From Here To There: The Approval Process
By Kurt A. Barwis, FACHE, President & CEO
Volume 1, Issue 6
What has been going on “behind the scenes” now that the Connecticut Legislature and Governor Dannel Malloy have cleared the way for investor-owned Tenet Healthcare Corporation to acquire Bristol Hospital and hospitals in Waterbury, Manchester and Rockville?
First of all, we are pleased that the Legislature and the Governor have recognized the right of Bristol Hospital and other community hospitals to determine their own future. The acquisition by Tenet will provide Bristol Hospital with the financial, operational and clinical resources we need to continue providing high quality health care services to the Bristol community for years to come.
To give you a sense of the timeframe, it is likely to be sometime in the spring 2015 before the transaction is complete and all the regulatory approvals are in place for Bristol Hospital to officially become a member of Tenet.
Between now and then the regulatory approval process involves a series of steps that engage the public, several state agencies and ultimately the Attorney General for the state of Connecticut.
The process began on July 21 when Bristol Hospital, Tenet and Yale New Haven Health Services Corporation (a proposed 20 percent owner of the Hospital) filed a Certificate of Need Determination request with the Office of Health Care Access (“OHCA”), and the Attorney General.
Within 30 days of filing the Certificate of Need Determination request , Bristol Hospital is required to conduct a public hearing to explain the terms of the agreement with Tenet. The public hearing is scheduled to take place at 6 pm, Thursday, Aug. 14, in the Bristol Hospital Hughes Auditorium.
The next step involves Bristol Hospital, Tenet and Yale submitting a Certificate of Need (“CON”), application to OHCA and the Attorney General for review once the application form is provided to us.
We then have 60 days to file the application with OHCA and the Attorney General providing all of the information related to the terms of the acquisition. OHCA and the Attorney General have 120 days to review our application. During that timeframe OHCA and the Attorney General will conduct their own public hearing at which representatives of Bristol Hospital, Tenet and Yale will be asked to testify and answer questions.
By what criteria will OHCA and the Attorney General judge our application?
We will need to assure “continued access to high quality and affordable health care after accounting for any proposed change impacting hospital staffing.”
Tenet must make a commitment to provide health care to the uninsured and underinsured.
Other criteria include demonstrating a clear public need, the impact on financial strength of the health care system and improvement of quality, accessibility and cost effectiveness of health care delivery in the region.
OHCA and the Attorney General will review utilization of existing health care facilities and services in the region, and whether there is any duplication of existing services or facilities.
Additionally the new law requires that the transaction not negatively impact the diversity of health care providers and patient choice in the geographic region, and any consolidation resulting from the transaction will not adversely affect health care costs or accessibility to care.
Use of the proceeds of the sale of the Hospital to Tenet is also governed by state law and will be subject to review by OHCA and the Attorney General. The proceeds of the sale will be transferred to a new foundation not affiliated through corporate structure, governance or membership with Bristol Hospital, Tenet or Yale.
According to state law the new foundation is to use the proceeds of the sale for appropriate charitable health care purposes consistent with the Hospital’s original purpose, or for the support and promotion of health care generally in the affected community or, with respect to donor restricted assets, consistent with the intent of the donor.
These are high standards to be sure, but I am confident that Bristol Hospital, Tenet and Yale will demonstrate that our affiliation meets all the requirements, and we will prove that this application is “Best for Bristol.”
From Skeptic to Supporter: Dr. Kenneth Benoit
By Kurt A. Barwis, FACHE, President & CEO
Volume 1, Issue 5
When retired surgeon Kenneth Benoit, MD, first learned of our plans to be acquired by an investor-owned health system, he was skeptical. In fact, Dr. Benoit says he “had a bias against it.”
But, as a member of the Bristol Hospital Board of Directors, Dr. Benoit applied his 30 years of medical experience to evaluating the potential impact of affiliating with a national health system. Now he regards the partnership of Yale-New Haven Hospital and Tenet Health “as the best of all worlds for Bristol Hospital, and I think the community will eventually see that as time goes on.”
