Chicago: A Case Study in Healthcare Market Consolidation

It was quite a morning for Evanston Northwestern Healthcare physicians as we heard from Mark Neaman, our President and CEO, about the rapidly-evolving healthcare market in Chicago. In his presentation, he chronicled the series of events that have lead to the changes seen so far in Chicago, and opened a glimpse of what’s to come.

Most of the news was old news:

1. He reviewed the financial struggles of Condell Medical Center in Libertyville from “contractual discounts” resulting in its suit with Blue Cross and subsequent countersuit of Blue Cross against Condell with the eventual withdrawal of Blue Cross patients from the Condell system. Condell bled so much red ink they were soon seeking a buyer as the economic impact of the situation became clear. (ENH looked at the opportunity, but Advocate was favored by Condell as their suitor),


2. The financial struggles and huge debt load of Rush North Shore, coupled with Rush Medical Center (downtown)’s desire to make a $1 billion dollar mega-expansion and ENH’s need for local geography, prompting ENH to bid for Rush North Shore, and


3. the newer alliance between Northwestern Memorial Hospital and its Northwestern Medical Faculty Foundation, making it a formidable competitor to the our financially separate ENH system as they also compete for market share in the desirable Northern and Western suburbs of Chicago – especially since they just bought 10 acres of prime real estate near I-294 and Willow roads, only 1 mile from ENH’s Glenbrook Hospital.

If the dust settles and the Federal Trade Commission approves, it is clear that the Advocate/Condell acquisition will compete with the ENH/Rush NS system, which will, in turn, compete against NMH/NMFF for the affluent patient population in Chicago.

Much of this healthcare system consolidation has been enabled by the emergence of the Electronic Medical Record that permits geographically disparate “virtual offices” to exist within a single healthcare system: it’s no longer which hospital or clinic you receive your healthcare from, but rather which “system.” The Mayo Clinic, with its satellite centers in Scottsdale, Arizona and Jacksonville, FL, has known this for years.

This has lead Evanston Northwestern Healthcare (ENH) to rethink their name and academic affiliation, since their tenuously amicable academic affiliation with Northwestern University has become seemingly irrevocably strained, limiting ENH’s ability to differentiate itself from its staunchest competitors (especially since its name contains "Northwestern"). For many reasons, it seems, the earlier 1994 academic affiliation agreement between Northwestern’s Feinberg School of Medicine is not likely to last much longer. While there were initial reports of an academic affiliation with Rosalind Franklin medical school, it was revealed today that ENH has recently entered into a 60-day agreement to evaluate a possible academic affiliation with the University of Chicago. This would be a represent a more formidable competitor to stem Northwestern's north suburban expansion.

Yes folks, our purple logo may soon change to maroon and the ENH 'brand' will likely cease to exist in the not-so-distant future.

All's fair in love and war when it comes to hospital systems, it seems.

It is important to note that these discussions are still ongoing, but public enough for them to have been announced to a significant portion of the ENH physicians today. Therefore, I suspect they are serious. Many questions remain unanswered. What this means to academic affiliations for ENH’s “affiliate” physicians, physician academic benefits, and the like, are uncertain. Clearly, ENH has a vested interest in maintaining its hard-earned physician affiliations and will be working to resolve these issues once the air clears a bit about our future.

While change is difficult, it seems necessary if ENH is going to continue its own growth strategy while the market forces evolve in Chicagoland. One thing is certain, though, the competitive climate between centers is more feverish than ever and change, it seems, is inevitable.

Perhaps on a broader note, other cities across America are likely to see the same forces toward consolidation, especially as the electronic medical record facilitates geographic spread of hospital system brand identity. It is clear that many doctors will increasingly become reliant on large healthcare systems to weather the economic impact of the threatened 10.1% Medicare physician pay cut in July, the ongoing unrealistic bureaucratic requirements for pay for performance measure documentation, the ongoing lack of tort reform, and increased work requirements by staff physicians to offset the upcoming resident work hour reductions from 80 to 56 hours per week.

-Wes