The Road Not Taken

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Stan Austin
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Re: The Road Not Taken

Postby Stan Austin » Thu Nov 29, 2018 3:40 pm

Mark- thanks for the response. But, I am still curious (all the actors in this are my contemporaries) as to what and when the light bulb went off and directed them to take the wrong fork in the road. Stan


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Re: The Road Not Taken

Postby Stan Austin » Thu Nov 29, 2018 3:45 pm

A Mayor taking a dagger into the throat of the City? Pardon the language but that is one sick mother fucking motive.






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Re: The Road Not Taken

Postby Stan Austin » Thu Nov 29, 2018 3:45 pm

A Mayor taking a dagger into the throat of the City? Pardon the language but that is one sick mother fucking motive.






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Mark Kindt
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Re: The Road Not Taken

Postby Mark Kindt » Sat Dec 01, 2018 10:35 am

Was It Truly Realistic To Save Lakewood Hospital?

Was it financially realistic to upgrade, improve, and right-size Lakewood Hospital for the future?

There are two points of evidence on this in the public record that makes this a viable option.

1. "Lakewood community has a sufficient population base to support an inpatient hospital with a modest number of beds." (Huron, August 2015, p. 71)

2. Metro Health System proposed to invest $100,000,000 over a ten year period. (Metro presentation, September 2014, p. 7, 12)

Planners at a major urban hospital system thought this was possible and so did one of the city administration's consultants.

It also seems clear that the city administration had neglected it largest "off-book" assets.

Here is a summary of the published cost estimates for upgrading the hospital and repairing the parking garage. They are significant.

Estimated Cost to Upgrade Lakewood Hospital.jpg
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Last edited by Mark Kindt on Sat Dec 01, 2018 10:41 am, edited 1 time in total.


Mark Kindt
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Re: The Road Not Taken

Postby Mark Kindt » Sat Dec 01, 2018 10:39 am

Here Is The Breakdown Of The Hospital Upgrade Costs

This is the CCF/LHA estimate to upgrade Lakewood Hospital for the next 20 years of service.

2015_SubsidiumOverview 47.jpg
2015_SubsidiumOverview 47.jpg (337.05 KiB) Viewed 7778 times


Mark Kindt
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Re: The Road Not Taken

Postby Mark Kindt » Sat Dec 01, 2018 11:13 am

City Administration Chose To Exit Healthcare Entirely

This slide is very interesting. I have added option numbers to aid in this review.

In October 2013, the LHA trustees and Subsidium were reviewing architectural plans from 2012 for the complete demolition of Lakewood Hospital and its replacement by a medical office building (Option 2).

The city administration itself ultimately chose the final option (3), that is, to exit the healthcare delivery business entirely.

Option 1, the option to right-size or reposition Lakewood Hospital, was ignored by both LHA and the City. The Metro Health System proposal was consistent with the goals of Option 1.

2015_SubsidiumOverview 26.jpg
2015_SubsidiumOverview 26.jpg (513.94 KiB) Viewed 7774 times


Mark Kindt
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Re: The Road Not Taken

Postby Mark Kindt » Sat Dec 01, 2018 11:26 am

Ending The City's Mission In Healthcare

The city administration has now ended the City's more than 100 year tradition of supplying hospital-based healthcare services to the community.

It has concluded that its emergency-preparedness infrastructure and its public safety responsibilities can be met without a local hospital.

This is the policy choice that has been made.

In my next few posts, I will review whether or not their was sufficient capital available to "right-size" Lakewood Hospital for future years of service to the community.


Mark Kindt
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Re: The Road Not Taken

Postby Mark Kindt » Sat Dec 01, 2018 3:46 pm

Even Liquidated And Closed Lakewood Hospital Was Highly Valuable

Here we can see that the transaction that closed Lakewood Hospital was well over $100,000,000 in value.

Losing Lakewood Hospital - Liquidation Value.jpg
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Mark Kindt
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Re: The Road Not Taken

Postby Mark Kindt » Sat Dec 01, 2018 5:10 pm

Upgrading And Right-Sizing Lakewood Hospital Could Have Been Fully-Funded

It seems pretty clear from a review of the two consultant reports and the Metro Health System proposal, that the upgrade and right-sizing costs of a repositioned Lakewood Hospital could have been fully-funded.

