Sunnybrook in merger talks with rehab centre

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Sunnybrook Health Sciences Centre is in merger talks with a rehabilitation centre, as cost pressures unleash a wave of consolidations among hospitals struggling to move patients through the system and free up beds.

Sunnybrook and St. John's Rehab Hospital said in a joint statement to employees on Tuesday that their boards of directors are exploring how a closer partnership could provide benefits to patients. The talks, they said, could lead to a merger.

The talks are the latest example of hospitals working in closer collaboration with rehabilitation centres. Funding that fails to keep pace with spiralling costs and a shortage of beds are forcing hospitals to fundamentally rethink how they can move patients more seamlessly and, at the same time, use their financial resources more efficiently.

University Health Network and Toronto Rehabilitation Institute announced in April that they are integrating their operations. UHN also provides information technology services for 14 hospitals, including Toronto Rehab and St. John's. St. Michael's Hospital recently reached a deal to share its chief information officer with Bridgepoint Hospital.

"Institutions are talking in ways they've never talked before," Robert Howard, chief executive officer of St. Michael's, said in an interview.

But these efforts do not address the underlying problem. Canada has not transformed its health-care system to meet the needs of an aging population. Hospitals are on the front lines of this troubling trend. Many of their acute-care beds are full of elderly patients who are not able to leave simply because they have nowhere to go.

With a shortage of community-based care, acute-care beds in hospitals have become the "default place" for many elderly patients, said David Walker, professor of emergency medicine at Queen's University and head of an Ontario government-appointed group examining the challenges of providing care to elderly patients.

"There's a large number of particularly frail, elderly patients in the wrong place," Dr. Walker said in an interview.

Ontario Health Minister Deb Matthews acknowledged in a speech on Tuesday that keeping a patient in hospital who should be receiving treatment in the community is the most expensive way to deliver health care. Ms. Matthews praised the local health integration network of Toronto for avoiding about $27-million in spending by recently finding alternate care for 37 patients who had been hospitalized for as long as 10 years.

"Now that is what I call getting value for money," Ms. Matthews said in her speech to the Economic Club of Canada.

Hospitals are under tremendous pressure to discharge patients to the appropriate care, whether it's to rehab, a long-term care facility or their own home. Barry McLellan, chief executive officer of Sunnybrook, said in an interview that the hospital can do a better job of getting patients into rehab through a closer partnership with St. John's.

The two hospitals have a long-standing relationship. St. John's, Ontario's second-largest rehab hospital with 154 beds, treats many burn and stroke patients from Sunnybrook. The rehab hospital also developed a program three years ago for oncology patients at Sunnybrook.

The merger talks, Dr. McLellan said, are a logical extension of that relationship. "This is all about improving the quality of patient care," he said.

Robert Bell, chief executive of University Health Network, said he expects to reduce administration costs by integrating with Toronto Rehab. Any savings, he said, will be reinvested in front-line health-care services.

Toronto Rehab treats patients from seven hospitals in Toronto, including the three that comprise University Health Network. Dr. Bell said the integration will help hospitals begin the rehab process as soon as patients coming into emergency are stable. Patients who begin rehab sooner tend to recover faster, he said, allowing them to spend less time in an acute-care bed.

St. Michael's Dr. Howard said this is all about providing better care with less money at a time when hospitals' costs are rising about 4 per cent a year but their funding is increasing by only 1.5 per cent. "You've got to start to find creative ways to get the work done," he said.