Tag Archives: Hospital mergers

Province needs to look at evidence around hospital mergers

Murray Martin should change his name to Dr. Doom.

Now in retirement, the former CEO of Hamilton Health Sciences is full of swagger about tough choices for health care, suggesting rising interest rates would pressure the government into making big cuts if they don’t make significant adjustments now.

Never mind that the Bank of Canada’s benchmark interest rate of 1 per cent has not budged since 2010. Changing interest rates also take considerable time to work through the system before they impact the rate the government pays on its bond debt. It’s not like the sky is about to fall.

Speaking at a Longwood’s speaker series earlier this week, the Toronto Star reports Martin as promoting BC’s approach – “we are going to make this change, you’ve got three options and if you don’t like any of them that’s too bad.”

Whatever happened to evidence-based decision-making?

Martin wildly believes the province should force more hospital mergers to find savings — this just days after the Scarborough-Rouge Valley hospital merger came to a screeching halt over the high cost of such a merger.

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Price too high for Scarborough-Rouge hospitals to sustain merger plan

In the end the price was too much.

The merger between the Scarborough and Rouge Valley hospitals appears to be sidelined after months of intense activity including unprecedented community consultation.

March 15 The Scarborough Hospital board passed a resolution that abandons the amalgamation “effective immediately,” although provides faint hope that the province will reconsider merger conditions set by the two hospitals, including funding for one-time costs.

Those costs are substantial – the two hospitals would be looking for about $30 million in one-time basic merger costs and an additional $5 million annually for salary adjustments. The province did ante up $3 million.

The two hospitals were also looking for more than $2 billion in new buildings to replace aging infrastructure and to double the size of the Ajax-Pickering hospital.

That’s a steep price when hospitals are likely to enter their fifth year with base funding either frozen or well below real costs. That funding restraint includes two years of zeros and counting.

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Scarborough-Rouge merger comes with costly conditions

The merger of The Scarborough Hospital (TSH) with the Rouge Valley Health System (RVHS) will not come cheap. Last night the hospital boards approved the idea of merger but only under very specific and costly conditions.

Nor will the merger necessarily stem the tide of cuts The Scarborough Hospital has been experiencing. At last night’s special meeting of the TSH board, CEO Robert Biron was asked whether continuing cuts would be seen as a failure of the merger?

Biron said funding constraint is part of the government’s transformation agenda and that merged or not, the hospitals would have to navigate it anyway. He told the board that together they were more likely to minimize the impact of such restraint.

Given an estimated $29.5 million in one-time fixed costs around the merger plus a wage harmonization bill of $5.4 million, these costs are likely to be held up against the loss of any services the merged hospital decides to shed in the future. There is still resentment over the loss of $17 million worth of services earlier this year to balance TSH’s budget.

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Scarborough-Rouge Merger: Some potential questions for tonight’s tele-town hall

Tonight The Scarborough Hospital and Rouge Valley Health System are having their second public telephone town hall to discuss the benefits and risks of a merger.

The first town hall on September 24 attracted more than 8,000 participants.

The irony of this process is that it has provided incredible amounts of information but many have still come away feeling that they don’t have enough detail to make a decision to support or reject merger.

Scarborough CEO Robert Biron says there is no hidden agenda.

He is right. What we have are two large urban hospitals that are under similar pressures to 149 other hospital corporations in Ontario due to the province’s decision to freeze hospital funding at least until 2018.

Most, however, have decided not to examine formal merger to deal with the funding freeze as have these two hospitals.

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Scarborough-Rouge: Merger process open, if not entirely perfect

After a lengthy period where hospitals appeared to be more interested in regional cooperation than formal mergers, the trend appears to be shifting again.

The financially stressed Scarborough Hospital has been looking for a dance partner for some time, initially proposing merger with Toronto East General Hospital. When that initiative spectacularly fell apart, the Central East LHIN directed the hospital to look closer to home at the Rouge Valley Health System which maintains a hospital on the eastern part of Scarborough and another in Ajax.

Our initial thoughts were that a formal merger would be very unlikely. After crawling out of their own significant financial difficulties, Rouge has been running surpluses for several years. It has also had to contend with rapidly growing demand on the Ajax side – the eastern GTA among the fastest growing regions in the province. Would they really want to take on new financial challenges that a merger with Scarborough would bring?

Both Rouge and Scarborough have been bruised by past battles with their communities over changes to clinical services. OPSEU even took the Central East LHIN to judicial review in 2008 over the secretive nature of its decision-making process when Rouge failed to consult on changes to its mental health services.

During those earlier battles Rouge Valley admitted to the Durham Regional Council that community opposition to their plans had made a dent in the ability of their foundation to raise money. Durham Region at that point had been considering withholding contributions (it didn’t).

Things have certainly changed.

