The merger of Shamokin Area Community Hospital (SACH) into Geisinger Health Systems (GHS) is now less than three months away.
Executives from both organizations maintain that little will change come Jan. 1, but there is plenty to consider as these two institutions come together.
SACH, which marks its 100th year in 2012, and Geisinger, which is just two years younger, are nonprofit entities, and they'll remain that way. As nonprofits, executives say, both share similar missions.
The changes start with the name. SACH will become "Geisinger-Shamokin Area Community Hospital, a Campus of Geisinger Medical Center (GMC)." It's a mouthful, but one that combines a respect for tradition and regulatory requirement.
During an interview Monday morning at The News-Item, Thomas Harlow, president and chief executive officer at SACH, Thomas Sokola, chief administrative officer for GHS, and David Jolley, vice president of public relations and marketing for GHS, discussed what the merger will mean.
Heintzelman: Is the official date still January?
Harlow: Jan. 1 is the effective day. It's going to be a very busy fall for all of us. I think there's some (anxiety) - maybe it's just on my part - to get to Jan. 1, because we've been really through this process for some time waiting for the regulatory approval. There's a desire to get it moving. I think it's the same for the staff.
Heintzelman: What physically needs to be done?
Harlow: A lot of the IT, because we'll be moving to Geisinger's information technology platforms, which are pretty extensive. There's been a lot of activity really for the last six months ... putting in infrastructure, things people wouldn't see unless they're in the hospital. It's not just replacing (computers), but we've added significant numbers.
Sokola: But Jan. 1, the nice thing is, we'll be ready. It'll be just like at GMC today; all the systems will be up and running. We'll have functionality in every department, which is really nice, because you'll be able to see a patient at Shamokin just like you're at GMC. You'll have one medical record number. And that's why it took quite some time for us, because we wanted to do it that way and we had the ability to do it because Shamokin's really in good shape, both physical plant and financially.
Harlow: The interesting thing, back to Tom's point - we look at the market data, and there are a lot of patients in our community service area here that go to Geisinger or utilize those services, so it's a unified record.
Heintzelman: If someone's a new patient, and they go to the hospital today, are they recorded as a Geisinger patient?
Sokola: Today? No, Jan. 1 they will be.
Heintzelman: The hardware's there, but you're not going to do that yet - you can't do that yet?
Sokola: We can't do that yet. Now, let's say after Jan. 1 a physician wanted to look back at a record, they'll have - let's use simple terms, an "app" - to go to and say, "I want to look at the last time they were here." So we have to build all that functionality, and it takes a lot of talent and time and energy.
Gilger: As far as the name, Geisinger-Shamokin Area Community Hospital, were there requirements in arriving at that name?
Sokola: It's actually longer than that (laughter).
Harlow: There's two reasons. Part of the structure we're going to from a legal and regulatory perspective, we're part of GMC, so we have to hold out to the public with that. But I think one of the reasons it's so long is that our board had asked to keep the local identity, and Geisinger said we appreciate and understand that.
Jolley: You guys call it SACH, right? So you're going to call it Geisinger-SACH or G-SACH - that kind of stuff just happens out in the community.
Sokola: I want to make sure you guys know the full name: Geisinger-Shamokin Area Community Hospital, a Campus of Geisinger Medical Center. And Mark, you mentioned, there is a regulatory requirement to have the GMC name in there, but we also want to make sure people don't show up at the wrong campus when they have an appointment.
Gilger: How many total employees are at each facility currently.
Harlow: At Shamokin we have 300.
Sokola: Geisinger in total has 14,000 (throughout the entire system).
Gilger: And bed facilities?
Sokola: GMC has 495 (in Danville). We also have a 40-bed joint venture with Health South Rehab hospital on the campus.
Harlow: Shamokin has 70. I'll break that down: 45 are acute care; 15 are skilled nursing, and 10 are in-patient gero-psych (geriatric-psychiatry).
