Crain's Cleveland article about Lakewood Hospital

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c. dawson
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Crain's Cleveland article about Lakewood Hospital

Postby c. dawson » Sun Jan 25, 2015 1:58 pm

Anything but healthy: Consultant says closing of Lakewood Hospital is the logical move
By TIMOTHY MAGAW
January 25, 2015 4:30 AM
REBECCA R. MARKOVITZ
Lakewood Hospital will close by 2016.
Out of date, half empty and bleeding money.

Those aren't exactly symptoms of a healthy hospital, but that's just what's happening at the 108-year-old Lakewood Hospital, the 233-bed facility owned by the densely populated West Side suburb and run by the Cleveland Clinic since 1997. In fact, hospital officials say it would have cost as much as $100 million just to keep the facility up to date until the Clinic's lease expired in 2026.

This month's news that the city would shutter the hospital by 2016 and sell a piece of the land on which it sits to the Clinic to build a $34 million family health center and emergency department came as a blow to many in the city who believe having a full-service hospital is a pillar of a strong community. However, the consultant that worked with Lakewood Hospital Association — the nonprofit governing body overseeing the hospital — stressed in an interview with Crain's that all alternatives were exhausted, and had the board taken no action, Lakewood may have been left with nothing.

“If you wait until the end and run the balance sheet all the way to zero, then you have no choice,” said Lisa Fry, a partner of Subsidium Healthcare, the Atlanta-based consulting group hired by the Lakewood Hospital Association in July 2013 to evaluate the future of health care in the city. “You end up with an empty building and not a whole lot of options, unfortunately.”

Aside from closing the facility, which hasn't turned a profit in a decade, the city considered finding a new partner. The board quietly solicited proposals from other local health systems, and despite some initial interest, there was no “firm alternative offer,” Fry said. The group even sought proposals from seven for-profit hospital systems — many of which have national footprints and seemingly specialize in scooping up struggling community hospitals.

Again, no one bit.

The conclusion? A hospital in Lakewood simply wasn't viable. On average last year, for example, only 54% of its beds were filled at any given time as more and more services were provided on an outpatient rather than inpatient basis.

“Our current model wasn't sustainable no matter who our partner was,” said Tom Gable, president of the Lakewood Hospital Association.

The Clinic's vision
The city and the Lakewood Hospital Association insist their soul-searching over the hospital's future wasn't at the Clinic's urging.

It also wasn't the Clinic's decision to ultimately close shop, and the opening of the new $143 million hospital in Avon wasn't Lakewood Hospital's death knell. The hospital's closure is only being tied to Avon's opening to ensure continuity for workers displaced by the closure and being offered jobs elsewhere in the Clinic system, particularly in Avon, according to interim Lakewood Hospital president Shannan Ritchie.

“The Avon and Lakewood decisions are separate, but they fit from an employee retention standpoint,” Ritchie said. “Whoever is going to be running Avon, they should know we have a great team of folks who are already a well-oiled machine we can plug in there. My commitment is to the employees.”

Moreover, Ritchie dispels any notion the Clinic drove Lakewood Hospital into the ground. Over the last several years, the Clinic's stripped some of its community hospitals of certain services — births, for example, are consolidated at the Clinic's Hillcrest and Fairview hospitals — to maximize efficiency throughout the organization. However, the Clinic had committed to grow certain service lines at the hospital, including rehab, ophthalmology, diabetes care and neurology. The size of the Clinic organization also helped the hospital save on some of its backend services.

“All of these together added up to us being much closer to break even, though we never jumped over that hump,” said Ritchie, who has led the hospital for two years and before that served as its chief operating officer. “We stabilized.”

The talking point as to why Lakewood Hospital is closing is that people just aren't being admitted. Procedures that used to require lengthy hospital stays require little to no extended stays after surgery. It's not a situation unique to Lakewood, as community hospitals across the country are grappling with the same issue and facing the steep financial problems that go along with lukewarm patient volumes.

Still, it's a tad curious as to why the Clinic is opening a new inpatient hospital — one with 126 beds, no less — if admissions are down across the region.

Clinic officials stress that the Avon foray is a response to the growing need for said services in Lorain County. The 190,000-square-foot Richard E. Jacobs Health Center — the facility on which the inpatient hospital is being built — has become the health system's busiest family health center and grown to average 42,000 patient visits each month. Moreover, food, laundry and other services at the hospital will be shared with the Clinic's other West Side outposts to save money.