The process at this stage appears to be an open one and perhaps even a partial model for other hospitals considering merger. A web site has been set up including an on-line survey. 16 community town halls are taking place. Staff town hall meetings are even being shared on YouTube by Rouge Valley. Staff who cannot attend the town halls are being invited to communicate during “huddles” in patient areas. Three tele-town hall meetings are being planned for September and October. Fifteen working groups have been set up between the two hospitals – 11 for front line clinical services and four looking at back office functions. The discussions from these groups are being shared in on-line workbooks that the public and staff can further contribute to.

The problem at this point is that everything is very vague – as one would expect early in the process. There are few concrete proposals to react to, and the hospital has suggested that many decisions may not even happen until a merger has already taken place and a new board appointed — including which services get offloaded to community-based providers. That may not satisfy those worried about loss of jobs, services and relocation of clinical care. Before a final recommendation is made, staff and the community should have an opportunity to look and respond to the proposed detailed plan. The hospitals have promised that the community will have an opportunity to respond should a recommendation come forward for merger.

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Plan to radically remake Windsor hospitals

The Windsor Star suggests today that the city is likely to be reduced to one acute care hospital. Hotel Dieu and Windsor Regional have agreed to a partnership that will see all acute services delivered from the Regional. Hotel Dieu would be reduced to the status of an urgent care centre and primarily work on outpatient services. There will be no inpatient beds.

Hotel-Dieu will manage all non-acute programs and services currently offered by Windsor at its west-side Tayfour campus according to the newspaper.

It is interesting that the hospital is quick to note that this is not a hospital merger.

Eventually the two hospitals will be replaced by a large mega hospital. No worries about money when it comes to bricks and mortar. In Ontario this appears to be a bottomless supply.

Details of the proposal have been already sent to the LHIN and the province, which makes us question where the public fits into this scenario? Aren’t integration proposals supposed to show evidence of stakeholder consultation first? Yet clearly this announcement is coming as a big surprise.

LHIN warns merger of two Toronto hospitals could undermine access and quality

As The Scarborough Hospital (TSH) openly advocates for a merger with the Toronto East General, CEO Dr. John Wright may have difficulty persuading the Central East Local Health Integration Network of the merits of bringing the two hospitals together.

In a preliminary report recently posted online, the Central East LHIN raises a number of concerns, including the fact that such a merger does not align with their clinical services plan.

The CE LHIN states there is no evidence that “this will improve quality or access,” suggesting that it may possibly undermine it.

The LHIN states that the current activity is not client-focused, lacks a clear engagement strategy, and has not garnered physician support.

They further state there is no evidence to suggest a merger would assist in addressing population health challenges within Scarborough.

The LHIN suggests that if TSH is interested in an alliance, that it would make more sense to look towards “integration” with the Scarborough Centenary Hospital, which is part of the Rouge Valley Health System.

This is not the first time that suggestion has been made. Community groups in Ajax, who have never been happy having their hospital linked to Scarborough Centenary, have long advocated that Centenary should join TSH, leaving the Ajax-Pickering Hospital to link to Durham’s Lakeridge Health.

No application has yet been made by the two hospitals to proceed with a formal merger.

CEO says he wants to increase power base through Toronto hospital mergers

After all the talk about system integration it’s notable that the CEO of a Ontario public hospital should argue for a merger on the basis of enhancing the institution’s power base.

This hardly strikes us as being in sync with the present evidence-based narratives emerging from the Drummond Report or the Minister of Health’s new action plan. Isn’t health planning supposed to be about providing care in the right place at the right time by most appropriate provider? The “power” scenario suggests the province may be making decisions on a different basis.

It is even more surprising given one of the two potential dance partners in the merger is Rob Devitt, CEO of the Toronto East General Hospital.

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Musyj calls for hospital mergers despite lack of supporting evidence

Windsor Regional Hospital CEO David Musyj is suggesting the best way to bend the health care cost curve is to amalgamate his hospital with Windsor Hotel Dieu Hospital.

As usual, Musyj lacks any evidence to support his suggestion, made before an audience of Rotarians in that city.

He may instead want to look at the independent Canadian Health Services Research Foundation web site, which says there is no evidence that such mergers save money.

“While the intuitive appeal of ‘bigger is better’ in hospital mergers is powerful, it’s clear the empirical evidence is weak and the potential for negative outcomes significant,” the Research Foundation states.

The Foundation warns that mergers are particularly difficult on staff morale, which has a direct impact on the quality of patient care.

They also note that mergers can disrupt services and absorb more management attention during a transition period, also affecting patient care.

The Windsor Star notes that the merger may be a tough sell given the last such merger cost the region two hospital sites and beds.

When mergers do occur, senior management usually go cap in hand to their boards, asking for more compensation to deal with the greater responsibility they now face.

Other money saving ideas Musyj gave the Rotarians include cuts to outpatient services and charging patients a fee for emergency room visits – the latter a clear violation of the Canada Health Act.

Musyj said Ontario needed a Royal Commission to look at the way the province delivers health services.

He also defended the LHINs, suggesting moving administrative offices to London or Toronto would not be in the best interests of his community.