What changed his mind?
As a vascular surgeon, Dr. Benoit has been on the front lines of the dramatic changes in health care in the last 40 years. Shortly after he joined Surgical Associates of Bristol in 1977, the three man group became one, and Dr. Benoit was a solo practitioner for a year. He recalls barely seeing his family for that year and promised his wife, he would find two surgical partners.
“We had a great run for 30 years,” he says of his partnership with Dr. Dan Scoppetta and Dr. Jim Sayre. All three of the surgeons took turns as chief of surgery and chief of staff at Bristol Hospital during their careers.
But when Dr. Benoit retired he already saw the difficult future for small physician groups. “Private practices are dying, and even big physician groups will become part of hospital foundations soon. It is just too difficult in this health care environment.”
During his due diligence visits to community hospitals owned by Vanguard Health Systems, and then Tenet Health, Dr. Benoit saw the same pressures on small hospitals were relieved by becoming part of investor-owned national health systems.
Dr. Benoit saw the benefits of investment in new technology, enhanced facilities, and advances in clinical care and service to the community at the hospitals he visited. But he wanted to know what the doctors thought.
He discovered, somewhat to his surprise, that the doctors told him “they were actually happier in their new situation. The hospitals had the technology and equipment they needed to help practice better quality medicine. Their morale seemed better.”
“I detected a better morale at all the community hospitals we visited. The doctors were content with their lifestyle and their practice of medicine. I did not get one complaint about any interference with the quality of their practice of medicine.”
By the end of the due diligence visits, Dr. Benoit was convinced.
“I started out with a bias against the for-profit health systems and I was completely sold at the end that it is the best thing for our community in Bristol.”
The People Who Make Bristol Hospital “Everyday Extraordinary”
By Kurt Barwis, FACHE, President & CEO
Volume 1, Issue 4
Who are some of the people who make “Everyday Extraordinary” at Bristol Hospital?
Physical therapist Mike Zinko, gastroenterologist Dr. Salam Zakko
, and nurses Stephanie Adkins, Lynn Gaski and Francine Leach come to my immediate attention for awards they received that honor their work at Bristol Hospital.
Last week as part of National Hospital Week, I saw the hospital week theme of “Compassion, Innovation and Dedication” representing the qualities of the people we recognize here for their work at Bristol Hospital.
Mike Zinko is our 2014 Employee of the Year. A physical therapist, Mike embodies our “Safety Starts with Me,” philosophy. He takes initiative and pride in his job and is well-respected among his colleagues. Patients compliment Mike for his compassion as he provides outstanding clinical outcomes.
A poster presentation by Dr. Zakko and his research team recently received national recognition, an Award of Distinction, at the Digestive Disease Week
conference in Chicago. Only 10 awards of distinction were issued among the more than 1,000 research projects presented from such centers as Harvard, Yale and Johns Hopkins. Dr. Zakko’s team from the Connecticut Gastroenterology Institute and Clinical Research Foundation
focused on how a breath test can predict the response of antibiotic therapy in patients with irritable bowel syndrome. We are proud of the research and innovation
being done at Bristol Hospital by Dr. Zakko.
During National Nursing Week three Bristol Hospital nurses, were recipients of the prestigious Nightingale Awards
for nursing excellence. Stephanie Adkins, Lynn Gaski and Francine Leach were recognized for their exemplary dedication
as nurses who have made a significant impact on patient care through the practice of nursing. The award highlights clinical practice leadership, scholarship, education and service to the community.
During National Nursing Home Week
, Therapeutic Recreation, Dietary and Social Services hosted a “Life Enrichment Event” at Ingraham Manor which showcased the hospitality and amenities enjoyed by the residents and their families.
