George Boardman: Dignity Health merger is about who calls the shots on your medical care |

George Boardman: Dignity Health merger is about who calls the shots on your medical care

George Boardman

Management was quick to reassure our community that nothing will change at Sierra Nevada Memorial Hospital after its owner, Dignity Health of San Francisco, completes a merger with Catholic Health Initiatives sometime in the second quarter of this year.

Management always says that when mergers and acquisitions occur, and they're probably telling the truth, at least superficially. The facility will look the same and the same people will be working there. The name won't change and "there are no current plans to close any facilities," according to the announcement of the merger.

But this merger is all about who gets to decide where and how you get your medical care. Unless Grass Valley is somehow protected from trends that are impacting everybody else, it probably means you'll get less of your future care in a hospital setting and more of it in clinics, doctors' offices, surgery centers and even drug stores.

"Right care, right place, right time, for the right reason, at the right cost," said Sheryl Skolnick, an analyst at Mizuho Securities. "High-cost inpatient facilities are the loser, oftentimes, in that scenario."

Hospitals have been experiencing a slow bleed since 2009, when hospitalizations began to drop. That was influenced by the recession and was reversed for a couple of years with the introduction of Obamacare. But hospitalizations declined in 2016 despite an aging population, down 0.6 percent, or 229,000, according to U.S. Census Bureau estimates.

Hospitals have responded by rapidly expanding outside their facilities, investing in outpatient surgery centers, occupational-health clinics and urgent-care centers. Surgery centers tend to be located in large population centers where they can serve a lot of people efficiently, which means you have to travel farther away from home.

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We should be thankful we're relatively close to the Sacramento area. I recently picked up a friend in Roseville, where he spent most of the day at an outpatient surgery center that treats nothing but skin cancers. He told me a couple of the patients he met had driven down from Reno and Redding.

Hospitals are also responding by bulking up through mergers and acquisitions, a trend that has accelerated in recent years. A total of 102 mergers or acquisitions of hospitals and other health care providers were announced in 2016, and even more than that were expected to take place in 2017, according to industry management firm Kaufman Hall.

Managed care companies such as Humana, which is in the process of purchasing a stake in the home-care and hospice operations of Kindred Healthcare, are moving deeper into the business of delivering health care outside of hospital walls. Among other things, they are seeking to squeeze out costs by speeding up the decline of hospital use.

CVS Health Corp. wants patients to stay out of emergency rooms and get more of their treatment at revamped, upgraded drug stores. CVS' pending purchase of health insurance giant Aetna will give it move leverage in negotiating drug prices, the same reason Walgreens wants to merge with Rite Aid.

As you would expect, the federal government also plays a role in the changes. About one-third of Medicare recipients are now in Medicare Advantage plans offered by insurers like UnitedHealth and Humana, giving them greater influence as they move care away from hospitals and try to drive down costs.

Lloyd Dean, CEO of Dignity Health, described the merger with CHI in part as a response "to the evolving health care environment." No kidding.

Not another one!

The MLK holiday was a slow news day in Sacramento, which probably explains why two guys with another plan for splitting up California received a lot more media coverage than they deserve.

This time it's "New California," 42 counties in northern and eastern California containing some 15 million people that will be split off from coastal California, creating a blue California and a red California.

"Well, (California's) been ungovernable for a long time," said movement co-founder Robert Paul Preston. "High taxes, education, you name it." Preston claims to have representatives across the state and will be organizing in the next 10-18 months before approaching the state Legislature to initiate a split.

Preston cites Article IV, Section 3 of the U.S Constitution, which allows for a state to be formed from another state with the consent of the original state legislature and permission of the U.S. Congress. That is how West Virginia was created.

This actually makes more sense than the State of Jefferson movement, which would create a new state out of the counties north of us. It's been clear to anybody who's been paying attention the last 20 years that the real political divide in the Golden State is east and west, not north and south.

It remains to be seen if New California and the State of Jefferson can unite in a common cause, but it's clear the Jefferson movement is going nowhere. It didn't even rate a mention in the media coverage I saw, which referenced the aborted "Cal Exit" effort shortly after Donald Trump was elected.

Meanwhile, the Shasta County Jefferson Committee fired off an email posing a simple question" "Confused? New California. Three States. Cal Exit." They promise to tell people who attend a meeting tonight in Shasta "what's really going on."

New California will pass, but maybe they can come up with a better-looking flag than that ugly thing the Jeffersonians like to parade around.

George Boardman lives at Lake of the Pines. His column is published Mondays by The Union. Write to him at

Observations from the center stripe: Pot town edition

CAN NEVADA CITY (population 3,100) really handle three pot dispensaries and two manufacturers, while Grass Valley (population 13,000) has no marijuana businesses? … JERRY BROWN, who has spent most of his adult life in elected office, will retire to Colusa County when his current term as governor ends. Don’t be surprised if he runs for the county Board of Supervisors … DIANNE FEINSTEIN, who has been criticized by progressives for being soft on Donald Trump, got a boost from the president when he referred to her as “sneaky Dianne” for releasing transcripts of some testimony … ITS REMARKABLE how so many of Trump’s partisans didn’t hear what he was saying at that DACA meeting …

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