Sisters Hospital does better job at caring for patients

By: Edwin Martinez

In the ongoing battle for supremacy in health care in Western New York the losers are patients whom face understaffed emergency and Neo-natal rooms particularly at Kaleida Health.

In the last year, Kaleida’s Board of Director has fired its long time Chief Executive, Chief financial officer and many other key players at kaleida. Also, only about three months ago they fired most of their long time doctors and replaced them with an outside group of doctors with little experience and not enough staff to cover the emergency rooms, Intensive care units, critical care units, neonatal intensive care units or The Vascular Heart Center

A visit to Kaleida now result in a patients seeing a Physicians Assistant who often has to wait for a doctor’s approval for important procedures. In healthcare, delay often results in sicker patients or death.

On medical floors throughout Kaleida health System, the other crisis is a shortage of nurses, which has resulted in patients having to wait for critical care. Some longtime nurses at Buffalo General have indicated to us that the shortage of Doctors in the Hospital floors, often results in patients waiting two or three days before a doctor sees a patient. They even indicated that when they call the doctor directly or call their office because of critical care issues with patients, too often the doctors don’t respond, resulting in patients not getting the proper care. The national standard patient to Nurse ratio on a critical care floor is 5 to 1. At Kaleida, it often 8 or 9 to 1.

An example of the problems can be viewed with a recent case where a elderly patient was admitted into the emergency room at Buffalo General hospital. Family had brought in the patient, because he had slipped and fallen at home. After being seen by a Physician Assistant at the hospital the patient was told that they would be keep for observation because he had a slight fracture in his back and that his white blood cell count was high. A few days later the patient was told, that his gallbladder needed to be removed, because it has infected. The patient was then moved to Kaleida’s High Point facility for rehab and the patient only got sicker and was moved back and fourth to Buffalo General because of several bout of high fever and vomiting. Eight weeks later his gallbladder raptured and the patient became septic and almost died. This patients has remained under Kaleida’s care for almost four months.

The problems at Kaleida Health are not just with the Hospital but also with its Nursing facilities.

It was late April and the employees – a registered nurse, seven licensed practical nurses and nine certified nursing aides – stood accused of neglecting a bedridden patients under their care.

One by one, each of those 17 former workers at Kaleida’s HighPointe facility on Michigan pleaded guilty and has been sentenced, ending a story that cast yet another critical spotlight on Kaleida and its nursing home care across the region.

“The treatment of the victim in this case was shameful, and I am pleased that those who were responsible have been held accountable,” Attorney General Eric T. Schneiderman said in a recent statement to The Buffalo News.

Initially charged with felony crimes, the defendants ended up pleading guilty to misdemeanors or violations. With one exception, a nursing aide who went to jail for 15 days, each was sentenced to community service.

As part of their sentences, they are required to take part in a “scared straight”-style program intended to educate other nursing home workers. State officials said the 17 will talk about their failure to adequately care for their patient and how that led to their arrest and prosecution.

In a recent Buffalo News story below written by Stephen T. Watson, highlight the battle over patients with little concerns for patients.

When Kaleida Health and a group of doctors applied in 2013 for permission to build a $2.6 million outpatient surgery center in Orchard Park, less than eight miles from Mercy Hospital, rival Catholic Health fought back.

Kaleida Health argued that the surgery center filled a need in the Southtowns. But Catholic Health maintained that the center was an incursion into the system’s traditional territory.

State regulators approved the Kaleida expansion, but only after an administrative law judge ruled Catholic Health’s concerns weren’t enough to sink the project.

From fights over turf to competition for doctors, patients and money, Kaleida Health and Catholic Health are locked in a fierce fight for Western New York supremacy.

Their chief executives work just blocks from each other along the medical corridor. Joseph D. McDonald, the Catholic Health CEO, is a transplanted Southerner whose cordial charm belies a toughness revealed in the system’s dealings with its unions, Buffalo’s largest health insurer and a downtown hot dog joint.