“This is the first time we've built a hospital that's supported by the whole system,” Clinic chief of staff Dr. Brian Donley told Crain's late last year.

Lessons from Huron
Parallels have been drawn between Lakewood Hospital and East Cleveland's now-defunct Huron Hospital, which the Clinic shuttered about three years ago. The situation, of course, is different given the ownership structure of Lakewood Hospital, and the fact that Huron's closure was a health system decision, while Lakewood Hospital Association officials stress they were the deciders of the fate of their hospital.

In the wake of Huron's closure, the Clinic, too, opened an outpatient facility, the $25 million, 50,000-square-foot Stephanie Tubbs Jones Health Center — one that appears to be slightly smaller than the 62,000-square-foot outpost planned for Lakewood. When the Huron closure was announced, emotions ran high — the city of Cleveland even sued the Clinic, albeit unsuccessfully, to keep it open — and there was some skepticism the outpatient facility wouldn't meet the community's needs.

That couldn't be further from the case, according to Dr. Nana Kobaivanova, medical director for the Stephanie Tubbs Health Center, who spent 13 years with Huron Hospital before taking on her current role.

Kobaivanova, who admits the community was wary of shutting the hospital, said the health center saw more than 46,000 patients in 2014 — a 19% increase over its first year of operations in 2011. Most importantly, she said almost 40% of those visits were for primary care. She said a strong primary care presence, which the health center provides, was needed in a community that been overly reliant on the emergency room for standard medical care.

“The community was uncertain about how their health care needs would be met,” she said. “We've gained that trust back, and we want it. We proved to the community that we will bring the best medical care the Clinic provides everywhere to East Cleveland.”

Lakewood's task
From a health care standpoint, Lakewood believes its bases are covered with the new health center and its proximity to the Clinic's other outposts — Fairview Hospital near Kamm's Corners and Lutheran Hospital in Ohio City, specifically. City and Clinic officials will meet with residents at 7 p.m. this Wednesday, Jan. 28, at the Beck Center on Detroit Avenue to field questions about the closure and to get feedback about what services should be included at the new facility.

“When you compare it to the uproar with (Huron Hospital), people are beginning to understand that health care is being delivered in a different manner,” said Bill Ryan, president of the Center for Health Affairs, a local health care advocacy group. “That different manner is beneficial to the communities.”

How the city will make up for lost revenue isn't quite as certain, though 4 acres of freed-up land available for development from the hospital's demolition appear to be key.

In 2017, the city expects it will lose about $1.5 million in revenue that now comes from the lease and payroll taxes, though the Clinic will purchase a Lakewood Hospital-owned office building in Westlake for $8.2 million to offset those losses, or as Lakewood Mayor Mike Summers characterized it in a recent conference, to serve as “a buffer to help us get from the old to the new.” Plus, the Clinic plans to ask the city of Avon to provide Lakewood a cut of the payroll tax revenue generated by the new hospital.

But at day's end, health care observers say a money-losing hospital isn't good for the local economy or the health of the community.

“What is very important for everybody in Lakewood is that their health care costs are contained,” said Ned Hill, dean of the Levin College of Urban Affairs at Cleveland State University and a Lakewood resident. “If this is part of the burden, so be it.”


Grace O'Malley
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Re: Crain's Cleveland article about Lakewood Hospital

Postby Grace O'Malley » Sun Jan 25, 2015 2:21 pm

If Ned Hill thinks it's a good idea then I definitely know it's not. If I recall, he wrote a blathering essay in the Pee Dee claiming that Lakewood would immediately turn into a ghetto with burned out buildings if the West End development wasn't built. For someone who has spent his entire life "studying" cities and hen making proclamations, I've yet to see him make one suggestion that actually helped improve the health of the urban area.

That Crain article had a lot of doublespeak in it. Read it carefully.


Tim Liston
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Re: Crain's Cleveland article about Lakewood Hospital

Postby Tim Liston » Sun Jan 25, 2015 2:29 pm

I'm not horribly upset about losing hospital beds in Lakewood. Hospital care has changed a lot in my lifetime. When I had my tonsils removed, I spent two nights in the hospital. Now it's a relatively simple outpatient procedure. When I was born, my mom spent three nights in the hospital. When my daughters were born, my wife and newborn spent one night in the hospital. Acute care has become more specialized and exacting (and geriatric?) and I suspect that there are benefits to centralizing such care. Can every "community" hospital have an ICU? Besides, the couple of encounters I had with Lakewood Hospital, with my now-deceased mom, left me really unimpressed.