Heintzelman: What has or will change in terms of employment? We've talked in the past that no one will lose their jobs and there would be no layoffs - and I take it that has been the case - and you've also hinted there may be a need for hiring.
Harlow: I don't think come Jan. 1 there's going to be employment growth right out of the gate. I think that as we develop programs and services and find - hey, there's a need here; we need "x" number of employees to support that - it could happen. We're working through that.
Sokola: There might be some (growth) in the form of some other changes that will occur. Geisinger Medical Center is Joint Commission Accredited; most large facilities are. Shamokin is not; it probably used to be years ago.
Harlow: It used to be.
Sokola: So there might be a need for support folks from a regulatory perspective. And then as we build programs, I think we would need to add employees on the campus. And if we have the ability for Shamokin folks who live right here to access those services right here, that would be ideal. We'll have to evaluate that, make sure we have the staff to take care of them and the infrastructure and so forth. I think you know, Tom and I have been working on how can we bring this together for over two years now. And we've talked about the relationships we already have. We have a specialty clinic right on campus - you've probably seen the Geisinger sign - and so a lot of our specialists come here to do outreach. We have some ancillary services -we have a sleep lab in that building. Potentially those services could grow. When we finally come together and flip the switch on Jan. 1, we'll have a better idea.
Gilger: Will the pay scale be changed at all?
Harlow: The short answer is no. No employee will make less base rate than what they make today.
Sokola: There could be instances where there might be a change - positively. But for the most part, yes, everyone will come over at their current wage.
Gilger: We reported previously that you have two unions. The OPEIU represented about 74 nurses and med techs and then AFSCME represented 172 workers in support-maintenance, housekeeping, those type of jobs. Is everything settled with the unions?
Harlow: OPEIU decertified a couple months ago. AFSCME is still in place. But I think it's been stated previously that Geisinger will not recognize the union come Jan. 1.
Heintzelman: Is there any trouble on the horizon because of that?
Sokola: So far not that we know of.
Gilger: Are you hopeful that they'll decertify the union by then?
Jolley: Decertification is something that the employees do on their own.
Sokola: We can't influence that at all - and we don't.
Jolley: But I think the key here is - and Tom (Harlow) can address this - reaction to the whole merger has been positive from the employees' perspective, and they feel good about it.
Sokola: As you can imagine, every department had to meet with their counterpart to work through and see how are we going to work together once this happens. And it's been great. Tom and I serve on a steering group to help resolve any issues that can't be resolved by those departments - but our meetings have been short (laughter). That's good!
Gilger: And the fact that you guys have been connected for the last several years in some capacity ...
Sokola: You would not believe how many people know each other. We have brothers - one works for GMC, one works at Shamokin. We've got nursing folks who know each other. And we have a lot of GMC employees who come from this area.
Jolley: There are 1,500 employees from Northumberland County who work at Geisinger.
Heintzelman: To wrap up on the unions, what happens to the union employees if they don't decertify?
Jolley: Nothing happens. They don't need to decertify. It's just Jan. 1 comes and they're part of a new employer; they move over with their existing salaries and so forth. Our position at Geisinger is that we appreciate the opportunity to deal directly with the employee, and we feel as though we have very market competitive and fair wage and benefit program and we don't see the need for a third party to be involved.
Heintzelman: Any contract that extends beyond Jan. 1 doesn't apply?
Sokola: Right.
Heintzelman: So Shamokin is going from more than three-quarters of its employees who are part of a union to no longer being in a union, but you really feel that will go across without any trouble?
Harlow: The employees have been pretty good in this process. Obviously, when you first make the announcement, there's a tremendous amount of apprehension and fear. But I think we've been able to communicate - this is what's going to occur - and as we've been getting more and more information out to them it's helped reassure them that they're not going to be job losses or pay cuts or anything. And I would tell you that Geisinger's benefit program, as Dave said, is pretty generous.
