Dozens of people including patients, providers and current and former employees have weighed in on Oregon Health & Science University’s proposed absorption of Legacy Health, most of them to register their opposition.
It’s not unusual that many people submit comments to the state’s health care merger review staff to oppose large proposed mergers in Oregon. But as the state’s 180-day review of the transaction continues, the comments filed so far stand out somewhat in that they include a large cross-section of people involved in different aspects of health care — including many that work with or for the health systems involved.
Oregon Health & Science University’s proposed takeover of Legacy Health would result in a system that controls five out of six hospitals in Multnomah County and seven out of 13 hospitals in the Portland area, according to a preliminary review issued by the state last month.
Leadership of the two systems say the merger will benefit Oregonians and take advantage of their strengths, such as by filling vacant Legacy Health beds and easing wait times at OHSU. And several unions — SEIU Local 49, AFSCME and Oregon Nurses Association and Basic Rights Oregon have signed a joint letter of support.
But their application to the state concedes that, if approved, the merged system would not register a profit for years. And critics, including former Oregon Gov. John Kitzhaber, have argued the state should explore offering a bailout for Legacy Health rather than risk higher costs and less choice for health care consumers in Oregon.
The trial lawyers were quick to come out against, citing the limitations on lawsuit payouts that OHSU enjoys as a public agency, which would be applied to Legacy patients as well if the deal goes through. Also lodging their opposition were leaders of the United Food and Commercial Workers Local 555.
In addition to the unions, current and former employees submitted comments. They raised questions and concerns about how the system is working now — as well as whether the merger would help or hurt.
“I fear there will not be affordable options available, as there will largely be only two accessible health care systems, and that will further limit equitable health care access,” wrote Amy Dyer, a registered nurse at Legacy. “How can you have competitive pricing when there (are) only two options? The answer is, you don't. This merger would be detrimental to the health care options available to local residents.”
Mark Vorpahl, a technician active in the Service Employees International Union who’s worked for Legacy 16 years, wrote that the merged system “could streamline care more, and if one hospital filled up we can make arrangements with other hospitals more easily. I assume it will be more uniform and more expedient.”
He added, “I am also supportive of this deal because OHSU is vowing to make improvements to patient care while making binding commitments to be a quality employer. OHSU seems to recognize that you can’t provide care without people.”
But another Legacy employee, registered nurse Rebecca Scott, registered concern, noting that her workplace is located outside Oregon adding that its future is uncertain. “With the acquisition of Legacy by OHSU, the biggest concern is what is going to happen to Legacy Salmon Creek Medical Center? ... The employees are very nervous and concerned about the future of their workplace.”
Jessica McManus, co-owner of Amenda Clinic in Northeast Portland, opposed the merger. “This corporate takeover will ultimately worsen patient access, as we have already seen from their previous takeovers. As a small clinic that serves a high level of Medicaid patients we often rely on OHSU as the only place in our community to access high-level specialty care, and now we are being turned away and told our patients have to be in the OHSU network for their referrals to be accepted, which would force these patients to lose their existing providers. We have struggled to find other places to refer them, but Legacy has been a staple in our referral network.”
Darin Friess, a longtime surgeon at OHSU, wrote in support of the merger, saying “OHSU is ... supposed to serve as the point of care for complex patients with medical needs that cannot be treated elsewhere in the state. Access at OHSU is so critically short that not only can those cancer, trauma, cardiac and complex surgical patients not ‘get in’ to a bed at OHSU, but those patients waiting for access to care are now crowding out other patients who want access to OHSU for health equity or quality reasons. Legacy has available hospital beds and operating rooms at cheaper costs than OHSU building more buildings. Legacy also has a large number of primary care patients that cannot access specialty care that OHSU is ready to provide.”
Steven Wong, a certified nursing assistant in Legacy Good Samaritan, supports the merger, noting OHSU’s commitment to invest heavily in upgrading Legacy facilities while preserving employee pay. “It speaks volumes that they are willing to invest in staff members and invest in our future, which is also an investment in their own future.”