Under McDonald, the upstart Catholic Health has gotten its finances in order and closed the gap with its larger rival. That’s a big reason why Kaleida Health hired Jody L. Lomeo last year to succeed James R. Kaskie as CEO. Lomeo is an outgoing, well-connected Buffalo native known for forging close ties with workers.

The competition has played out in advertisements on TV, billboards and the Internet.

The systems also vie to recruit doctors to their hospitals and affiliated practices. They try to grab market share, through partnerships with rural hospitals or construction of new outpatient centers. And they’ve invested a lot of money into new technologies and facilities that can duplicate services provided by their rival.

In recent years, as Kaleida Health has had an up-and-down financial performance, Catholic Health has seen its revenues and income soar.

At Catholic Health, revenues rose 20 percent between 2010 and 2014, when it took in $953.6 million and earned $40.8 million. Kaleida Health’s revenues rose just 7 percent over that time, to $1.29 billion in 2014. And Kaleida Health earned $15.2 million last year after losing $15.3 million the year before.

“I think the Catholic Health system focused on the inevitable change in reimbursement at a time when Kaleida was focusing on capacity to take care of the really, really sick,” said Dr. Thomas C. Rosenthal, who retired recently as director of variation reduction at Optimum Physician Alliance, a group with ties to Kaleida Health and BlueCross BlueShield of Western New York.

Mergers in late 1990s

It’s a contest fought at close range by systems with vastly different cultures.

Kaleida Health, which formed in 1998 by the merger of Buffalo General Hospital, Children’s Hospital, Millard Fillmore Gates Circle and Suburban hospitals, and DeGraff Memorial Hospital, has a reputation for treating the sickest patients and has made a statement with its investment in the Buffalo Niagara Medical Campus. The system built the Gates Vascular Institute, a cutting-edge cardiac and stroke center, started construction on a new Children’s Hospital and is aligned closely with the University at Buffalo medical school, which is moving to the campus.

The smaller Catholic Health was created in 1997 when Kenmore Mercy Hospital, Mercy Hospital and Sisters of Charity Hospital in Buffalo, Our Lady of Victory in Lackawanna, St. Joseph in Cheektowaga and the combined St. Jerome and Genesee Memorial hospitals in Batavia joined together in a “virtual merger” that shared income but not assets.

The system in recent years has carved out a stronger relationship with some of the region’s rural hospitals, and with a network of doctors who practice at its hospitals, but it has little presence on the Medical Campus.

The systems compete fiercely for patients across the board, with Kaleida Health’s share of hospital discharges in Western New York’s eight counties slipping from 33 percent in early 2010 to 30.4 percent at the end of 2013, while Catholic Health’s rose from 24.2 percent to 29 percent over the same time. 

The financial picture for Catholic Health was far cloudier in 2002, when McDonald took over as CEO.

Thirteen years ago, McDonald received a wake-up call from the auditors going through Catholic Health’s books.

Catholic Health was coming off losing $6.7 million in 2001 and $15.8 million in 2002. The system’s position was so precarious, the accountants told McDonald, that they might not be able to vouch for its ability to make it through the year.

McDonald had struggled during his short time on the job to pull together the board members, religious sponsors and administrators of the recently merged hospitals.

Applying the training he received in a college drama class, McDonald brought up the auditors’ warnings in a presentation to the recalcitrant system officials.

“I said, ‘The way we were organized, directed, staffed, controlled and led is not going to guarantee that Catholic Health will survive.’ I stopped. I repeated it again. I repeated that three times for effect,” McDonald recalled. “And I said, ‘So, we need to move forward.’ And I came up with a series of things we needed to do. It wasn’t rocket science.”

So how did the system succeed to the point it has nearly closed the gap in market share with Kaleida Health?

Officials inside and outside Catholic Health credit a strategy of investment in information technology, experiments in efficient delivery of care and strong partnerships with doctors’ groups and smaller hospitals.

