The board of Fishermen's hospital has taken the first tentative step in sealing a new partnership with Quorum Health Resources to take over many of the services necessary to run the hospital.

"This engages us to the point where Quorum can go on their fact finding mission," said board President Marv Schindler. "It's going to be a huge amount of information to gather: equipment and supplies ... everything."

At a meeting Monday night, the board signed an agreement to allow Quorum's research arm to analyze the current status of the hospital, its financial status and needs for the future. This initial phase -- expected to last about 90 days -- sets the stage for Quorum to bring down a transition team to step in and take over functions from the hospital's current management team, Health Management Associates.

"They will inventory of all the equipment, interview all the doctors," said the board's consultant, Dr. Stephen Dresnick. "What they come up with is a presentation to the board which talks about financial issues, how much money is going to need to be raised and how that raise should occur."

"It's a financial analysis," said Doug Johnson, Quorum's vice president of business development. "They have to transition from HMA ... and they are going to need capital."

The transition process will only begin when Quorum and the board can agree on terms for a final contract, including a final cost, how much money the hospital will need to raise through loans or bond offerings, and length of term -- expected to initially be the five year contract the board asked for when seeking bids.

"There will be a game plan that will be discussed with the board," Dresnick said. "The board remains the decision maker."

If a deal can be reached between the board and Quorum in that "phase two" process, the final step would be for Quorum to make a medical staff transition plan. Board members and Dresnick have said it would be unlikely for any staff to be let go, though some new staff may be brought in to begin to grow the services the hospital offers.

"The question is whether or not you've got enough doctors and enough doctors of the right mix," said Dresnick.

The exception may be the top employee at Fishermen's, CEO Kim Bassett. Bassett has said she would like to stay on at the hospital after the transition. She may have the chance, as Quorum will be tasked with providing a list of candidates for the job, but the board will make the final hiring decision.

In the new structure at the hospital, the board will assume management control, while Quorum will provide billing, purchasing and operational services. In the hospital's current arrangement with HMA, the board leases the hospital and has little say in day to day affairs of the direction the facility will take.

"Once the lease ends, Quorum will be responsible for the day to day operations," said Johnson. "We'll advise them. They have to authorize us to act."

The board has trust in Quorum, said Schindler.

"What advice we get from them will be good advice," Schindler said. "There will be almost no circumstance where they will not give us more than one option."

Dresnick said the focus now is on the analysis phase.

"The important thing was to get this thing started," he said. "The goal is to make the transition as seamless as possible."

Dresnick and board members have said they will try to keep the lines of communication with the Middle Keys community open, but the negotiation will involve working out financial issues that it would not be beneficial for competing health care providers to know about.

"The goal is to try to continue to make it transparent," said Dresnick. "There are some issues that need to remain confidential until they're resolved."

Schindler said the board needs to stay nimble, and privacy allows them to act more quickly.

"They need to know where their hospital is going," Schindler said of Middle Keys residents. "But for the decision making process, you can't bring the public in. You'd never get anything done."

Dresnick said the important thing to keep in mind is that everything is on track and on schedule for a smooth transition.

"When you look at the scope of what is to be, I think the message is the board has done a great job of sticking to a timetable and getting through some fairly complex issues," Dresnick said. "At the moment there is nothing foreseeable that we are not going to meet the timetable and have a very good transition."

The hospital engaged in a search for a new service provider -- and management style -- as its relationship with HMA gradually soured and it became clear renewing the lease that expires July 2011 wasn't an option. Quorum was chosen from a field of eight bidders with a range of options for working with or under the hospital's board.