City finances: hospital & refuse collection

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Jim O'Bryan
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Re: City finances: hospital & refuse collection

Postby Jim O'Bryan » Tue Jul 14, 2015 9:12 pm

Tim Liston wrote:Though I do know that every Lakewood public official who has tried to participate has been run off this site. Plus previous Directors of LakewoodAlive.


That is an utter lie, Tom George still posts, Marking posts, Favre posts, even Kevin Butler
posts, though has little he can speak about now. Ian Andrews posts, Alisson posts,
Ken posts, even FitzGerald posted before going to county. Slindell posted, Dan
O'Malley just signed up and plans to use the Deck.

The past directors of LakewoodAlive were told by their board not to post because they had a
tendency to "blow up" and "misstate things." You going to hang that on the LO? Really?

Tim to be honest, and I will bring the threads back, old LakewoodAlive, Jay and Mary Ann
were caught time and time again let's just say flying pretty loose with the truth.

The Deck is a terrible place for liars, they are always found out.

Jenn Pae is tough and honest, she'll be back, on her terms, the LO way.

As for the concept, "Like asking when did you stop beating your wife?" The answer is
obvious, "I never started." There is always an answer.


.


Jim O'Bryan
Lakewood Resident

"The very act of observing disturbs the system."
Werner Heisenberg

"If anything I've said seems useful to you, I'm glad.
If not, don't worry. Just forget about it."
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Michael Deneen
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Re: City finances: hospital & refuse collection

Postby Michael Deneen » Tue Jul 14, 2015 9:26 pm

Tim Liston wrote:Though I do know that every Lakewood public official who has tried to participate has been run off this site. Plus previous Directors of LakewoodAlive.


To be fair, Tim, you've done your share of "running off".
You and Bill are historically the toughest questioners on the board.

A few months ago Christine Gordillo made an innocuous post about some award, and you ambushed her with totally unrelated complaints about taxes.
I'm not complaining...it's fair to question public officials that post here.

That's why so few of them participate...they don't want to get dragged into discussions where they can get caught in a gaffe.
They tend to arrive only when they need votes, then disappear after the election.


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Jim O'Bryan
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Re: City finances: hospital & refuse collection

Postby Jim O'Bryan » Tue Jul 14, 2015 9:46 pm

Michael Deneen wrote:
Tim Liston wrote:Though I do know that every Lakewood public official who has tried to participate has been run off this site. Plus previous Directors of LakewoodAlive.


To be fair, Tim, you've done your share of "running off".
You and Bill are historically the toughest questioners on the board.

A few months ago Christine Gordillo made an innocuous post about some award, and you ambushed her with totally unrelated complaints about taxes.
I'm not complaining...it's fair to question public officials that post here.


Mike/Tim/All

The Lakewood Observer has always been a put up or shut up project, in every form, online
and in print. It is not always for the weak of heart, but elected officials should not be
weak of heart.

There is an interesting trade off, large audience depending on topic, but it is here forever
so can come back to haunt you, and you cannot control the room and the message. Usually
variable facts win the day, example the picture of the "Downtown Logo" in print 3 months
before the committee was formed to discuss the idea and come up with it. Of course that
looks bad and the person is embarrassed, and leaves. Is that the LO's fault?

Jenn Pae made it clear she was signing in as a resident. I believe this is to allow her more
opinion, which is what the LO is based on, and a slight relaxation of some of the legalities
of her position. Jenn is a good enough Lakewoodite, I can give her room.

Actually I suggested Christian Gordillo to the School Board caused she loved arguing
with me, and setting me straight. As long as I have known Jenn Pae, she is a hard core
Lakewoodite, loving mother invested in the community on many levels. She can also
handle her own, and kick my ass probably physically too.

But then, if she puts it out, it is part of the conversation and the record, right?

Sometime we are all light on the facts, but it is the most honest 12 year conversation in
this City, and for that matter, most cities! I am thnakful for all that take part.

Carry on kids, someone just jumped in the Lake I have to go!

.


Jim O'Bryan
Lakewood Resident

"The very act of observing disturbs the system."
Werner Heisenberg

"If anything I've said seems useful to you, I'm glad.
If not, don't worry. Just forget about it."
His Holiness The Dalai Lama
Jennifer Pae
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Re: City finances: hospital & refuse collection

Postby Jennifer Pae » Wed Jul 15, 2015 4:59 am

Bill Call wrote:
Jennifer Pae wrote:My biggest fear as Finance Director as it relates to the Lakewood Hospital situation is the City having to bring the properties back on its books. ~ Jenn


Why would you fear that?