What concerns me more, and what should concern all of us, is what gets left behind. Without digging in, I can't say how best we can go about that. It would really depend most I think on enforcing whatever operating agreement was put in place when the Clinic took over the operation of the Hospital back in the 90's. It's one thing to lease the property, it's another thing to pinky-swear that you will provide certain services come hell-or-high-water for the duration of the lease. I suspect that the non-Clinic parties (e.g. the City) are not in a very good bargaining position, but I have no idea what the operating agreement, if there was one, said. If there was not a strong operating agreement, then we are SOL and pretty much have to take what the parties are inclined to offer.

All that said, the lack of transparency I think is really disheartening and dishonorable. CCF is a not-for-profit concern, based on their ostensible obligation to provide care widely throughout all communities regardless of economic circumstance. I believe they are failing to live up to that obligation. I honestly don't understand why the profits that the CCF obviously makes are transferred from the taxpayers, the insured and those who need health care but who are less able to pay, to those who work for the Clinic.


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Jim O'Bryan
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Re: Crain's Cleveland article about Lakewood Hospital

Postby Jim O'Bryan » Sun Jan 25, 2015 2:49 pm

"The Clinic's vision
The city and the Lakewood Hospital Association insist their soul-searching over the hospital's future wasn't at the Clinic's urging.

It also wasn't the Clinic's decision to ultimately close shop, and the opening of the new $143 million hospital in Avon wasn't Lakewood Hospital's death knell. "

Again, hate to mention this.

But this was not at the Cleveland Clinic's urging? hmmmmmm

The group doing the soul searching ends up with over $100 million to play with? hmmmmm

.

.


Jim O'Bryan
Lakewood Resident

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If not, don't worry. Just forget about it."
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Bill Call
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Re: Crain's Cleveland article about Lakewood Hospital

Postby Bill Call » Tue Jan 27, 2015 10:47 am

c. dawson wrote:It also wasn't the Clinic's decision to ultimately close shop, and the opening of the new $143 million hospital in Avon wasn't Lakewood Hospital's death knell. The hospital's closure is only being tied to Avon's opening to ensure continuity for workers displaced by the closure and being offered jobs elsewhere in the Clinic system, particularly in Avon, according to interim Lakewood Hospital president Shannan Ritchie.



Thanks for the article. It's a nice summary of the official position.

There are sound financial and logistical reasons for the Clinic to move its facilities out of Cuyahoga County. Lakewood Hospital won't be the last to be closed down.

However, I'm not buying the official line that the Avon facility had nothing to do with the closing of Lakewood Hospital.

Why transfer Lakewood doctors to Avon?
Why transfer whole departments to Avon?

A lot of people from Westlake, Rocky River, Avon and Avon Lake used Lakewood Hospital. They will now be going to Avon as will many Lakewood residents.

Lakewood Hospital was not a money loser. Yes, after depreciation and interest it had a small loss but how much of that loss was due to the Clinics neglect?

The Clinic official in the article states that

“All of these together added up to us being much closer to break even, though we never jumped over that hump,” said Ritchie, who has led the hospital for two years and before that served as its chief operating officer. “We stabilized.”


The Clinic is telling us that they are willing to invest $120 million in Lakewood. (That's a lie but I digress.)

What if they invested that in the Hospital? What if they did not transfer entire departments to Avon? Would Lakewood Hospital have started to make money?

At the very lease the City of Lakewood should be getting a facility more like what they have in Brunswick.

http://my.clevelandclinic.org/locations ... swick-fhsc

It will never happen because the Clinics new Avon facility needs Lakewood's business.

The real crime here is that City officials and Hospital Trustees have no interest in defending the interests of the people of Lakewood.


Mark Crnolatas
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Re: Crain's Cleveland article about Lakewood Hospital

Postby Mark Crnolatas » Tue Jan 27, 2015 11:40 am

Ok. Will someone summarize this entire matter for me. It must be my age. :roll:


After the dust clears ...will Lakewood have a stand-alone Emergency Room type of thing like many little townships in the U.S., and if the patient condition is more serious than a "patch-em-up" or the need for immediate ICU care... the person will be transported via helicopter or EMS truck to a full functioning hospital? Example: Persons involved in a serious car vs. tractor-trailer collision, for example.

