a telephone conference call.

The public hardly noticed.

There was a more profound aspect to the nuptials, because the boards of the two institutions could, for the first time since their plans for medical matrimony were announced more than a year ago, meet in the same room at the same time and… get to know each other. We wish them and the patients they serve happiness and a long life together. And yet plenty forces at work today could make it a rocky relationship.It was not a marriage of equals. Albany Med, a billion-dollar annual operation, has about four times as many beds as Columbia Memorial. Albany Med also has Albany Medical College, dozens of specialty practices and a separate affiliation agreement in progress with the Saratoga hospital. And while both Albany Med and CMH have been careful not to describe this as a merger or an acquisition, Albany Med now has effective control over the budget, capital spending and the management of CMH. All this was made public long before last week’s announcement.

Despite the understandably lopsided arrangement, CMH remains a separate and distinct entity, with responsibility for day-to-day management of its operations and the thrust of its longer term planning. Its board will remain predominantly local.

The qualifier is that two members of the Albany Med board will sit on the CMH board and CMH gets two seats on the Albany Med board. That will enhance board-to-board communications. But until last week it was illegal, because until they affiliated the two hospitals were considered competitors.

Government regulators frown when competitors cooperate. It smells like price fixing.

Even with that anti-competition hurdle removed, CMH and Albany Med face daunting changes in their industry. Big hospitals have traditionally been centers of care as well as primary sources of revenue. But new trends have emerged. The delivery of healthcare is quickly dispersing to smaller facilities located where the people are. CMH officials proudly point to the popularity of their Rapid Care outpatient clinic and satellite lab in a Valatie shopping plaza. And CMH is now constructing a new Rapid Care center in Copake. If anything, the affiliation appears to ensure that those two projects will be fully staffed; possibly there will be other new Rapid Care facilities. Who knows?

CMH President and CEO Jay Cahalan said flatly in the teleconference that there will be no layoffs as a result of the affiliation, and there’s no reason to doubt his sincerity. But healthcare is in flux and the state is just now embarking on a major program designed to improve the quality and coordination of healthcare in the greater Capital Region. There could well be shifts in where healthcare funding goes and what sorts of jobs are created and eliminated. But any employment realignments won’t be the result of the CMH-Albany Med affiliation. It’s also likely that the affiliation will provide CMH employees expanded opportunities to adjust to the changes that must inevitably come.

On the downside, there’s the possibility that the whole healthcare system could be thrown into chaos following this fall’s election if Congress and the next president make good on the GOP’s promise to repeal Obamacare. That could leave millions of people nationwide and thousands in this region without healthcare insurance and create unprecedented financial uncertainty for hospitals large and small. There’s no way to predict how such a reckless act would impact CMH, but it’s fair to assume that having an affiliation with Albany Med leaves CMH and the people of this county better prepared for any disruptions in funding–better than if CMH were standing alone.

On a positive note it’s got to be a good influence on CMH caregivers to know the public will expect them to meet the standards of care associated with Albany Med. It’s not exactly clear how that will play out in service to the public, but AMC is a major regional medical center with an academic medical sciences component. That matters to caregivers practicing here now and to others who might want to live and work in this special place.

In healthcare as in most other fields, bigger isn’t necessarily better. But the status quo was never an option. There will be rough spots in this affiliation, but considering the alternatives, it’s a good deal.

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