If the hospital closes, the $50 million in Hospital assets, the $30 million in Foundation assets and all the land and office buildings become city property. The LOI calls for the City to pay for demolition and site preparation and take possession of that property already.

Remember that the LOI is a proposal, and for those of you who haven't read it here is the link: http://www.onelakewood.com/pdf/Lakewood ... al_LOI.pdf

In this proposal, the City gets the remainder of the Lakewood Hospital site after the hospital building is demolished (paid by LHA & CCF) and the FHC is built, and the City would also get the parking garage, the two professional buildings, and the homes. The City would not get the Lakewood Hospital Foundation monies, as mentioned in the LOI, but would go to the new community wellness foundation.


The expired LOI calls for the very scenario you are afraid of.

There is a lot in the LOI that I'm not a fan of especially the City getting those properties. The concept of shifting the Clinic's proposed FHC to the westside of Belle remedies those concerns. Stay tuned on this topic.

Why are you afraid of the City taking back possession of 7+ acres of downtown property?

I'm afraid of the City taking back, owning and maintaining a parking garage, two professional office buildings and a handful of residential homes. I'm not afraid of downtown property that can be redeveloped for highest and best use without the City responsible for demolition and site prep.

Why are you not afraid of losing 1,000+ jobs?

I am afraid of this, which is addressed in my April 20th COW report. It is definitely a hit to the City, but there are remedies in the LOI and hopefully more can be negotiated to assist the City with these losses

The proposal as outlined in the expired LOI and Mayors letter to the City would close the Clinics facility on Madison and facility on Detroit and move those doctors to a new site prepared by the City. The City loses a hospital and the Clinic consolidates its current offices in one office on a prime piece of downtown real estate.

Why aren't you afraid of that?

I believe those are Clinic owned properties, and not LHA's, so there is not much the City can do about the Madison and Detroit medical offices. This will hopefully be part of the negotiations too.

This site has a nice graphic illustrating the economic multiplier affect of medical employment:

http://www.aha.org/content/11/11econcontrib.pdf

According to their research hospital employment has a 2.2 multiplier affect around the local community. How will the City make up that lost activity? The only proposals so far call for a recreation center.

Here is what I posted on the Buzz regarding the recreation center discussion:

I think one of the unfortunate outcomes of the community dialogue is idea that the hospital is going to be torn down and a city run recreation center will be built in its place. That hijacks the conversation.

First, I want to say, what is so bad about a rec center? It is an asset to many communities and benefits the wellness of a city's residents, and I'm sure there are a lot of people in Lakewood that would like one.

Apparently a recreation center concept was discussed by LHA as a potential option for the hospital site, and Section II.O of LOI from LHA and Clinic leaves open that possibility.

However, with all of that being said, I personally do not support the construction of a City-run recreation center at Lakewood Hospital site. I would like to see the highest and best use of the land if the hospital is no longer viable.

Like you mentioned with Winterhurst, the user fees covered the cost of operations, but there were not sufficient revenues to cover the significant capital needs for the facility, and tax dollars were needed to cover those expenditures.

This is what municipal recreation centers run into. They may be "profitable," but typically not profitable enough to cover the capital needed to build and maintain it.


What is the economic benefit of a recreation center?

See my comment above

City officials in Cleveland are enthusiastic about MetroHealth's expansion on W25th:

http://www.crainscleveland.com/article/ ... 5th-street

The Hospital expansion will revitalize an entire neighborhood.

MetroHealth is significantly challenged in how it is going pay for its plans. It and the County are maxed out on the ability to issue new debt. Metro was able to borrow $75million in Build America Bonds in 2010 at a very high interest rate: http://www.crainscleveland.com/article/ ... l-projects, and it is spending those dollars on projects on W.25th and throughout Northeast Ohio.
Metro's ability to finance future projects is sketchy at best, and that was my biggest concern with their ill-fated proposal to LHA


In Avon the Mayor and other officials have bragged often about the hugely positive affect the new hospital will have on their community.

What do they know that we do not?

Yep. That sucks, and the worst smack in face for Lakewood


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Re: City finances: hospital & refuse collection

Postby marklingm » Wed Jul 15, 2015 10:24 am

Jennifer Pae wrote:According to their research hospital employment has a 2.2 multiplier affect around the local community. How will the City make up that lost activity? The only proposals so far call for a recreation center.

Here is what I posted on the Buzz regarding the recreation center discussion:

I think one of the unfortunate outcomes of the community dialogue is idea that the hospital is going to be torn down and a city run recreation center will be built in its place. That hijacks the conversation.

