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Search the lists of hundreds of hospitals that make up U.S. News & World Report's July 28 compilation of the very best facilities in each of 17 fields, and only one Western New York facility makes the cut.

Roswell Park Cancer Institute is rated the 14th best cancer facility in the nation, based on surveys of cancer experts, data like mortality rates and staffing levels and the amount of cancer-related technology available. It also made a second list for its cancer-related gynecological research.

The institute's cancer rating has slipped a bit since 1994, when it was ranked fifth. But its consistent placement in the upper echelon of cancer hospitals remains one of the best advertisements and development tools for Western New York and New York State.

The 1997 rating should reinforce for any skeptics, whether here or in Albany, as to just how important Roswell Park is. Let it slip into mediocrity and become just another hospital, and one more thing will be lost that distinguishes Western New York, gives this area a national presence and acts as a development catalyst by attracting outside dollars and talent.

That's why it's essential that the Roswell Park restructuring plan outlined last month succeed. The plan has the potential not only to stem the hospital's decline, but to reinvigorate the facility and restore it to the very top of the cancer-fighting field.

To see how important the restructuring is, one need only look at categories in which Roswell Park fared poorly compared to the nation's other 41 premier cancer facilities. For instance, the local hospital has more nurses per bed than any facility on the list.

Though the state and the hospital's unions agreed to an 18-month no-layoff clause as part of the structuring plan, the management flexibility envisioned eventually should give Roswell Park the autonomy it needs to bring staffing costs in line with those of competitors.

Similarly, Roswell Park fared poorly in terms of technology compared with the nation's other top cancer centers. But a restructuring that frees hospital management from the shackles of the state bureaucracy will make it easier for Roswell Park to purchase equipment to stay on the cutting edge of cancer research and treatment.

That, in turn, will lure more specialists, patients and insurance dollars to Buffalo instead of to Cleveland, Baltimore or Rochester, Minn., homes to some other top facilities.

The restructuring would convert Roswell Park from a state-controlled facility to a public-benefit corporation. That would free Roswell Park from some of the constraints -- and costs -- of state labor contracts, purchasing rules and other bureaucratic hindrances that make it hard to compete in the new health-care marketplace.

Roswell Park would not be totally unshackled from Albany. A new 15-member oversight board still would be appointed by politicians, and the quality of those appointments will be a key determinant of its fate. Hospital revenues also would go first to the state to pay off bonds that financed the $241 million rebuilding off the cancer center -- an undesirable burden.

On the more positive side, a continuing state link means the hospital would get at least $70 million for each of the next three years for operations.

But the key problem remains how to raise money for research, a necessity for maintaining a national reputation. The hospital must find a way to fund research without passing the cost to patients and their insurers and thereby making itself non-competitive with hospitals that just focus on treatment.

Dr. David Hohn, Roswell Park's chief executive officer, says that's a problem all comprehensive cancer centers are facing. But without an endowment to raise money, Roswell Park starts at some disadvantage.

Hohn points to the possibility of corporate and drug-company funding and the need for continued state support and federal dollars. He also cites insurance companies as potential funding sources because Roswell Park research can save insurers money in the long run.

But the ability to attract such outside funding depends in large measure on Roswell Park's continued reputation as a top-flight facility. While not putting too much importance on the magazine ranking -- and while saying it didn't take some factors into account -- Hohn says it's significant that the hospital has remained in the Top 20 even while struggling with old facilities and an outmoded management structure.

He's right; that is significant. It means the rebuilding project leaves Roswell Park poised to shoot back to the very top of the ratings.

But state-of-the-art facilities will mean little if state officials, labor leaders and hospital managers can't finalize this restructuring plan in a way that gives Roswell Park the resources and autonomy it needs to capitalize on that $241 million investment.

If all of those with a hand in writing Roswell Park's future want to know what's at stake, all they have to do is open up U.S. News & World Report -- and then imagine opening it at some point in the future and finding Western New York's premier hospital no longer on the list.

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