LEWISTOWN - As the merger between the two entities moves forward, Lewistown Hospital and Geisinger officials addressed issues discussed by The Concerned Physicians and Practitioners of Mifflin and Juniata Counties, a group opposing the change.
The opposition group had previously brought to light a number of arguments against the merger, including the topics of transparency, document disclosure, jobs, threat of monopoly, patient cost and past proxy voting.
In response, Frank Trembulak, executive vice president and chief operating officer of Geisinger Health System, explained to the community and hospital employees that, though these questions can be answered in a general sense now, the merger is still in the very early stages and, as more specific details become available, information will be shared.
"Today we can only answer questions that are very high level which is not satisfactory to most people," Trembulak said. "We are just kicking off the information process on Friday, getting teams together from Lewistown Hospital and Geisinger to look...at how different things are accomplished today and how we can do them in the future."
The hospital's future, said Glenn Steele Jr., Geisinger president and CEO, is not something to be afraid of. The merger with Geisinger is a tool to increase jobs, resources and programs offered by the hospital to its community, he said.
"The rationale for this process is not operational ineptness as (hospital president and CEO) Kay (Hamilton), her colleagues and the professional staff have a very viable community hospital," Steele said. "The reason they were looking to do something, whether it was with us or someone else, is because of the amount of investment that is necessary. It's because the hospital is small and the resources are limited in a small community."
If programs are built correctly in the coming years, the number of jobs will only increase, Steele said. For every doctor the hospital recruits in the future, four more support staff will be hired, he said.
Additionally, where certain departments require a more efficient structure, effectively making certain jobs redundant, those employees that are displaced will be offered another position within the Lewistown Hospital system, Steele said.
"What we will do is move to the most efficient structure we possibly can," Steele said. "But we aren't coming in here to constrict. We have made a commitment to keep the acute care services open for eight years at least."
Along with program building, Geisinger is committed to keeping the level of care at affordable costs that Lewistown Hospital is known for by continuing to accept insurances that already exist in the local market, Steele said.
"First of all, as a provider, 70 percent of our non-Medicare/Medicade business is paid through non-Geisinger insurance," Steels said. "Only 30 percent is paid for through Geisinger insurance. However, the fact that we are both an insurer and a provider in the same company at Geisinger allows us to actually do things that most providers can never do with most insurers."
Referred to as the sweet spot, the 30 percent of patients that use Geisinger insurance as well as health services allows Geisinger to provide better care by creating a payment system based on quality of care as opposed to units of work, Steele said.
Geisinger is also required by the Attorney General to have market based contract rates with the insurers, Trembulak said. However, Geisinger has no say how the insurers interpret that contract into a policy offering and a premium that is then sold to employers, he said.
"The insurers can offer high deductible plans and co-pay plans causing employers to shift their choice of insurers," Trembulak said. "It's easier to connect the dots to the cost of care, but the insurance provider is also making sure they make their profit."
In an effort to further reduce costs, Geisinger will also be adding a 24/7 urgent care facility, Steele said. That way, individuals who don't have a true emergency don't have to come to the emergency room and pay the associated fees, he said.
"The classic rip-off is when a patient comes to the emergency room for an aspirin and gets a bill for $30," Steele said. "Urgent care is something that's convenient and can get as much non-emergent volume out of that emergency room as possible."
These agreements, programs and commitments are all bullet-points that are listed in the letter of intent, signed by Lewistown Hospital and Geisinger Health System, Hamilton said. Though these topics may be discussed, the specific document, in addition to the original Request for Proposal, is a proprietary confidential document that, legally, cannot be shown to those outside the Board of Directors, she said.
"In one of the early meetings, with the physicians and other parties, the comment was made that they would be able to see the request for proposal," Hamilton said. "We subsequently learned from our legal counsel they would not be able to. The documents are legally confidential so they can't see the actual documents, but they can know what the bullet points are and that's what we have been talking about."
In fact, such physicians and staff will be involved with the various program development that will be included in the definitive agreement, or final contract, Hamilton said. At that point, the participating group, including independent physicians and those working for the hospital, will know all merger details, she added.
When the definitive agreement is complete, it will go to the Board of Directors for voting and the vote for change in ownership will go to the corporate members, Hamilton said. The concern that final votes will be by proxy because proxy votes were used previously are unfounded as the corporate members were not involved with any previous vote, she said.
"I have no idea where that came from because there was no proxy vote or any vote for the corporate membership," Hamitlon said. "The corporate memberships only vote by the bylaws on the election of directors, a change in bylaws or a change in ownership. So there was no vote for the letter of intent."
Within the next week, Lewistown Hospital will be activating an online link for the local community and hospital community to anonymously submit questions, which Hamilton will personally answer. All questions and answers will then be posted to the website at www.lewistownhospital.org.