First, I want to say, what is so bad about a rec center? It is an asset to many communities and benefits the wellness of a city's residents, and I'm sure there are a lot of people in Lakewood that would like one.

Apparently a recreation center concept was discussed by LHA as a potential option for the hospital site, and Section II.O of LOI from LHA and Clinic leaves open that possibility.

However, with all of that being said, I personally do not support the construction of a City-run recreation center at Lakewood Hospital site. I would like to see the highest and best use of the land if the hospital is no longer viable.

Like you mentioned with Winterhurst, the user fees covered the cost of operations, but there were not sufficient revenues to cover the significant capital needs for the facility, and tax dollars were needed to cover those expenditures.

This is what municipal recreation centers run into. They may be "profitable," but typically not profitable enough to cover the capital needed to build and maintain it.


What is the economic benefit of a recreation center?

See my comment above



Thank you for your post, Jen.

I take exception with the comment that the "idea that the hospital is going to be torn down and a city run recreation center will be built in its place ... hijacks the conversation."

In fact, the idea that the hospital is going to be torn down and a city run recreation center will be built in its place has always been part of the conversation between Mayor Michael P. Summers and his Administration.

As you even admit in your post, "[a]pparently a recreation center concept was discussed by LHA as a potential option for the hospital site, and Section II.O of LOI from LHA and Clinic leaves open that possibility."

So, there is no hijack here.

The discussion of the City taking over the Recreation Department and creating a City recreation center was first raised by City Council leadership and the Summers Administration, respectfully.

It is still part of the discussion unless City Council, the Summers Administration, and LHA are going to affirmatively state that those two issues are now off the table, forever.

Again, thanks for the post.

Matt


m buckley
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Re: City finances: hospital & refuse collection

Postby m buckley » Fri Jul 17, 2015 7:16 pm

Metro's ability to finance future projects is sketchy at best, and that was my biggest concern with their ill-fated proposal to LHA - Jennifer Pae


I am trying to understand this. Are you saying that MetroHealth does not have the capacity to operate Lakewood Hospital and would be unable to follow through on the proposal to LHA? Are you suggesting that is why LHA and Mr. Summers ignored their proposal? Also - how does this imagined failure compare to the Cleveland Clinic's (which clearly has lots of capital at its disposal) actual failure to make the capital investments it agreed to make in Lakewood Hospital?

And can you please explain your response to Mr. Call's question about Avon? He asked what Avon knows that we do not, given how much they are applauding the hospital there and the economic growth it will bring. You replied:

Yep. That sucks, and the worst smack in face for Lakewood.


Do you mean that it "sucks" that they are pointing out that they are gaining a huge asset at our expense?


" City Council is a 7-member communications army." Colin McEwen December 10, 2015.
m buckley
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Re: City finances: hospital & refuse collection

Postby m buckley » Mon Jul 20, 2015 8:31 pm

Ms. Pae, Last Friday I posted the following:

Quote: Metro's ability to finance future projects is sketchy at best, and that was my biggest concern with their ill-fated proposal to LHA - Jennifer Pae

I am trying to understand this. Are you saying that MetroHealth does not have the capacity to operate Lakewood Hospital and would be unable to follow through on the proposal to LHA? Are you suggesting that is why LHA and Mr. Summers ignored their proposal? Also - how does this imagined failure compare to the Cleveland Clinic's (which clearly has lots of capital at its disposal) actual failure to make the capital investments it agreed to make in Lakewood Hospital?

And can you please explain your response to Mr. Call's question about Avon? He asked what Avon knows that we do not, given how much they are applauding the hospital there and the economic growth it will bring. You replied:

Quote: Yep. That sucks, and the worst smack in face for Lakewood. - Jennifer Pae

Do you mean that it "sucks" that they are pointing out that they are gaining a huge asset at our expense?


I would appreciate a reply to clarify your comments. If I understand you correctly, the Lakewood City Finance Director is stating that "Metro's ability to finance future projects is sketchy at best", meaning that they would never be able to follow through on their proposal to LHA.

This is indeed a revelation. I think it would be a public service if you would post your conclusion in Crain's and other media outlets to prevent Metro Health from repeating the sham of making offers that they are fiscally incapable of backing up.


" City Council is a 7-member communications army." Colin McEwen December 10, 2015.
Bridget Conant
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Re: City finances: hospital & refuse collection

Postby Bridget Conant » Mon Jul 20, 2015 9:24 pm

I thought it rather presumptuous that Ms Pae would summarily dismiss MetroHealth as if she herself had analyzed their books.