Often we are called upon to advocate for the patients who rely upon us for care. During my visit to the Bristol Senior Center
more than 100 senior citizens told me of their concerns about Medicare rules
requiring the three-day stay for a patient to be covered post discharge in a skilled nursing or rehabilitation facility or hospital. This issue is being debated across the country, and all of us should support our seniors in contacting our elected representatives in Washington, Congressman John Larson
and U.S. Senators Richard Blumenthal
and Chris Murphy
With all that has been going on here at Bristol Hospital recently I also wanted to make sure you heard the exciting news that the Connecticut Legislature has cleared the way for our planned sale to Tenet Health
. Passage of the legislation awaits the signature of Governor Dannel Malloy and there are several other regulatory steps to be taken. We are excited to move ahead toward a sustainable future for Bristol Hospital and our community.
Bristol Should Have the Right to Determine its Health Care Future
By Kurt A. Barwis, FACHE, President & CEO
Volume 1, Issue 3
A significant issue has been overlooked in the discussions about the proposed Tenet Health acquisition of Bristol Hospital, and that is the right of the Bristol community to determine its own health care future.
Our Board of Directors, stewards of the Bristol community, unanimously endorsed an acquisition proposed by investor-owned Tenet Health. Our business community agrees. Jim Albert, president and CEO of the Central Connecticut Chamber of Commerce
, wrote a letter to Governor Dannel Malloy, stating that this partnership “is the best way to preserve the viability of Bristol Hospital.”
Bristol area legislators have championed the acquisition plans for Bristol Hospital.
Our decision is the result of a deliberative process that has taken years. Bristol Hospital did our due diligence, studying the impact of acquisition on other community hospitals across the country.
Meanwhile the Legislature faces a May 7 deadline on proposed bills that could dramatically affect the future of health care for all of Connecticut.
Let’s look at this issue another way. There are examples of for-profit companies seeking to enter, expand, or even just STAY in Connecticut.
Compare this to Tenet Health
, an investor-owned national health system with 77 hospitals coming to Connecticut to secure hospital care in four cities; Bristol, Manchester, Rockville and Waterbury. Each of these hospitals is a valued community asset, employing thousands of people all together.
Tenet Health is not asking for any state incentives; in fact, Tenet-owned hospitals would pay property taxes to the communities in which they are located.
Tenet, the third largest investor-owned health system in America, employs 59,000 people and in 2012 cared for four million patients.
At issue in the current session of the Legislature is a concern that acquisitions of community hospitals by for-profit health systems will reduce quality of care and eliminate jobs to make a profit.
Let me add a more recent study to the argument, endorsed by the Federation of American Hospitals and the American Hospital Association
that makes a compelling counter argument.
Noting that hospital mergers are reviewed by the federal government for potential antitrust impact, the study said the majority of mergers do not negatively affect competition.
Further, the report says “negative realignment effects often cite outdated data not reflective of today’s market.”
“Without realignment, patients and communities could face disruption and instability, hospital closures, and reduced access to care.”
It is time for us to let the Legislature know what we think of Bristol’s right to determine our own health care future.
We Care About Quality
By Kurt A. Barwis, FACHE, President & CEO
Volume 1, Issue 2
“What kind of care can we expect from a for-profit hospital? Won’t they skimp on quality just to make a buck for their shareholders?”
I hope I got your attention by acknowledging that we have heard this question numerous times as we work toward preparing Bristol Hospital for the future, either as part of another organization, or on our own in the evolving health care environment.
Guess what? We also asked this question about quality of care when we did our due diligence discussions and visits, first with Vanguard, and later with Tenet Health.
The people we care for at Bristol Hospital are members of our community. You are friends and neighbors, family, respected and valued partners. Our vision is to be recognized as the best community hospital health care provider in Connecticut.
So we would not align Bristol Hospital with any organization for any reason other than to provide the best health care possible.
And you know what? Bristol Hospital already has a strong record of providing quality care. Recent reports from the Connecticut Department of Health
verify that Bristol Hospital receives high marks for ability to prevent infections for central lines and urinary catheters. Bristol Hospital met the state standard of having no more than one infection
for these procedures.
