Calbone Clarifies Hospital Changes

SARATOGA SPRINGS — Last October, Saratoga Hospital and Albany Medical Center (AMC) announced a new affiliation [see Visionary Healthcare, p. 1, October 30, 2015 edition of Saratoga TODAY]. The two health institutions signed a letter of intent to affiliate, paving the way for a more comprehensive, cost-effective and integrated health care system. At the fall press conference, Angelo Calbone, President and CEO of Saratoga Hospital, assured that under the terms of the letter of intent, Saratoga Hospital would retain its name, local leadership and governance, and oversight of services delivered in the community. Recently, that assurance has been called into question due to the use of the term “parent” in the formal application to finalize the agreement, which is currently being reviewed by the State Department of Health. That, combined with the announcement of the decision to close Saratoga Hospital’s nursing home, has raised some eyebrows on social media and in the community, so Saratoga TODAY sat down for an exclusive interview with Calbone for some clarity. “We take pretty seriously that we are the only hospital in the county and that is our primary mission,” said Calbone. Neither decision – closing the nursing home or affiliating wit AMC – came lightly, Calbone said. The nursing home discussions have been ongoing since 2007, when the hospital reduced its nursing home beds from 72 to 36 in order to create more inpatient and acute care space. “As we looked at future bed needs and growth, and as we continue to do the things the community expects us to do, we are running out of beds again. There’s really only one way to increase capacity and that’s to take that second floor. And we anticipated this would happen ten years ago. Now is the time to do it.” On Tuesday, June 21, Saratoga Hospital initiated the process of communicating with the residents and families of Saratoga Hospital Nursing Home that the facility will close in the fall, perhaps sooner. The nursing home will be renovated to create additional space for the hospital’s acute care patients. To close the nursing home, the procedure the hospital was obligated to follow with the New York State Department of Health is a complicated, time-sensitive process which limits what can be publically discussed about the closing. This is why the hospital could not share this information earlier. The formal closure plan was submitted June 1. The projected closing date is early Fall. The hospital has been working with local long-term care facilities to identify how best to find residents new homes. “Our discussions with these facilities have been encouraging,” said Calbone. “We believe we can find the right place for each and every resident. We are committed to help in any way we can during this transition. For our nursing home staff members, every effort will be made to secure a position for anyone who wants to continue employment, whether with Saratoga Hospital or another healthcare facility.” The current 36 beds in the nursing home include 8 short-term rehab beds; all 36 beds are included in the closing plan. There are currently 23 nursing home residents who will be affected by the closing. Regarding the AMC affiliation, Calbone explained that it was a multi-year process that involved many thorough discussions with the board. “The board has a responsibility to know and understand how this will work,” said Calbone. “We spent upwards of two years in negotiating the specific terms of the relationship, making sure a very high degree of local autonomy and control stays intact.” Calbone explained that creating a meaningful affiliation is done through a parent model in New York State, and it is how the State Department of Health regulates them. Although the model does list Albany Medical Center as the parent, the terms in detail are unique to this particular affiliation of the two institutions, and not readily apparent in the public eye. “So, internally we knew that is how this structure would work, but ‘parent’ is just a term that is used to describe how relationships are built, and doesn’t reflect the years of negotiations on specific terms. What I believe has happened is that individuals have probably looked at the regs as they are stated in somewhat generic form as to how parent relationships in hospitals work in the State of New York, and took it literally,” Calbone added. “But unless they were in the room with the board, they won’t know the details. This meets the spirit of those regulations, but leaves a high level of local control and autonomy in place.” The reason they had to use the parent model goes back to anti-trust laws and other legalities that protect the American public. “We are a business,” said Calbone, “and we cannot work closely as two institutions on regional planning, working to create programs, sharing of information and movement of potential medical education back and forth; you just can’t do some of those things without a relationship because it would break the law. You must connect yourself sufficiently to do it in New York State, and that’s called a parent model.” Calbone said unequivocally that Saratoga Hospital remains a licensed hospital, which by its nature requires a number of responsibilities to be maintained by the local board. He confirmed that the parent, AMC, would have to approve the local board members. Although it is a confidential agreement, Calbone could say, however, that the board members put before AMC would first be recruited, interviewed, and vetted by the local board before they are put forward for action by the parent. “Also, they can’t be denied and replaced by other candidates,” said Calbone. “They can only come through the local process of the local board. You wouldn’t know that unless you were part of the negotiations.” For Calbone’s role, the local board can unilaterally dismiss any CEO they don’t find acceptable, but in choosing a new one, it will be done collaboratively. He said the “parent model” term has been over-interpreted as too dominant, but emphasized that the standard written into regulations don’t reflect the very unique relationship established between the institutions that is very respectful of the history of the hospital and the value the local board brings to oversee the operations. “We weren’t forced to do this,” said Calbone. “The local board felt this was the best time to move ahead and it would be helpful to us and our patients. There is grave risk to institutions over the next five years and we choose to take this time to do this while we are successful.”