Jolley: For example, the for-profit company up in Scranton that controls two of the hospitals just did the announcement for Moses-Taylor and said, 'Well, we'll have jobs for these folks for one year.' Here, we're not saying you'll have a job for a set period of time. We're saying you're a Geisinger employee.
Heintzelman: Probably the biggest thing we've heard is that "the big guy is in now in town now." Lack of competition, no options, you lose the community feel, etc. How do you address that concern?
Harlow: I think one of the things that will come out of this from a positive is that if you've been a patient at Shamokin hospital over the past several years, the faces that you see, the people that you deal with, are going to be the same. I think our goal and our challenge is to maintain that community feel in this organization. And I would tell you I think there's an opportunity to do that - but utilize the resource base that Geisinger brings to bear. If we had a change of hundreds of different people coming in or going out of here, I think that's disruptive. But if someone comes in every month for lab work and sees the same person, I think there's some reassurance there that it's not changing. The people won't change Jan. 1.
Sokola: Same place, same people. And I would say we cognizantly thought about this, about how this would feel for the community hospital that has been here and done a great job - all you have to do is walk through the place; it's well kept. When we talked to our management group, we talked about how we're not coming in just to be the 800-pound gorilla and say this is the way it is. We're going to learn from each other. For instance, Shamokin has SNIF (skilled nursing facility) beds; we don't have SNIF beds. They do a great job keeping this facility up and do some things that I'm sure there are things we can learn.
Jolley: What Tom said is true. I've been through a lot of community hospitals, and the first day I came down here to meet Tom, I was impressed. Over the years the board and leadership there has done the things to maintain the facility - you don't (normally) see that.
Heintzelman: It's one of the more positive stories in our community.
Harlow: It is a great story and we've talked about it before. But if this board had taken a different track, I think where we would be would be tremendously different. When they made money, they had the foresight to say, "Let's reinvest it into this facility." I think that's one of the things Geisinger found attractive.
Sokola: Being able to reinvest the dollars back into the system rather than give it to the owners of a for-profit is important.
Heintzelman: Will it cost more for services at Shamokin because of the merger?
Harlow: It's hard to say. A lot depends on who you have your insurance through. For example, were have a contract through Capital Blue Cross or Highmark, and we negotiate rates. We agree on a rate for whatever the service might be. With Medicare and Medicaid, it's whatever the government wants to pay. There's no negotiating with Medicare.
Heintzelman: So will you have to renegotiate those rates?
Harlow: It would really fall under Geisinger's contracts then.
Heintzelman: So do things cost more there than at SACH?
Harlow: We haven't been able to share that information to this point because we're competitors. I couldn't tell you if you needed a chest X-Ray at Danville what that charge is. The direct impact to patients might mostly be determined through what their co-pays and deductibles are, or whether they have insurance or what type of plan they have.
Heintzelman: We had a story in the paper today about the U.S. Supreme Court taking up the Affordable Care Act. Tom (Harlow), we've had discussions about your concerns about the president's health care law, yet Geisinger has received compliments from the president for how you function. Your comments on that interesting mixture?
Sokola: From our perspective, we are innovative, and we have been successful, and that's part of the reason we've got so much national recognition, in trying to set up models that don't just treat the disease but actually prevent it from happening. Obviously we're a hospital and we'll get paid for admitting or readmitting a patient, but we want to stop that admission by getting out to them and making sure they do their medication reconciliation and don't get hospitalized. We also have an insurance company ... so the sweet spot for us is to take the insurance aspect - keeping people well, that's better for that business - then meshing it with our providers, who focus on how to keep people well. That gives a better outcome to the community.
Heintzelman: So, how does Geisinger view the president's health care plan and do you want the (court) challenges to be successful?
Sokola: I think we're all for a model that does what I just said: allows an integrated health system to improve the health of the community. Is it tested yet? Obviously not, but we're supportive in some of the models we've done and kind of match up with the Accountable Care Organization; that's why we've been named by the president. We're supportive of the model whether it be the president's plan exactly, as long as the model gets us to the end. Regardless of what happens there, we'll continue to doing the things that we've been successful with.