We heard during recent community conversations that Bristol Hospital has come a long way in the past several years to improve quality and patient care. Members of the community have noticed and told us they can tell the difference.
How did that happen?
It started from the top. Our Board of Directors felt so strongly about patient safety that they committed the hospital to achieving Zero Preventable Harm. Our entire hospital staff became engaged on a “high reliability” effort.
Health care is complex, involving a multitude of hand offs and coordination of care for patients who may have multiple health complications. Using national best practices, we created additional structures, extra steps, and enhanced training in techniques to validate and verify every patient care initiative.
These are times that are requiring hospitals to adapt to lower reimbursement from Medicare and Medicaid, our commercial insurance payers, and we increasingly have to employ the best business-managed approach to caring for patients efficiently and effectively.
That means we are all about delivering the highest quality of care to patients “the first time.” In addition to quality being our mission, consider this fact. Two thirds of patients at Bristol Hospital are covered by Medicare or Medicaid which means first, that we are paid about 78 cents on the dollar for care.
Second, consider this, payments to hospitals under Medicare are verified by the federal Center for Medicare Services, CMS
. They don’t evaluate whether a hospital is for profit or not for profit. CMS is looking only at outcomes, meaning that we are paid based on the quality of care we provide the first time.
And isn’t that our mission anyway? To provide quality care to the people of Bristol.
Bringing You Timely Information About Bristol Hospital
By Kurt A. Barwis, FACHE, President & CEO
Volume 1, Issue 1
Something is missing in all the news out there about Bristol Hospital and Health Care Group
, and that is the opportunity for me to communicate in a timely manner, directly with you, our staff and physicians, and friends in the community.
That changes starting now.
Through this new blog, I will be keeping you up to date on what is going on at Bristol Hospital.
While the state legislature is in session over the next several weeks, you will be hearing a lot in the news and from me here of the progress with our proposed acquisition by Tenet Healthcare Group
and its exciting partnership with Yale New Haven Health System
But there is a great deal more happening at Bristol Hospital. Much of that news explains why Bristol Hospital is so attractive to a national hospital system willing to make a substantial investment in Bristol’s future.
Yes, Bristol Hospital is in its strongest position in years. But the future is not all that bright for community hospitals such as Bristol. The impact of the federal Affordable Care Act,
what you know as “Obamacare” will make hospitals financially and clinically responsible for the health of the communities they serve. Continued cuts to Medicare and Medicaid, increases to Connecticut’s “provider tax” on hospitals and even a proposed property tax on non-profit hospitals make it increasingly difficult financially for hospitals to serve the community.
Our board of directors, stewards of the community, have looked ahead to the future with us, and are taking strong, strategically focused actions to put Bristol Hospital in the best possible position to be a vital health resource for Bristol and the region for years to come.
The investments we have made in improving the Emergency Center,
expanding orthopedic capability,
opening the new Beekley Center for Breast Health and Wellness
demonstrate that Bristol Hospital is serious about our commitment to the highest quality health care.
We have observed the trends of other community hospitals merging with larger health systems in Connecticut. But we also looked further, to what is happening across the country, where hospital mergers and acquisitions are happening at a record pace.
Members of our board, our leadership team and physicians have conducted due diligence visits on Tenet Health hospitals across the country. We saw vibrantly sustained hospitals, playing important roles in improving the health of the communities they serve.
We saw hospitals emerge from bankruptcy such as the Detroit Medical Center, thanks to Tenet, saving thousands of jobs, and supporting community health initiatives.
We saw hospitals in Massachusetts, many in communities like Bristol, such as St. Vincent hospital in Worcester and Metro West in Framingham, where employees and physicians told us they felt a tremendous sense of engagement in their hospital mission.
We heard of Tenet’s support for quality patient care and service, and that new financial resources were made available to support investments in upgrading technology, and patient care facilities.
Keeping good access to local health care at a hospital you know and trust is why Bristol Hospital is engaged in this path at this time. Follow along with us and I will make sure you know the latest.