Wednesday, April 21, 2010

The Myth of the Hybrid Model

The Citizen

SUTTER vs THE DISTRICTThe hybrid model is often mentioned as the best way to save San Leandro Hospital's emergency room. The idea has been around for nearly a year. Many take credit for its creation. Many new to the situation saddle up to advantages: a plan that puts nearly every segment of medical services under one roof, which seemingly placates every stakeholder's position and sorts out the rearranging of the county's rehabilitation services throughout the region due to the cost and timing of state-mandated seismic retrofitting of hospitals. The apparent win-win situation has one major problem: Nobody has ever come close to loosening the purse-strings.

The Alameda County Health Care Services Agency has long maintained an annual subsidy between $6-9 million is needed to institute the hybrid model at San Leandro Hospital. Alex Briscoe, the director of the county department, has told The Citizen on many occasions during the last six months, any plan must also include a long-term commitment close to 10 years. San Leandro Mayor Tony Santos, Eden Township Healthcare District Director Dr. Rajendra Ratnesar have taken credit for the plan, but have never brought financing to the table. Alameda County Supervisor Alice Lai-Bitker has also taken credit for creating the hybrid plan, but she too, has never attached a dollar figure anywhere close to the minimum $6 million per year.
Some believe Sutter has never had any intention to negotiate and will not start now
Lai-Bitker, who is not running for re-election this year, will ask the Eden Township District Board of Directors tonight for a contribution to the hybrid proposal. District Chair Carole Rogers says the board did not seek Lai-Bitker's proposal. A letter to the board last month asked for the District's consideration and referenced a similar letter sent last July.

Talk of the hybrid model first gained wide attention during three heavily attended public meetings that month. Following a rousing presentation days before to the board by Prime Health owner Dr. Prem Reddy, who asserted his Southern California hospital provider could operate the hospital, Lai-Bitker told the board she would ask the Board of Supervisors to rescind their offer to convert the hospital to a acute rehab-only facility since the hospital now had a viable suitor. The announcement elicited a joyous response from many members of the audience and annointed Lai-Bitker the savior of San Leandro Hospital, but the proposal went nowhere. Sutter Health, who reportedly loathed having an operator like Prime in the neighborhood, made it known they would not cooperate with any sort of hybrid model. Subsequently, Lai-Bitker could only muster support from Supervisor Nate Miley. The issue of rescinding their offer to the county never had a third vote on the five-person board and was never discussed.

Despite periodic flare-ups, the viability of the hyrbid model, namely the presence of dollars associated with it, has never changed since last summer, yet the list of supporters continue to rise. Assemblywoman Mary Hayashi is said to support the hybrid. Supervisor candidate Wilma Chan supports it. The list includes Hayward Councilman Bill Quirk, Santos' opponents for mayor this November and most of the candidates for supervisor.

The rabid support for the hybrid plan has become the most politically expedient position that paints an open-minded stance towards the situation, while allowing them to grandstand for the voter's admiration. Whatever the  plan's positives, it is basically a proposal made of straw.

For the hybrid to function as a potpourri of medical services, including the crucial inclusion of an emergency room, it must also be a hybrid of donors. Last fall, there were reports the Eden Township District, Sutter and the Alameda County Medical Center, who would operate San Leandro Hospital as an acute rehab facility if Sutter obtains the deed to the hospital, were approached on the subject of a three-way deal to subsidized the hybrid model. Sources say Sutter had no inclination towards entering such an arrangement and the others were highly skeptical. Any future deal in the short-term was scuttled when Sutter sued the District last October demanding it recognize its right to purchase the hospital. That case is still very much at the center of where both sides stand regarding any sort of cooperation and led to the District filing a counter-claim last month.

Many sources close to both the county and the District say the only possible way for the hybrid to work is if Sutter leaves the hospital situation entirely. But, they also say that is very unlikely, while some believe Sutter has never had any intention to negotiate and will not start now. Whatever the hybrid's positives, it's a deal nobody other than politicians seem to be interested in.

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How about Sutter opens the SLH's 4th floor for business like it promised, with a profitable 20-bed rehab services to boost supposedly feeble revenue SLH generates. I bet SLH could oushine its big brother up the hill (EMC) in no time. Despite Sutter's smear campaign, painting SLH as a loser and a money pit, it is neither by a long stretch. SLH is a well-oiled lean machine waiting for its owner to poop or get of the pot so it can get on with the important business coded in its mission statement which is to serve the sick and the underprivileged.

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