Heintzelman: One of the biggest issues is requiring that everyone have insurance. Is that a good idea?
Jolley: We think that it's important there be options for affordable insurance. How you actually do that is a more complicated issue. We would appreciate that, of course, (all having insurance) because we treat everyone who comes in our doors - insured or not insured.
Harlow: Do you wear the hat of a taxpayer and your political beliefs or do you wear it as a health care administrator? We'd all prefer that they have affordable options because people make decision not to get care because they don't have the resources.
Jolley: And then they use more expensive care - the ER.
Harlow: Or they delay until it gets more complex. But as a taxpayer, my personal belief is that we shouldn't mandate people to do things. But I think it would be great if everyone had those options for low-cost or some type of care.
Gilger: Will people's insurances be affected come Jan. 1?
Harlow: Not really. One of the things that was a concern is the Medicare Advantage plans. We participate with some (four) that Geisinger doesn't. Those we have contracts with today will continue for a three-year period. And that was part of the Attorney General's request - that, hey, you can't just drop this.
Sokola: And we'll negotiate with those (providers) when it gets closer to the term of the arrangement. A lot can happen in three years.
Gilger: How many patients does that effect?
Harlow: We're talking 1,000 to 2,000 in Northumberland County.
Heintzelman: As for insurance on a broader level, is there any change? If someone took their son to Shamokin three months ago for treatment and got out their insurance card, will they do the same come Jan. 1?
Harlow: No, no change. I don't believe there are any commercial plans that (both hospitals don't accept).
Sokola: The only issue to my knowledge is what we just talked about (Medicare Advantage).
Heintzelman: It occurred to me that this could be of great benefit in regards to the local clinics, such as up near Kulpmont. If you go there and you need further treatment at the hospital, maybe now you only go to Tharptown instead of Danville?
Harlow: Yes, and it goes back to what Tom and I were saying about program development. Is there an opportunity to keep more care local? That really goes back to something Dr. (Glenn) Steele (Geisinger CEO) has said continually: his vision is to keep that basic community care in your local community and use Danville as the high-end facility.
Sokola: We already have the specialty outreach site (at SACH), so a lot of specialists come here, and that's really bringing care back to the community, and we envision doing more of that.
Heintzelman: One of the things we hear a lot about is competition - that we're losing competition with Shamokin's merger with Geisinger. And you're under way with a similar affiliation in Bloomsburg. Can you address that?
Jolley: Dr. Steele talks a lot about competition and he feels it's a good thing, it drives you to be your best. If you look throughout the whole (Geisinger) health system, we have a lot of competition. A strong competitor is really lining up with Community Health Systems. They're out of Tennessee, but they have (hospitals in) Sunbury, Berwick, Lock Haven, Wilkes-Barre (General) and Moses-Taylor and Mercy (in Scranton). CHS is much bigger and it's a for-profit. But they focus on the hospital; we focus on the whole continuum. There's also Evan, too, in Lewisburg (not a CHS hospital).
Harlow: The dynamics of the industry is forcing consolidations. We saw it firsthand. Our board did everything right and we were still forced to take this road. ... We had to ask the question: Do we want a facility in this community for the long-term? The choices were pretty stark.
Sokola: And it's not like we don't know this community. Tom knows Dr. Steele. Tom knows some of the (Geisinger) board of directors. Our missions are very similar, and every dollar that's made goes back into the community.
Heintzelman: Anything else you'd like to express?
Sokola: I wanted to say that the physicians in the community have been great. We're glad to have them.
Harlow: We do have excellent physicians in the community. They're an important part of the care that's delivered here. We are pleased to be able to work out an arrangement that they can continue to practice here. ... I think one of the original promises we had was try to take the strength that Shamokin Area Community Hospital always had and combine it with the resources and capability of a facility like Geisinger, keeping health care local and making it better. We're optimistic that it will work.