 |
|
Case A |
Case B |
Case C |
Case D |
 |
| Partner |
Acquisition of Catholic hospital by a NFP hospital affiliated with a NFP system; Catholic hospital now non-sectarian. |
Merger of academic medical center and small Catholic hospital to form non-sectarian NFP integrated system; the Directives continue to apply at Catholic campus. Merger is part of a larger integration that involved a medical school & physician group practice. |
Consolidation of Catholic and Protestant hospitals to form non-sectarian NFP medical center. |
50/50 joint venture between a district hospital and a Catholic system. |
|
| Type of Affiliation |
Acquisition with alienation of Catholic property. |
Merger. |
Consolidation with alienation of Catholic property. |
Joint Venture - New non-sectarian NFP corporation formed to run hospital. |
|
| Year of Affiliation |
1995 |
1995 |
1994 |
1996 |
|
| Region |
Northern Central |
Northeast |
Northern Central |
West Coast |
|
| Local Market Characteristics |
NFP system 1 of 3 hospital players in the local market. Catholic hospital located in economically depressed community. Low managed care penetration. |
New system is the only hospital player in the local market that is surrounded by a great deal of rural poverty. Capitated managed care expected to increase. |
New medical center is the major hospital player in a 'conservative' and 'older' middle-class community. Managed care is growing. |
Catholic system is a major hospital player in a multiple provider, largely middle- class community. |
|
| Financially Stronger Partner |
Non-Catholic hospital |
Academic Medical Center |
Equal Partners |
Catholic system |
|
| Earlier Affiliation Episode |
1990s |
1960s (different partners) |
1970s |
1995 |
|
| Factors Motivating Recent Affiliation |
Survival of Catholic hospital.
Increasing market share. |
Managed care.
Capitation.
Survival of Catholic hospital. |
Positioning for managed care growth.
Capitation.
Reducing service duplication. |
Managed care.
Capitation.
Survival of district hospital.
Expansion of Catholic system. |
|
| Key Issues in Affiliation Process |
Physician-hospital relationships.
Workforce reduction.
Loss of Catholic identity. |
Maintaining Catholic mission and values.
Physician-hospital relationships. |
Abortion.
Maintaining Catholic mission and values.
Communicating acceptance of consolidation. |
Provision of women's reproductive services.
Workforce reduction. |
|
| Factors Facilitating Affiliation Process |
Market research.
Internal/external communication strategies.
Addressing Catholic issues early on. |
Early approval of Bishop.
Physician support. |
Agreement that decisions not to be constrained by religious ideology.
Full board commitment and proactive involvement in affiliation.
Support of Catholic order.
Internal/external communications strategies. |
Community education and involvement in decisions.
Formal commitment between partners to promote shared values. |
|
| Post-Affiliation Governance |
Single board for non-Catholic hospital. |
New system board with equal representation from each of the 4 partners. Also, each partner kept its own board. |
New board for medical center with equal representation from the 2 partners and community representation. |
New board for joint venture corporation with equal representation from Catholic system & district hospital. Hospital continues to have its own elected board. |
|
| Current Challenges |
Stabilization and enhancement of services. |
Utilization of Catholic campus.
Building physician management skills.
Cultural integration. |
Cultural integration.
Responsiveness to women's health needs. |
Financial stability.
Further workforce reductions planned.
Union issues. |
|
|
|
Case A |
Case B |
Case C |
Case D |
|
| Affiliation Description |
Acquisition of Catholic hospital by a non-Catholic NFP hospital affiliated with a NFP system; Catholic hospital now non-sectarian.
1995 |
Merger of academic medical center and small Catholic hospital to form non-sectarian NFP integrated system; the Directives continue to apply on former Catholic campus.
1995 |
Consolidation of Catholic and Protestant hospitals to form non-sectarian NFP medical center.
1994 |
50/50 joint venture between a district hospital and a Catholic system.
1996 |
|
Prenatal/
Obstetrical Care |
Prenatal & OB services, including prenatal genetic counseling, continue at non-Catholic campus.
OB services discontinued at former Catholic campus in 1994; not provided after acquisition. |
Prenatal & OB services, including prenatal genetic counseling, continue at non-Catholic campus.
OB services not provided at former Catholic campus before or after merger. |
Prenatal & OB services provided pre- and post-consolidation.
Prenatal genetic counseling continues in on-site specialty clinic.
Labor and delivery unit being expanded. |
Prenatal & OB services continue at district hospital.
Prenatal genetic screening continues to be referred to local specialty group.
Birthing unit being remodeled. |
|
| Family Planning |
Contraception services continue at non-Catholic campus.
Post acquisition, former Catholic campus stopped applying the Directives and began community contraception education.
Both campuses continue not to operate family planning clinics.
Rape services and emergency contraception provided at rape crisis center in system hospital 10 miles away. |
Contraception services continue at non-Catholic campus.
Former Catholic campus continues to apply the Directives to provision of contraception.
Both campuses continue not to operate family planning clinics.
Rape services & emergency contraception continue at non-Catholic campus.
System partners with community- based organizations to promote reproductive health. |
Contraception services continue at both campuses.
Both campuses continue not to operate family planning clinic.
Rape services & emergency contraception continue to be provided in the Emergency Room. |
Contraception services continue at district hospital.
Hospital continues not to operate family planning clinic.
Rape services & emergency contraception typically referred to rape crisis center at County Hospital but continue to be available at district hospital. |
|
| Sterilization |
Continues at non-Catholic campus for men & women.
Became available at former Catholic campus post-acquisition. |
Continues at non-Catholic campus for men & women.
Continues not to be performed at former Catholic campus. |
Was performed at both hospitals for men & women and continues to be provided at new medical center. |
Continues at district hospital for men & women. |
|
| Infertility Diagnosis And Treatment |
Continue at non-Catholic campus. |
Continue at non-Catholic campus. |
Continue not to be provided (low demand and specialists not available). |
Basic workups and treatment continue at district hospital.
Advanced treatment referred to specialists. |
|
| Abortion |
One abortion performed at non-Catholic hospital in last 10 years to save life of woman.
Abortions continue not to be performed at former Catholic campus.
Referrals provided to Planned Parenthood or system hospital 10 miles away.
Board has not addressed non-surgical abortions; perception is that provision of RU486 will be left to MD-patient relationship. |
2nd trimester abortions continue at non-Catholic campus in cases of fetal anomaly or for health or life of woman.
Abortions continue not to be performed at former Catholic campus.
Referrals provided to local providers of elective abortion.
Board has not addressed non-surgical abortions. |
Discontinued at former Protestant hospital after consolidation, by decision of new Board, except for life of woman.
Nearest provider 50 miles away.
No policy against abortion referrals.
Board has not addressed "mandated benefits" that include abortion or non-surgical abortion. |
Discontinued at district hospital after joint venture except for life of woman.
Abortion referrals made by hospital personnel to local providers.
Catholic system approved CME course on non-surgical abortions to be offered at district hospital.
Provision of RU486 will be left to MD-patient relationship. |
|
: The Ethical and Religious Directives for Catholic Health Care Services (National Conference of Catholic Bishops 1995).
