“Well, Mr. Hanke,” Romey said, “I’m afraid those days are coming to an end. Look at your last five years. Every year your volumes have dropped, and so have your margins. Allyson has tried to keep up through cost-saving measures, but it’s like swimming against the tide.”
Romey glanced over at Allyson, who kept up her stoic expression, making it hard to gauge if she was going to go off script or not.
“If you don’t jump on the ACO bandwagon now,” Romey continued, “while the terms are favorable, a larger provider is going to come here and gobble you up and take all the profits with them. There is a premium I’m willing to pay for early entry. Further down the road another player, I’m afraid to say-even White-might not be so generous. And that day is coming sooner rather than later. Your own balance sheet is red flag enough.”
A moment of silence allowed reality to sink in.
“How would you envision this moving forward, Mr. Janowski?”
Romey sensed that Vince Hanke would still take more cajoling. Change did not come easy to anybody, but at the end of the day, money was the motivator for everyone at this table.
“I want to start tomorrow by entering into a management agreement with you,” Romey said. “White Memorial will send over a temporary CEO who will begin the process of converting your hospital to the ACO model. And I will begin the transfer arrangements for your patients who would be better served at our larger facility. Your rehab patients make a good place to start.”
“What about our medical staff?” Dave Craig sounded angry, with good reason. A gastroenterologist and chief of the medical staff, he would bear the brunt of the upheaval.
“During the transition, your staff would practice just as always. As we move things along, we will train your physicians in the White ACO way of doing business. They’ll learn how to integrate their treatment plans with the network available to them. We’ll teach them how to move patients through our continuum of care, and by doing so minimize the cost of that care while maximizing the quality. I am certain that when your doctors realize the payback from risk-sharing with the feds and other insurers is robust, they will be happy to participate in this new system. Higher profits for you should trickle down to your physicians. This is a win for everyone involved.”
“What if our patients don’t want to go to the city for care? White Memorial hasn’t always had the best reputation.” The dissenting voice came from Rabbi Sarah Gertz, who represented the interests of the labor unions and members of the community at large.
“Ah, bad reputations live longer than they should, and new ones take a long time to get started,” Romey said. “There is the old White Memorial under the old regime, and the new White Memorial under my direction. I think you’ll find quite a difference between the two. Certainly we cannot force a patient to use White, but we count on word of mouth from the patients who do use the facility, and we offer a wide range of amenities to convince them to come back to us if they must. Once a person has been to White, will they spread the word? I’m betting a lot of capital on this arrangement that the answer will be yes.”
“And our employees? What about Allyson?” Vince Hanke glanced over at Allyson, who looked increasingly uncomfortable in her seat.
Yes, what about her? Romey thought.
“Allyson and I have discussed this arrangement in great detail,” Romey said. “All of the numbers are in the packet we provided for your review. She has gone over them carefully, as has your CFO. Allyson will of course assist with the transition effort as co-CEO, and we’ll jointly manage PR to make sure the right messages are sent to the community, hospital staff, and to your patients. Naturally, we’ll reevaluate Allyson’s role and position with Suburban West once the transition effort is complete.”
Vince fixed Allyson with a peculiar stare. “Allyson, is this true?”
Allyson straightened her suit and cleared her throat. Maybe it was only Romey who could see the strain in her eyes, who noticed her wan complexion. This was the moment of truth, and Romey felt a kick to his heart. If Allyson defied him, he would destroy her.
“Financially, this deal favors the board and the patients of Suburban West,” Allyson began. “As a board member, and hospital CEO, I have a fiduciary responsibility to recommend what is in the best interest of Suburban West and its stakeholders.” Allyson turned her head to look Roman Janowski squarely in the eyes. “Therefore, I recommend Mr. Jankowski’s proposal without reservation.”
Romey let go the breath he had been holding and finally took a drink of water. All that talking had left him feeling parched.
CHAPTER 23
It was a crisp autumn afternoon in early November, three weeks after Sam’s death. Most of the leaves had escaped from their branches and the slate-gray sky held the stark promise of winter. Parents and friends on the sidelines watched the soccer game, draped in heavy coats and scarves. Some were cocooned beneath blankets pulled over their lawn chairs.
Julie knew most of her fellow spectators by name, but the soccer field was where their orbits collided. She stood next to Paul, who sipped hot coffee from a thermos. The game was almost over. The score remained a one-to-one tie.
Julie felt good to be doing something other than working or continuing her search for an expert’s opinion on Sam’s death. She held out hope that an expert would emerge from the shadows soon enough. With Michelle’s help, they had posted Julie’s inquiry on the most trafficked blogs and medical message boards. That seed-scattering approach should eventually bear fruit.
Right now, though, it was all about the game.
The left wing’s pass to Trevor came as a perfect feed between two defenders. Trevor, patient and aware, waited until the first defender committed to the ball before he made his cut. Julie squeezed her hands together as the excitement built in her chest. The rest of the crowd, some twenty-odd spectators, must have felt it as well, because their collective voices rose to a fever pitch.
Matt Davis, the father of one of the midfielders, shouted, “Shoot!” so loud that Julie jumped a little. But Trevor did not fire off a rocket like he could have. A defender had quickly closed in and any shot Trevor took would most likely have been deflected.
Instead, Trevor pulled the ball back with his foot, then a scissor move, before cutting hard to his left. To Julie’s adoring eyes, Trevor looked like The Flash dressed in his red uniform. Showcasing deft footwork, Trevor maneuvered the ball to his left foot as two defenders in white uniforms encroached on the ball with speed. Trevor’s window of opportunity was closing fast.
Riverton Academy, a private school in Cambridge with 350 students in grades six through eight, prided itself on academics and athletics. The boys’ and girls’ soccer teams were the crown jewels of its sporting programs. Trevor had plenty of natural ability, but he’d lacked the drive to be more than a role player for the Riverton Hawks middle school team.
Since Sam’s death, however, Trevor seemed to have found his wheels. The last game had been his first as a starter. He still had zero goals on the season, but that could change if he took the shot.
“Shoot, Trevor!” Paul yelled.
Julie sucked in a breath as her body tensed. How was it that a kids’ soccer game got her nerves jangling like a code blue?
Trevor feigned a cut to his right, swung back his left leg, and brought it forward with speed. The ball shot off the ground with velocity and immediately gained height. It passed between two defenders without deflection and was on a trajectory to hit the upper right corner of the goal. Julie’s hands went to her mouth.