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Ripples from All Children's-Johns Hopkins merger could touch many

ST. PETERSBURG — The news that All Children's Hospital is becoming part of Johns Hopkins Health System has caused a major splash in the Tampa Bay area medical community.

Who's going to feel the ripples?

Will the entry of the prestigious Baltimore university and medical system, home to Nobel Prize winners and the nation's top-ranked hospital, cast a shadow on other nonprofit hospitals here, drawing donors like moths to a flame?

Will the Johns Hopkins' alliance drain patients from other local hospitals' pediatric wards?

Will new bosses from Baltimore make major changes among managers and physicians on the staff in St. Petersburg?

Sick kids and their parents appear to be the clearest winners of the surprise announcement Tuesday that merges the area's top children's hospital with a national leader. But even those benefits won't go much beyond branding initially. It could be years before rewards from expanded joint research efforts result in better patient care.

Like a couple — one better-looking and five times as rich — working on a relationship, Johns Hopkins and All Children's are pairing up while onlookers anxiously await the outcome. Joshua Nemzoff, a hospital acquisitions specialist from New Hope, Pa., said nobody should have any illusions about the result, expected to be finalized by year end.

Regardless of how many local members are on All Children's board, if Johns Hopkins is assuming responsibility for the hospital's debt — which it is — it will gain control of the operation, Nemzoff said.

"It's an acquisition," he said, saying the Baltimore group is assuming about $240 million in debt in exchange for a hospital with about $200 million in cash on its balance sheet. "In essence, All Children's is giving its hospital to Johns Hopkins for nothing. But if you're going to give up control to somebody, you may as well give it up to one of the finest medical centers in the world."

Though doctors who have sold their practices to All Children's and have become its employees are reportedly nervous about being replaced by Johns Hopkins, Nemzoff said after three decades of handling hospital acquisitions, he's never seen widespread physician turnover.

"There's always a worry that academic medical centers are going to come in and look at the local medical staff and say they don't know what they're doing, but nothing could be further from the truth," Nemzoff said. "They're not going to replace anybody; they're just going to expand on the good work these physicians are already doing."

The same assurance was given by Gary Carnes, All Children's president and chief executive. But Dr. James Orlowski, chief of pediatrics at University Community Hospital in Tampa, has heard anxious comments from fellow physicians. "Johns Hopkins will have more say (on staff decisions) than Gary Carnes will have," he said.

Orlowski said that when Nemours, a children's health system founded by Alfred duPont, expanded from Delaware into Orlando and Jacksonville, it brought down many of its own physicians to the consternation of local doctors.

But Jay Wolfson, a professor at the University of South Florida's College of Public Health, said the alliance between Johns Hopkins and All Children's will be less disruptive. "Nemours was building a new organization from the ground up," he said. "This is All Children's getting to use a brand name and creating a portal to southern and Central America for Johns Hopkins. It's a new model."

Wolfson thinks doctors, as well as his employer, USF, will be able to navigate new relationships with Johns Hopkins.

"Organizations are amenable to mixtures of relationships that would not have been doable a few years ago," he said.

The reason: money. With Medicaid cuts coming and the health reform bill affecting how and how much providers will be paid, everyone's looking for ways to reduce costs.

Even Michael Aubin, who runs St. Joseph's Children's, the Tampa hospital that might be expected to feel the biggest impact from the new alliance across the bay, sees benefits from the arrangement. If more research is conducted locally by Johns Hopkins, he hopes his hospital can collaborate. If more pediatricians are trained at All Children's, he thinks it will help meet local demand. And the allure of the Johns Hopkins brand?

"All Children's has a very good brand right now," said Aubin, whose hospital has 174 beds, compared to All Children's 259. "But we're in a very different geographic area with a lot of kids. We'll focus on those areas where we're strong clinically and see what happens."

Nemzoff, the hospital merger specialist, says parents will go out of their way to have their children treated at a Johns Hopkins affiliate. "I'd be very nervous if I were at St. Joseph's," he said.

Amid the uncertainty, All Children's wants to be sure major donors, who were given early notice of the Johns Hopkins plan, keep giving. Craig Sher, a member of All Children's board, said people will be able to fund more interesting research and faculty chairs than was possible at a freestanding hospital.

"Why wouldn't they want to go with the best?" he asked.

Kris Hundley can be reached at or (727) 892-2996.

Ripples from All Children's-Johns Hopkins merger could touch many 07/21/10 [Last modified: Thursday, July 22, 2010 12:36am]
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