Mindy Palmer, a housekeeper at Randall Children’s hospital, wrote that “I clean the Isolette beds, the special beds where premature babies are given a safe, incubated space to stabilize and grow. It is a lot of work to clean these beds, and important too. While every job has its challenges, I like my job and the work that I do. Sometimes I worry about the transaction between Legacy and OHSU, but as long as I have a job, benefits, and the basics, I am not worried. Because of this, it is valuable to me that OHSU has put in writing and signed an agreement saying that we will be keeping our jobs, benefits, and that our pay will not be cut.”
Jennifer LeTourneau, a Legacy Health internist who’s worked in graduate medical education and has also worked at OHSU, wrote to express concern about the effects of mergers on cost and access, as well as medical education. “There is concern after the combination that the regional medical school and universities with health professions programs may lose their clinical rotation opportunities as OHSU would choose to utilize those opportunities for their own tuition-paying students. This is not a service to the state of Oregon as it severely limits the diversity of student opportunities and recruitment/retention of our health care workforce.”
William K. Dettwyler, a retired medical technologist, wrote that “one is a state agency and the other private, how can that be mixed and work efficiently? The size of the merger is also troubling.”
Rose Lee, an occupational therapist and long-time Legacy Health employee, wrote to oppose the merger, saying “OHSU’s recent strategies, including layoffs and cost-cutting measures, demonstrate a concerning trend where
financial considerations seem prioritized over employee and patient well-being ... Legacy has a culture of people first and I feel that OHSU prioritizes money first.”
Capella Lapham, a nurse practitioner at OHSU, wrote to oppose the merger, saying competition would help support workers, creating competition among employers. She said she also opposes the merger as a kidney transplant recipient, saying Legacy’s program offered more options. “I now am able to work full-time as a health care provider and professor of future health care workers. If I had to go through OHSU's program, I would still be on dialysis and waiting for a deceased donor match.”
She added, “I am a rural health care provider and I often face the challenge of referring patients for specialty care. Having another highly specialized hospital system in the state is crucial for my patients. At one time, OHSU's Urology Department would only see surgical urology patients and my uninsured patients needing "medical" urology care were forced to see local providers and pay out of pocket. At one time, the entire OHSU Cardiac Transplant team resigned en masse, this cost my friend a heart transplant. My friend who is currently fighting breast cancer waited for over a month to hear back on a referral for breast cancer treatment at OHSU, she was able to get into Providence within a week of her first call. It is essential for patient access to have alternatives for specialty.”
Rob Morgan, a physician and Legacy employee, wrote to “offer my tentative support to this merger. I believe that other competing for-profit health care systems are putting profits over patient care, and something must be done to correct this. While the OHSU- Legacy merger will certainly come with tradeoffs, we cannot afford (literally and figuratively) to let for-profit corporations come in and acquire more of our state's health care resources, and I fear this is what would happen to Legacy if it is not taken over by OHSU.”
Robert McKelvey, a retired OHSU professor who served as director of child & adolescent psychiatry there, wrote in opposition, saying “Hospital corporations are already too large, making the focus increasingly on money rather than patient care. Replacing the Legacy system with an enlarged OHSU will diminish competition in the Portland area and the state and likely increase the cost of health care for the individual patient.”
Kent Smith, a Legacy employee, wrote that “several dozen if not over 100 employees have already been impacted by positions being eliminated in preparation of this "merge" so that Legacy can meet a financial goal set forth by OHSU ... This is causing great distrust and fear amongst employees within Legacy as no one feels secure.”
Legacy doctor Andrew Dilla wrote in to oppose the merger, saying it “would create a juggernaut controlling more than half of the general acute hospital beds in the Portland metro area. Portlanders are lucky to enjoy a health care market with four large systems competing for their business and their employment. Disrupting this system with what could arguably be called a monopoly is likely to lead to higher costs for care and lower pay for health care workers, while disincentivizing quality of care. Legacy should explore other avenues of obtaining funding to continue providing excellent care and service to the community, while remaining independent.”