This article may be enlightening to her:

http://www.crainscleveland.com/article/20150408/FREE/150409869/metrohealth-system-continues-its-impressive-financial-turnaround

Some quotes:
MetroHealth’s financial rebound comes in the wake of Medicaid expansion, which pumped more dollars into the health system as more of its patients signed up for coverage. Also, the health system posted a record-breaking number of visits — more than 1 million — in its outpatient facilities.

That number should grow even larger as the health system plots new outposts in Brunswick and Westlake this year and Brecksville the following year. Also, MetroHealth said it hired more than 200 people last year.


Brian Essi
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Re: City finances: hospital & refuse collection

Postby Brian Essi » Tue Jul 21, 2015 6:37 am

CCF forecasted/estimated that Lakewood Hospital would benefit $500K a year due to expansion of Medicaid in Ohio.

In 2014, the audited financial statement indicated a $3,6 million.

So even financial folks at CCF who are running a hospital aren't capable of seeing the future.


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Jennifer Pae
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Re: City finances: hospital & refuse collection

Postby Jennifer Pae » Tue Jul 21, 2015 8:50 am

m buckley wrote:Ms. Pae, Last Friday I posted the following:

Quote: Metro's ability to finance future projects is sketchy at best, and that was my biggest concern with their ill-fated proposal to LHA - Jennifer Pae

I am trying to understand this. Are you saying that MetroHealth does not have the capacity to operate Lakewood Hospital and would be unable to follow through on the proposal to LHA? Are you suggesting that is why LHA and Mr. Summers ignored their proposal? Also - how does this imagined failure compare to the Cleveland Clinic's (which clearly has lots of capital at its disposal) actual failure to make the capital investments it agreed to make in Lakewood Hospital?

And can you please explain your response to Mr. Call's question about Avon? He asked what Avon knows that we do not, given how much they are applauding the hospital there and the economic growth it will bring. You replied:

Quote: Yep. That sucks, and the worst smack in face for Lakewood. - Jennifer Pae

Do you mean that it "sucks" that they are pointing out that they are gaining a huge asset at our expense?


I would appreciate a reply to clarify your comments. If I understand you correctly, the Lakewood City Finance Director is stating that "Metro's ability to finance future projects is sketchy at best", meaning that they would never be able to follow through on their proposal to LHA.

This is indeed a revelation. I think it would be a public service if you would post your conclusion in Crain's and other media outlets to prevent Metro Health from repeating the sham of making offers that they are fiscally incapable of backing up.


MetroHealth is a public entity and a component unit on Cuyahoga County's financials. All of its financial statements are easily available as well as on http://emma.msrb.org/

It is one thing to have the debt capacity to issue bonds for capital improvements, but the most important thing is to have a dedicated revenue stream for repayment. This is what the County is facing with its difficulty in its ability to borrow for new projects: http://www.cleveland.com/cuyahoga-count ... _hold.html

Import to note in that article they doubt the County can contribute $15 million to Metro's Critical Care Pavilion: http://www.cleveland.com/architecture/i ... cart_river

This article shows that Metro is big on ideas, which is great, but how they are going to pay for it is TBD.

MetroHealth is subsidized by Cuyahoga County property tax payers at around $40 million a year for uncompensated care, so when it is claimed that MetroHealth is able to make a profit on Medicaid rates, you have to take that into consideration. Yes, more people are on Medicaid that in prior years, but it is not the payer mix that healthcare providers prefer.

In fact, MetroHealth is also chasing the outer-ring wealth with its construction of its Brecksville outpatient facility with an emergency room which is going to be right across the highway from UH's Brecksville outpatient facility with an emergency room: http://www.cleveland.com/broadview-heig ... etroh.html

This only emphasizes what is happening in healthcare: a shift to outpatient care and the health systems chasing the populations with greater private, commercial insurance to coverage to build their new facilities. And most important: the extreme competitiveness in the Northeast Ohio healthcare market.


Jennifer Pae
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Re: City finances: hospital & refuse collection

Postby Jennifer Pae » Tue Jul 21, 2015 9:02 am

m buckley wrote:
Metro's ability to finance future projects is sketchy at best, and that was my biggest concern with their ill-fated proposal to LHA - Jennifer Pae


I am trying to understand this. Are you saying that MetroHealth does not have the capacity to operate Lakewood Hospital and would be unable to follow through on the proposal to LHA? Are you suggesting that is why LHA and Mr. Summers ignored their proposal? Also - how does this imagined failure compare to the Cleveland Clinic's (which clearly has lots of capital at its disposal) actual failure to make the capital investments it agreed to make in Lakewood Hospital?

