By Christopher Guadagnino, Ph.D.

Published March 1999

• React to this article in the Discussion Forum.

PND: Can you describe the proposal being considered at Germantown Hospital with regard to acute care beds?

EJ: There has been modeling of various scenarios that looks at the feasibility of moving the acute care beds that currently exist at Germantown onto the Albert Einstein Medical Center campus. The plan, if that decision would be made, would be to continue what’s being described as a vibrant Germantown campus which would include an emergency room, operating rooms and a short stay, 10 to 20 bed unit that could accommodate various types of diagnoses and patients on that campus. But more difficult cases—cases requiring more than two days and/or of high specialty nature—would be moved to the medical center.

PND: What would the time frame for this proposal be?

EJ: There hasn’t been a decision yet. It’s going to be, potentially, as early as this summer. I do not think that is going to be a sudden July 1 date. The decision is either, do you do it in the summer or do you give a more prolonged period of time to make sure everybody’s needs and wants are accommodated.

PND: What alternatives are there besides this proposal?

EJ: The other scenario is to continue the current make-up of beds at the Germantown campus and to put resources in to make it a viable campus. If the beds were moved, they are still, at least on the docket, dollars from the Albert Einstein Healthcare network that would be placed onto the Germantown campus that would improve the emergency room, improve the operating rooms, improve the medical office buildings, put a dialysis unit on site. That was part of the original merger agreement that took place back in the summer of 1997.

PND: Who made the proposal to move the acute care beds and for what reasons?

EJ: The proposal was put together by an administrative team that was composed of the CEO of Germantown Hospital, as well as financial people. It became apparent that the financial viability of the campus is really in question with the current beds and the current reimbursement. Our volumes have been diminished each year without any clear-cut sign that they are going to increase. The capacity of Einstein was there.

PND: What role did physicians play in this decision making process?

EJ: Early in the process the financial modeling was predominantly done by the financial people at both Germantown and the Albert Einstein network. Physician involvement, including myself and the president of the medical staff, late in the fall was then obtained to respond to and look at these various models. Right now the decision making will be made by the board of Germantown Hospital, which is composed of three physicians as well as approximately 35-40 former members of the original Germantown board.

PND: What is the level of physician support for this proposal?

EJ: As you might guess, physicians are not overly supportive of a concept that would move the acute care beds. Their ability to practice, their ability to maintain and follow their own patients and take care of their patients is a concern. There was a general medical staff meeting in the middle of January where the medical staff came out in their largest numbers in a number of years to express very objective but passionate concern about whether the proposals were viable or not. The consensus is a concern over losing patients.

PND: Could you elaborate on physician concerns about the proposal?

EJ: Losing their patients to another facility is a major concern. Will the patients buy into this? Does the medical center have the capability of absorbing the additional amount of workload: the emergency room, the hospital beds, out-patient services, etc.? Also, can Einstein deliver on the things that have been promised, for example, the emergency room at Germantown, the OR’s, the things that make that campus an access point. Many of them feel enough time wasn’t given to this process: a year and a half after a merger all of a sudden we’re talking about moving beds. The opportunity for Germantown to have within its continuum of care additional beds really hasn’t been given. But will their patients go there and will they have the ability to practice medicine on the Einstein Medical campus are what physicians’ two biggest concerns are.

PND: How are those concerns being addressed?

EJ: Many of the physicians are saying we’ve haven’t seen a whole lot. For example, an upgraded operating room suite has been talked about for a year and a half now. That has not gone into effect. I think what they need to see is that deliverable happen. Actually there’s been budgeted dollars to renovate the same-day surgery area and there is a committee that has been working for three or four months on what the configuration of the emergency room should look like. So all of those things are being addressed. What I’m saying is, they need to happen in order for the confidence of the physicians to be there.

PND: What about Germantown’s specialists? Won’t their medical practices be the most vulnerable to dislocation if acute care beds aren’t there anymore?

EJ: I’m a nephrologist and my partners have the same concern about that. Einstein, as opposed to a number of other medical centers, has an open medical staff to anyone who wants to use it. There have been discussions going on for a year and a half about merging the medical staffs anyway. The feeling of most people is that, as long as the primary care physicians and the patient flow comes to the medical center, then those traditional referral patterns would continue. So just get on staff at the medical center and you’ll continue to see the flow of patients.

PND: Wouldn’t physician oversupply be an issue there?

EJ: The market will drive that and traditional referral patterns don’t go away. So if the primaries at Germantown send their patients to Einstein, even if there’s four other options, they are going to continue to use their traditional referral base. If an nephrologist joins the Einstein staff, even if there are other pulmonologists and nephrologists, the primary care physician sends them to a specialist, not to pulmonary service or a kidney service. So an over-population of specialists doesn’t hit the individual primary care office.

PND: Could you articulate some of the concerns of patients over this proposal?

EJ: I think their biggest concern is their ability to get the type of care they’ve been getting in the environment they’ve been getting it. Germantown is a small community hospital with an inner-city population. The patients at Germantown have been getting the ease of access, availability and timeliness that goes with a community hospital. Albert Einstein Medical Center is a tertiary medical center and therefore it’s incumbent that you know you don’t get that same family atmosphere that you have at a place like Germantown. There have not been concerns at all from the patients’ point of view, or anyone else, about the quality of care. There is some reluctance on patients’ part, and it’s a major concern of the physicians, as to whether patients will go to a big medical center, or would they rather continue to go to a community hospital. There is this "barrier of Broad St." that everybody talks about: are patients going to want to cross Broad St. to get to the medical center, or will they go to other community hospitals, be it Chestnut Hill or Roxborough or Jeannes?

PND: How will these patient concerns be addressed if the proposal is enacted?

EJ: There has been and will be continued dialogue between physicians and their patients about the ability to give that community hospital-like atmosphere at the medical center. There have been some discussions of populating, say, a given floor of the medical center so you continue to have that culture that gets translated. There’s been some discussions of marketing efforts to patients to insure that their needs will be met in a larger medical center. Patient access was addressed in a number of areas. For specific diagnoses like dehydration and even some surgical procedures, the patients still would be coming back to Germantown. Physicians will be clearly notifying patients how they would get to and where they need to go at the medical center.

The ability to move patients via ambulance is pretty easy and we already have on the docket agreements with ambulances services to be able to easily do that transporting.

Seventy-five percent of the admissions to Germantown Hospital come through the emergency room right now. So the major access point at Germantown is the emergency room. And the feeling is that, if the emergency room gets renovated and built up appropriately, then that would continue to be a major access point for the community.