OR...The WHOLE of what is now Lakewood Hospital will become a parking lot (so to speak) and OUR EMS will take emergencies to "other hospitals" ?? :shock:

Mark A. Crnolatas Sr.
In God I trust, All others pay cash.


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Jim O'Bryan
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Re: Crain's Cleveland article about Lakewood Hospital

Postby Jim O'Bryan » Tue Jan 27, 2015 12:56 pm

Bill

I think much of the confusion is do to the hundreds of threads.

Things to remember...

A year before Fairview was purchased, the Clinic approached Lakewood about building a $60
million dollars facility in Lakewood, and were turned down. A year later Fairview is announced.

The Clinic is spending $10 million on the entire deal, not all in Lakewood, and where the
money goes outside of Lakewood depends on who owns the property on Columbia Road.

No matter, they are spending $120 million I do not see where that is up for dispute except
in some of the maybe numbers which are not part of the $120 total

Again, I know you hate to read this but, the Clinic has issued no lies, false reports or
anything that would take away from the facts. The only thing they commented on was the
hospital not making money. Well there are two ways hospitals report "profits." The most
common way, and I have no idea why, is without Medicaid payments figured in. When
you figure them in the Hospital is making money, but barely compared to other Clinic hospitals.

The Cleveland Clinic is reacting to a conversation started by the City, not working on
"their plan to put Lakewood Hospital out of business." They have said they were prepared
to continue on, and as they have yet to lie about anything else, I am willing to give them
the benefit of the doubt on this.

On the flipside we have a select small group bragging about the coup and landfall of money
as far back as 1.5 years ago. We also have City Council passing a blanket executive session
over all of the conversations going back 2.5 years.

One might ask, do we want to force a hospital to go back on what they have done? Or is
it like sending food back to a kitchen to be done right?

One side, the evil giant has been honest about everything including the Avon Facility since
1995. The City on the other hand has conspired to work in secret, getting rid of a
community owned facility for a handful of magic beans to be planted by friends of the
mayor! I hate to put it that way, and I hate to think what went into this sausage, but
let's make sure we get it right.

FWIW

.


Jim O'Bryan
Lakewood Resident

"The very act of observing disturbs the system."
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Re: Crain's Cleveland article about Lakewood Hospital

Postby Bill Call » Tue Jan 27, 2015 1:03 pm

OK fine.

Clinic officials have made a lot of public comments about the hospital. Please provide some quotes from those officials where they state they wanted to keep the hospital open but Mayor Summers wanted it closed.


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Re: Crain's Cleveland article about Lakewood Hospital

Postby Corey Rossen » Tue Jan 27, 2015 1:21 pm

Does anyone locally affiliated with the hospital have anything to say about the situation? I would hope with such deep roots in Lakewood there might be a hometown response from within.

http://www.lakewoodobserver.com/read/20 ... -president


Corey Rossen

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Bill Call
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Re: Crain's Cleveland article about Lakewood Hospital

Postby Bill Call » Tue Jan 27, 2015 2:13 pm

Corey Rossen wrote:Does anyone locally affiliated with the hospital have anything to say about the situation? I would hope with such deep roots in Lakewood there might be a hometown response from within.




According to Jim O'Bryan the trustees and the City waged a campaign to destroy Lakewood Hospital to loot its treasury and the heroic Cleveland Clinic fought tooth and nail to keep it open but finally gave up and moved to Avon.

The other theory is that the Clinic is determined to move its operations to regions along major freeways just outside of Cuyahoga County and to facilitate that plan it relocates doctors and services to it's outlying regions and closes its facilities in Cuyahoga County.

I guess I wouldn't rule out treachery on the part of elected officials. However, it seems like a complex plan spanning multiple administrations. Are they really that clever? Is anyone that clever?

It seems pretty unlikely that what I think are decent people would engage in that kind of subterfuge. On the other hand it's not much of a stretch to think the Clinic wanted the hospital to fail because their business plan required it.


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Re: Crain's Cleveland article about Lakewood Hospital

Postby Jim O'Bryan » Tue Jan 27, 2015 2:22 pm

Bill Call wrote:OK fine.

Clinic officials have made a lot of public comments about the hospital. Please provide some quotes from those officials where they state they wanted to keep the hospital open but Mayor Summers wanted it closed.


The Crain communication article. "The Clinic's vision The city and the Lakewood Hospital
Association insist their soul-searching over the hospital's future wasn't at the Clinic's urging."