And can you please explain your response to Mr. Call's question about Avon? He asked what Avon knows that we do not, given how much they are applauding the hospital there and the economic growth it will bring. You replied:

Yep. That sucks, and the worst smack in face for Lakewood.


Do you mean that it "sucks" that they are pointing out that they are gaining a huge asset at our expense?


There is nothing in the 1997 lease between the City of Lakewood and the Lakewood Hospital Association (LHA), and 1997 definitive agreement between LHA and the Cleveland Clinic Foundation (CCF), that prohibits CCF from constructing other facilities or providing certain types medical services in its facilities.

This is not a defense of CCF and their construction of the Avon facility, but an understanding of what lead that to occur. The construction of Avon is a reflection of the rapid changes in healthcare delivery, and how medical providers are reimbursed for services. There is no coincidence that MetroHealth, University Hospitals, Cleveland Clinic, and other health systems are all currently building new facilities in the outer-ring suburbs. They are chasing the wealth, and the signing of the 2010 Patient Protection and Affordable Care Act (Obamacare) only made that chase more important for the survival of these competitors. Private, commercial insurance reimburses medical providers the best, Medicare second best, and Medicaid the worse, but better than not being paid at all (uncompensated care).

With the Affordable Care Act, medical providers are “rewarded” for keeping patients healthy through prevention and “punished” when patients are in a hospital bed. Less hospital beds are needed overall, and the outer-ring suburbs have a great percentage of residents covered by private insurance.

Then why is CCF building Avon when closing Lakewood? In my opinion, and only my opinion, like UH and MetroHealth, it is chasing the wealth of the population in the outer-ring suburbs. What areas have seen the greatest growth on the Westside? It is Avon, Avon Lake, North Ridgeville, Medina, etc. Unfortunately, there is not that magnitude of population growth and level of median household incomes in Lakewood Hospital’s service area. And the outer-ring suburbs are where a large number the decision-making doctors live.

Yes, as I have said that sucks for Lakewood and is a smack in the face for its residents, but it is a pure and simple business decision, not a conspiracy.


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Jim O'Bryan
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Re: City finances: hospital & refuse collection

Postby Jim O'Bryan » Tue Jul 21, 2015 9:54 am

Jenn

Thanks for jumping in.

It has always been my understanding from those that did the 1997 deal on both sides, that
the growth of Fairview was the result of the 1997 deal. Mayor Cain had decided it was more
important to fight to save the Lakewood Hospital, then have the Clinic build it out as they
then went and did with Fairview.

It has been my understanding from those in Lakewood and those in Avon, that it is more
of a convenience for staffing, and very little else. So it is workers not services being
transferred.

Also, f you know, if an elected officials serves on one or more Boards, which takes
precedent? Their elected position, the boards they sit on, or are they equal?

Don't post during work hours, hate to see you get in trouble.

.


Jim O'Bryan
Lakewood Resident

"The very act of observing disturbs the system."
Werner Heisenberg

"If anything I've said seems useful to you, I'm glad.
If not, don't worry. Just forget about it."
His Holiness The Dalai Lama
Jennifer Pae
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Re: City finances: hospital & refuse collection

Postby Jennifer Pae » Tue Jul 21, 2015 3:20 pm

Jim O'Bryan wrote:Jenn

Thanks for jumping in.

It has always been my understanding from those that did the 1997 deal on both sides, that
the growth of Fairview was the result of the 1997 deal. Mayor Cain had decided it was more
important to fight to save the Lakewood Hospital, then have the Clinic build it out as they
then went and did with Fairview.

It has been my understanding from those in Lakewood and those in Avon, that it is more
of a convenience for staffing, and very little else. So it is workers not services being
transferred.

Also, f you know, if an elected officials serves on one or more Boards, which takes
precedent? Their elected position, the boards they sit on, or are they equal?

Don't post during work hours, hate to see you get in trouble.

.


Thanks for your concern Jim, and as much as some folks might like to see me get in trouble, I'm a Lakewood resident who job it is to have the City's Finances in her best interest whether it is during Monday - Friday 8 a.m. to 5 p.m. or not.

I'm going to speak up no matter what time of day, especially as it pertains to municipal government financial issues.

Social media has evolved so much, so let's work to tear down barriers to communication and sharing information. Hopefully others may jump into the conversation who haven't so far because they felt they might get into trouble or attacked. I know it is not easy.

As far as your questions, they are good ones, but not in my wheelhouse.


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Re: City finances: hospital & refuse collection

Postby Stan Austin » Tue Jul 21, 2015 4:06 pm

Jenn--- tell the refuse director to get with it and respond. (Just a helpful hint :wink: ) Stan



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