In the table below, I have limited my source information to the two consultant reports to establish values. I have assumed that a new provider could reduce the administrative fees charged by the incumbent member of LHA.

Under this model I present a recapitalization of Lakewood Hospital at $105,000,000 over two phases between 2016 and 2019. --Clearly sufficient to meet the upgrade costs as presented.

In fact, this model establishes a significantly lower termination cost for the incumbent provider (CCF) than the liquidation under the Master Agreement. It does not specifically relate to Metro. Any provider would work.

This is a win-win model for all participants. (or would have been.)

Funding A Right-Sized Lakewood Hospital.jpg
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Mark Kindt
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Re: The Road Not Taken

Postby Mark Kindt » Sun Dec 02, 2018 9:54 am

The Missing Analysis -- Emergency (Disaster) Preparedness

Let me explain why an upgraded, right-sized Lakewood Hospital was a superior choice for the public rather than a new medical office building offering outpatient emergency services.

Aside from jobs, revenues, healthcare, and charitable care, why would an acute-care hospital, like the former Lakewood Hospital, be crucial to our community?

After years of reviewing publicly-available documents...

Nowhere, I repeat, nowhere did I ever see any analysis of the role of local hospitals in supporting governmental disaster preparedness or public safety needs.

In the review by LHA with its consultant and the City with its consultant, it was an assumption (erroneously taken for granted) that a public hospital had no such role and that the "profitability" of non-profits was the only relevant consideration for public needs.

Yesterday, you may have noticed that large firetrucks were parked on Detroit so that they could protect the public for any untoward incident.

However, had such an unfortunate incident occurred, the doors of a once very nearby local hospital would have been locked. --Now unavailable to meet the public safety needs of those in need of medical assistance.

Simply put, a municipality is not a business. It has duties, such as disaster preparedness and public safety, that are inherent in its functioning. They cannot be dismissed to achieve not-profit "profitability."


Mark Kindt
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Re: The Road Not Taken

Postby Mark Kindt » Sun Dec 02, 2018 11:48 am

The Source Documents

I have attached PDFs of the primary source documents, so that readers can review them and verify my references.
Attachments
No Material Advantage to CCF Offer.pdf
(1007.46 KiB) Downloaded 262 times
2015_SubsidiumOverview.pdf
(1.41 MiB) Downloaded 259 times
Lakewood Metro Presentation 9.17.14_Redacted.pdf
(1.44 MiB) Downloaded 259 times


Mark Kindt
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Joined: Sat Dec 03, 2016 11:06 am

Re: The Road Not Taken

Postby Mark Kindt » Sun Dec 02, 2018 11:51 am

The Source Documents II

I have attached PDFs of the primary source documents, so that readers can review them and verify my references.
Attachments
City Revenues from of the Hospital Transition as of April 16%2C 2018.pdf
(78.01 KiB) Downloaded 259 times
15-Master-Agreement-City-of-Lakewood-Lakewood-Hospital-Association-Cleveland-Clinic-fully-executed-12212015.pdf
(3.7 MiB) Downloaded 267 times
Huron-Consulting-Final-report.pdf
(1.58 MiB) Downloaded 263 times


Mark Kindt
Posts: 2637
Joined: Sat Dec 03, 2016 11:06 am

Re: The Road Not Taken

Postby Mark Kindt » Sat Dec 08, 2018 4:27 pm

For Future Reference

The Deck essay is continued in "Measuring the Damage" at this link:

viewtopic.php?f=7&t=25049


Mark Kindt
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Joined: Sat Dec 03, 2016 11:06 am

Re: The Road Not Taken

Postby Mark Kindt » Wed Feb 20, 2019 2:23 pm

Witness The Road Not Taken

Once again, I quote the Subsidium consulting report to the Mayor:

"[...] the value provided to the community could be close to zero [...] This proposal asks the City [...] to conclude that they are better off without a full service medical/surgical hospital for an additional twelve years. Given the values above it is difficult to make that conclusion."

The New Model of Healthcare in Action:

The New Model of Health Care - 2019.jpg
The New Model of Health Care - 2019.jpg (1.01 MiB) Viewed 6235 times


(Image courtesy of Lakewood Observer)



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