After waiting nearly a month for a formal reply to his proposal from UPMC, West Penn Allegheny Health System CEO Christopher Olivia said he decided to up the ante yesterday.
In full-page ads in the Pittsburgh Post-Gazette and the Pittsburgh Tribune-Review, Dr. Olivia offered to treat any UPMC Health Plan patients in the Monroeville area at his system's Forbes Regional Campus, as long as UPMC cancelled its plans to build a new hospital about a mile away.
And, the ads suggested, the $250 million that UPMC would save by shelving the new Monroeville hospital could go toward keeping open UPMC Braddock, which UPMC announced it would close at the end of January, and the nearby UPMC McKeesport.
While Dr. Olivia said UPMC's board never responded to his private offer, UPMC's public answer came swiftly enough yesterday.
First, UPMC spokesman Paul Wood asserted that the health system's board had never received a proposal from West Penn Allegheny.
Then, referring to an antitrust lawsuit that West Penn Allegheny had filed against UPMC, Mr. Wood added:
"As with the recently dismissed federal antitrust lawsuit, we suggest West Penn Allegheny Health System focus on their own grave financial difficulties and operational failings rather than proposing to eliminate the competition they sued to preserve."
To some, Dr. Olivia's ad blitz might seem like just the latest volley in a public relations war between the region's two largest health systems.
But he said the proposal was sincere.
When UPMC officials sought zoning approval for a new hospital of more than 100 beds on Route 48 near the intersection with Route 22, they argued that about 80 patients a day were traveling to UPMC hospitals in Oakland and Shadyside because they didn't have a facility near their homes.
If that's the case, Dr. Olivia said, his system would be willing to contract with UPMC to serve its health plan subscribers at Forbes.
But Mr. Wood said that the patients traveling to use other UPMC hospitals are actually covered by a variety of plans, and that the offer to cover UPMC Health Plan members is "a red herring."
And he insisted that UPMC has no plans to close UPMC McKeesport, which, like the Braddock hospital, serves a lower-income population in the Mon Valley.
Instead, Mr. Wood said UPMC plans to shift some psychiatric care beds and employees from Braddock to UPMC McKeesport, which will strengthen that hospital. Similarly, alcohol and drug treatment beds that are at Braddock will go to UPMC Mercy, shoring up that facility, he said.
Dr. Olivia said he was not trying to tell UPMC how to run its health system. "You haven't heard me make negative comments in the press about UPMC because that's not what I'm here to do," he said.
"But," he added, "if you're going to withdraw services from a poorer community [Braddock] and put them in a more affluent community [Monroeville], you have to ask: Is that the best use of charitable assets?"
After all the back and forth yesterday, there were two questions that neither Mr. Wood nor Dr. Olivia would answer.
Do they believe that only one hospital can survive in Monroeville, and do they believe the residents in that area need two hospitals?
Those are the kinds of questions that were once considered by federally authorized health planning groups known as Health Systems Agencies.
In the late 1970s and early 1980s, those agencies made recommendations on any plans to build major new health care facilities or open new clinical programs.
But after Republicans took over the White House, the Health Systems Agencies were ended in the mid-1980s.
After that, the only official oversight on new hospitals or clinics came from the state Health Department, which had to issue a "certificate of need" for any major new facility.
Then, even that limited check on hospital expansions ended in 1996, when the state Legislature failed to renew the authorizing legislation.
Beaufort Longest, director of the Health Policy Institute at the University of Pittsburgh, said he would not want to go back to the days of the Health Systems Agencies.
"We went down that road of centralized planning and it did not work and the law that authorized it was repealed," he said.
On the other hand, Dr. Longest said, the current system doesn't work well either. "What we need is a health care market that actually works, where citizen opinion and input is taken into account as one of the variables that drives these kind of decisions."
Dr. Longest said he favors doing a better job of educating hospital boards of directors about their obligations to serve the entire community and take the whole health care system into account when they consider new buildings or programs.
"I think little by little we're beginning to see boards begin to think that way," he said. "I think there are serious board education programs going on elsewhere in the country where the idea is to help boards have a broader perspective on the health care system."
Dr. Olivia said there is one other type of restraint that has been used in some cases around the nation: action by attorneys general.
As the state officials who oversee charitable organizations, he said, some attorneys general have sued hospital systems over proposals to close facilities in poor communities or make other changes that might hurt the residents of a region.
Such lawsuits have been filed in New York, California and other states. Dr. Olivia said West Penn Allegheny has not asked the Pennsylvania attorney general's office to look at any UPMC decisions.
Mark Roth can be reached at firstname.lastname@example.org or at 412-263-1130.