“They’ve done a good job of understanding the needs of the physicians who refer and the needs of the patients who are referred,” said Dr. Michael W. Cropp, president and CEO of insurer Independent Health.

And the system was an early adopter of an experiment, known as an accountable care organization, meant to deliver better, coordinated care at a lower price to Medicare patients.

At 13 years, McDonald’s tenure at Catholic Health is well beyond the 3½ years of the average hospital chief executive, according to a 2013 survey by Black Book Rankings.

A former health care executive and consultant from Knoxville, Tenn., colleagues say McDonald is warm and engaging, makes steady eye contact in conversation and has done well identifying and promoting talented executives.

“I think his manner and his personality bring a lot of Tennessee with him,” said Dr. Edward Stehlik, a Town of Tonawanda internist and leading member of the Catholic Medical Partners physicians group.

Southern charm aside, McDonald can be tough, whether in bargaining with Catholic Health’s employee unions, who have protested the system’s negotiating stance, or in a battle with BlueCross BlueShield of Western New York over a Medicare Advantage plan that excludes non-emergency treatment at Catholic Health hospitals. And a standoff involving Catholic Health, a food truck and Rocco Termini’s Dog é Style restaurant drew widespread attention.

Kaleida battles back 

The surging success of Catholic Health put Kaleida Health on the defensive.

The Kaleida Health board in January 2014 ousted Kaskie after eight years as CEO, saying a change in leadership was needed.

“We weren’t operating from a position of strength and, competitively, we weren’t as well-positioned as we could have or should have been with the assets that we had,” said John R. Koelmel, the former bank executive who is chairman of Kaleida Health’s board of directors.

Lomeo, former CEO of Erie County Medical Center, has employed a personal touch since replacing Kaskie.

Lomeo moved his office back onto the Medical Campus, to be closer to many of Kaleida Health’s workers. He holds monthly meetings with union leaders, who generally praise how responsive he is to their concerns. He has made a point to take impromptu tours of system facilities to casually engage with employees.

Since taking over Kaleida Health, Lomeo has pushed to lower the system’s costs, in part by reducing the average length of stay for patients, and to boost revenues through tactics such as enrolling eligible patients in Medicaid who otherwise would be billed directly and be unlikely to pay.

Hearts and NICUs

The competition between the systems long predates their current chief executives.

For a starting point, look no further than the war for the hearts of Western New York. This fight began in 2000, when Catholic Health announced it would start offering open heart surgeries and minimally invasive cardiac care.

The system’s CEO at the time, Dale St. Arnold, was looking for a way to stem losses and to keep the hundreds of patients who were being sent to Kaleida Health or ECMC for heart surgeries, catherizations and stents.

Over the most recent three-year period for which the state Health Department reports statistics, 2009 to 2011, Catholic Health’s Mercy Hospital performed 496 coronary angioplasties, during which a stent is inserted to open a blocked coronary artery. Buffalo General Medical Center and the former Millard Fillmore Hospital at Gates Circle, combined performed 771 over that time.

At Mercy Hospital, 417 heart-valve replacement surgeries were done between 2009 and 2011. At Buffalo General, 493 were done, and at Millard Fillmore, 259, according to the Health Department.

The neonatal intensive care units, or NICUs, operated by each system are another area of intense competition.

“Neonatal is where all the money is. The neonatal service is by far the most profitable service at any hospital ,” said Larry Zielinski, a former president of Buffalo General who teaches at UB.

Catholic Health has NICUs at both Sisters of Charity, which has a Level III, and Mercy, which has a Level II. Level III NICUs can care for infants born as early as 23 weeks.

Between 2008 and 2010, Sisters’ 20-bed NICU had an average of 21 patients and Mercy’s 15-bed NICU had an average of four patients, according to Health Department data.

Catholic Health delivers half the babies in the region, so it’s only appropriate that it have a NICU to serve those infants, McDonald said.

