Three top administrators of the new UCSF Stanford Health Care (USHC) came to Stanford April 10 to talk with faculty members at a town hall forum. Attendees were reassured that faculty members at both Stanford and UCSF will play a key role in shaping the organizational and financial structure of USHC.

A board including faculty from both sites will have a one-year deadline for figuring out how to bring together all physicians into one integrated group and develop a new funds flow, said USHC Chief Medical Officer Bruce Wintroub. "It will be a very inclusive process," he said, referring to his CMO role as "the keeper of the academic mission."

Issues involving non-faculty members of the medical stafff were not directly addressed at the faculty forum, although in the past, Peter Van Etten, CEO of the USCH, has said that hospital privileging will not be affected by the merger and will be addressed at each medical facility of the merged entity.

Meanwhile, Malinda Mitchell, interim president and CEO of SHS, said in late April that final agreements creating the new merged entity are expected to be completed, as announced, by July. Activation, including regulatory licensing and payroll administration, is expected around September, she said.

Van Etten said the day-to-day direction of the newly merged organization will be set by a Leadership Group that includes faculty representatives and the deans of the two medical schools. This group will design the physician organization, consider issues involving the flow of funds between the two merged partners, and develop service lines, to be called "clinical partnerships" in the new organization, Van Etten said. The Leadership Group will meet weekly, he added.

"It is critically important that the faculty themselves provide leadership" on such issues as contracting, financing and staffing, Van Etten told the audience at the Beckman Center's Munzer Auditorium.

Some faculty members at last month's meeting expressed concern about how clinical services might be integrated at the two sites.

The integration of physicians and programs will be decided on the basis of both academic and business interests, said Bill Kerr, chief operating officer. Van Etten added that administrators will look to the faculty to take initiative and provide input in the decision-making process.

"We're going to have to look to the academic leadership to be responsive in cases where there is a clear economic drive," Kerr said. "However, we don't want to achieve this business goal at the risk of creating chaos in the traditional academic department. So it's going to be a balancing act."

Wintroub said these decisions will be made "very carefully," keeping in mind such issues as whether patients will be willing to drive 40 miles to receive care and whether preserving a particular program might make it more costly to operate.

In response to a question about possible downsizing of the work force in the new organization, Van Etten noted that the merger was not intended to eliminate jobs. He said it is estimated that of 11,000 jobs, only 240 would be lost as a result of the move, half of them in managerial positions.

The business plan of the merger, Van Etten said, is to increase the two partners' total market share, thus providing more income to support the academic mission of each.

He acknowledged that there has been opposition to the merger, both from individual lawmakers and from unions. "I am confident we can address the issues that have been raised by legislators and others," Van Etten said. "This is a large, complex undertaking, and it is inevitable that there will be those who are concerned. On the other hand, I believe we can address those concerns and move forward with the proposal."