The only way I can read that is, the Clinic was prepared to continue on, and the City new it.

Bill, if City Hall had waited 13 years to figure out what to do next they would have been
negligent. If City Hall waited for the Clinic to leave they would have been negligent. But
in doing that how did they expedite the clinic leaving and why?

Bill, go to your wife, who you have a marriage contract with, and say, "Hey you have been
OK, but I think the future of marriage is changing, and I need to go try some things, like
that young, hot, athletic, future of wives over there.

Let me know what she says. :wink:

.


Jim O'Bryan
Lakewood Resident

"The very act of observing disturbs the system."
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"If anything I've said seems useful to you, I'm glad.
If not, don't worry. Just forget about it."
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Re: Crain's Cleveland article about Lakewood Hospital

Postby Jim O'Bryan » Tue Jan 27, 2015 2:50 pm

Corey Rossen wrote:Does anyone locally affiliated with the hospital have anything to say about the situation? I would hope with such deep roots in Lakewood there might be a hometown response from within.

http://www.lakewoodobserver.com/read/20 ... -president



Corey

Just Curious, I would ask the same of Bill or others, what is the best case outcome you
get out of this from where we are at right now. We have no time machine.

The deal from the Clinic is good for 90 days, from there who knows where it goes? The
deal right now is $120 mill with the Clinic spending about $40 mill on themselves. Eastlake
sued and got $20 million.

What do you think?

.


Jim O'Bryan
Lakewood Resident

"The very act of observing disturbs the system."
Werner Heisenberg

"If anything I've said seems useful to you, I'm glad.
If not, don't worry. Just forget about it."
His Holiness The Dalai Lama
Bill Call
Posts: 3215
Joined: Mon Jun 06, 2005 1:10 pm

Re: Crain's Cleveland article about Lakewood Hospital

Postby Bill Call » Tue Jan 27, 2015 3:03 pm

Jim O'Bryan wrote:
The Crain communication article. "The Clinic's vision The city and the Lakewood Hospital
Association insist their soul-searching over the hospital's future wasn't at the Clinic's urging."

The only way I can read that is, the Clinic was prepared to continue on, and the City new it.




That's worth thinking about. Can it be it really is all about looting the treasury? My words not yours but that is the implication.

I guess it is possible someone at City Hall thinks some kind of "new development" is better than access to medical care and 1,100 jobs. I asked if anyone is that clever. Is the better question: Is anyone that stupid?

I can't think of one development project that would be worth the loss of a first class medical facility.

If they have such a grand idea why didn't they buy the Lakewood Center building when it went into foreclosure? I think if sold for under $5 million.


Corey Rossen
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Re: Crain's Cleveland article about Lakewood Hospital

Postby Corey Rossen » Wed Jan 28, 2015 8:19 am

Jim O'Bryan wrote:
Corey Rossen wrote:Does anyone locally affiliated with the hospital have anything to say about the situation? I would hope with such deep roots in Lakewood there might be a hometown response from within.

http://www.lakewoodobserver.com/read/20 ... -president



Corey

Just Curious, I would ask the same of Bill or others, what is the best case outcome you
get out of this from where we are at right now. We have no time machine.

The deal from the Clinic is good for 90 days, from there who knows where it goes? The
deal right now is $120 mill with the Clinic spending about $40 mill on themselves. Eastlake
sued and got $20 million.

What do you think?

.
Jim,

If the hospital is closing its doors and being torn down, and these plans are confirmed, then we need to move on in order to create the most amount of time to capture the best, next, thing - whatever that may be. Whether it is something that creates the most amount of jobs or something that the community wants/needs - that is yet to be decided.

If the hospital can be kept in town by winning a community fight, then I say we fight. If the plans to get rid of the hospital have been in the works for years, and everyone is in on it, then it is a hard fight to win. And who leads this fight? Community leaders are heads of Boards at the hospital, and I don't see them fighting.

It is hard to get accurate information when rumors fly so easily. Add a spin to each one and they are nearly impossible to pick apart. It makes it hard to believe anything that is in print, mentioned in the coffee shops or over a digital fence. Sure, if you wait long enough somethings will end with an "I told you so" but who has the patience for that?

I know that some powers that be in Lakewood do not voice their views over this fence, but maybe they would in an interview to be printed in the LO paper. These powerful people, that hold such authority and hometown awards, should be willing to speak about how their title and position in the community are benefitting the community. Just a thought.
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Corey Rossen

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