Individual providers concerned
Dr. Kate Ropp, an anesthesiologist, wrote that the merger could “cause such a disruption that patient care will be negatively impacted for months/years to come. With any major change, there are often multiple departures/resignations for a variety of reasons. Given the current backlog for multiple specialties, the loss of just one more specialist from the community may cause patients to wait up to a year to see a certain type of doctor.”
She added, “further, I worry that the strong sense of community-level care will be diluted by the academic tiered care of OHSU. While I appreciate the prospect of two local organizations banding together to protect from a private-equity buyout, I'm not sure how the combination of two financially struggling organizations will provide the security needed.”
Tina Castañares, a family physician and consultant, wrote, “The current leadership commotion at OHSU suggests it is an unpropitious time for such a major venture, and that the risk of potential monopolization (or at least market domination) of services is significant.”
Mike Axley, president of Oregon Anesthesiology Group, which serves Legacy patients, wrote in support of the merger, saying “this merger could potentially offer significant benefit to Oregonians and the Pacific Northwest region at large in terms of patient access, cost of care and quality of medical services.”
But he also expressed concern that independent practices be preserved, and suggested “guardrails” be put in place to ensure that.
Patients cite problems
Patients also weighed in.
“I am a senior living in Tigard OR. The only medical organization (corporation) who will accept me as a patient on Medicare is OHSU. The closest office is Hillsboro, a heavy traffic 30-40 min drive. Not easy when one is sick and old,” wrote Roxanne Overton. “If this merger means I can have a primary care doctor close to home, then please do it. It’s reprehensible that I have to pay premiums for services I can’t use where I live.”
Karen Koch, a patient at both health systems, wrote, “I would prefer to keep it separate. I get much faster, better, service from Legacy than I have ever seen at OHSU.”
Claudia Sieverling, a patient and rural Washington County resident, wrote that OHSU’s merger with Tuality means that “the Maple Street clinic is so understaffed that it is often 3 or 4 MONTHS before you can get an appointment to see a doctor. So, we go to the emergency room in Hillsboro (is a minimum 45-minute drive from where I live) for anything that is urgent. The e-room staff then say, ‘This isn't an emergency. Why didn't you go to your doctor?’ Small town medical services suffer when local, small (read: unprofitable) hospitals and medical facilities are shuttered. I fear that the same would happen with Legacy.”
Randall Hledik, a patient of Legacy Meridian Park Medical Center in Tualatin, wrote that “The care provided by the staff is excellent. ... We hope you will maintain the excellent service we count on.”
John Sears wrote to express concern about the impact on Legacy’s kidney transplant services.
“There are only three transplant teams in our market. This merger could effectively reduce that to two. My Nephrologist recommended I use Legacy for my transplant. OHSU has a reputation for being more selective in their evaluation process for transplants. This merger could reduce options for patients and overall market capacity for transplants.”
J Champie, a retired nurse and a patient of Legacy Medical Center and OHSU/Adventist Medical Center, expressed “concern regarding OHSU's ability to seamlessly allow patient access to physicians, medical reports and even patient access to communicate with physicians ... As OHSU's business umbrella covers more medical/hospital organizations it limits choices for: 1) health care over a widening geographical area, health insurance options, and, 2) empowers OHSU without strong oversight or assurances of continuity from current physicians/surgeons.”
To be honest, I have received very good health care from both institutions,” Gary Whitehouse wrote, “but I've found Legacy's providers more responsive to and focused on individual patient needs and preferences. I would not like to see Legacy get swallowed up by the bureaucracy that runs OHSU.“
Charlotte Shupert, another patient, wrote that “it may make economic sense to an accountant to combine two financially struggling institutions so that duplicative operational costs can be eliminated with cuts to staff and services. It makes no sense at all from the patient’s standpoint given that we are finding it next to impossible to get any kind of test or appointment in a timely way now. If Legacy and OHSU merge and services are cut, I will have to resort to scheduling next year’s mammogram on the way out of the office from this year’s visit.”