“We’ve been doing mothers-newborn care before anybody started it,” said McDonald, noting Sisters was the first hospital in Buffalo.

Forging partnerships 

The systems compete intensely to win the loyalties of doctors, medical practices and rural hospitals.

Catholic Medical Partners, which is affiliated with Catholic Health, and Kaleida Health’s Optimum Physician Alliance both woo doctors and doctors’ practices, in part because affiliated physicians are more likely to refer their patients to their own hospital system.

Catholic Medical Partners, which was formed in 1996, represents nearly 1,000 doctors and gives Catholic Health close ties to many of the region’s primary care physicians. Catholic Health and Catholic Medical Partners also collaborated on an experiment, known as an accountable care organization, that is meant to deliver better, coordinated care at a lower price to Medicare patients.

Optimum Physician Alliance, on the other hand, is playing catchup with Catholic Medical Partners.

“My guess is the Catholic system has done a better job of developing and maintaining physician relationships than Kaleida has done recently,” said William Joyce, chairman of the Buffalo Niagara Medical Campus and former chairman of the Kaleida Health board. “They’ve been really smart about that.”

Doctors can feel caught in the tug-of-war between the two systems. Three physicians who switched, or were recruited to switch, affiliations between Catholic Medical Partners and Kaleida’s Optimum Physician Alliance, or vice versa, all declined to comment when contacted for this article.

The systems also look to forge closer ties with rural hospitals, and those partnerships are paying off for Catholic Health.

Shortly after McDonald took over, he hired John Friedlander, the former Kaleida Health CEO, to study the flow of hospital inpatients in the Buffalo and Rochester markets. Friedlander found, as system officials had suspected, that most of Catholic Health’s patients came from Buffalo and its suburbs.

“We were predominantly an Erie County-centric organization,” McDonald said.

Catholic Health sought to expand its patient base by reaching agreements with outlying hospitals. The larger system provides the smaller hospital with interim staffing, helps with strategic planning and, in the case of Bertrand Chaffee Hospital in Springville, leases an on-site cardiologist to the hospital three days per week.

The partnerships also include the recent merger with Mount St. Mary Hospital in Lewiston and an affiliation with Medina Memorial Hospital.

The agreements have started to reshape the system’s inpatient mix. In 2003, just 7.7 percent of inpatients at the four Catholic Health hospital sites came from outside Erie County; by 2013, that share rose to 10.8 percent, according to the state Health Department.

Advertising for patients 

Anyone who drives along the region’s highways, or opens a newspaper, can see how fiercely the hospital systems vie for patients. Kaleida Health in 2013 spent $2.1 million on advertising and promotion, according to its filing with the IRS, while Catholic Health spent $2.5 million in the same year.

Catholic Health billboards that said the best place for stroke care is, for example, just around the corner at Kenmore Mercy drew the ire of Kaleida Health officials.

Kaleida Health, for its part, touts its Gates Vascular Institute as a Top 15 cardiac center in the country, while Catholic Health argues that its surgeons and cardiologists deliver equally good care to patients.

“Where the Catholics have the best services and the right services, they certainly should compete for that business. Where they have better services, they should win a disproportionate share of those battles,” said Koelmel, the Kaleida Health board chairman. “But where they don’t, it’s a disservice to either position, promote or compete as though they do.”

Outside ratings

With both hospital systems saying they deliver top-quality care, who’s right?

There are a lot of ways to measure quality in a hospital, and state and federal health care agencies, along with professional organizations, are making it a priority to track and publicize this data.

Patient feedback, for example, is a key quality measure for the federal government.

The Centers for Medicare and Medicaid Services assign hospitals an overall rating on a five-star scale based on how well patients believe hospital employees communicated with them, controlled their pain and kept their bathrooms clean, among other responses to the survey. The centers’ Hospital Compare site gave the Kaleida Health system of hospitals a two-star rating, the same rating earned by Mercy Hospital, while Sisters Hospital received three stars.