NYAPRS Note: Below are two articles from this week’s Crain’s Health Pulse that highlight the ongoing tension surrounding the closures of two hospitals in Brooklyn. As the state moves toward integrated practice settings and away from institutional care, private hospital systems often have two options: adapt to community-based service delivery models, or risk bankruptcy and failure. There is a continuous balance between policy reforms and budget agendas set by state lawmakers and agencies in Albany, with competing interests and the regional preferences and needs of hospitals, unions, and community members. This balance is particularly difficult to manage with healthcare systems in the five boroughs. Various viewpoints all seek to answer the question: what is our system going to look like in the coming generation? To raise your voice in answering this question, join DOHMH and NYAPRS at two upcoming forums: November 1 @ 125 Worth St. in Manhattan from 2-5pm, and November 7 @ Brooklyn Borough Hall from 11am-2pm.
Brooklyn's health care crisis debated
At a Crain's health care conference Thursday, Stephen Berger, who chaired the Medicaid Redesign Team's Brooklyn work group, said bluntly that some of the borough's hospitals must close. "Hospitals are part of the health care system, not the health care system," said Mr. Berger, who gave the keynote address at the conference on the future of Brooklyn's troubled hospitals. As part of the plan to turn the acute care system into one focused on primary care, he called for University Hospital to close and for SUNY Downstate to instead use Kings County as its teaching facility.
He also called for the creation of an authority run jointly by the city and state to jump-start the restructuring.
But Mr. Berger ran into opposition from NYSNA Executive Director Jill Furillo. The panelist said her union has a "zero tolerance" policy when it comes to hospital closures. She said a primary care network would have to be developed in advance of any changes in order to ensure access to health care.
"When you close hospitals, you close primary care networks, and that's what's happening in Brooklyn," said Ms. Furillo. "The state has abdicated its role."
Another panelist, Ngozi Moses, executive director of the Brooklyn Perinatal Network, agreed the state should take a greater role.
"Leadership has not come out of the office of the governor," she said. "We don't want Albany to make decisions for us, but we need a commitment from the governor."
The looming question was how to pay for primary care. Hospitals need higher reimbursement rates from payers to implement these changes, noted Alan Aviles, president of the Health and Hospitals Corp
A plan for Brooklyn's share of the waiver
A union-funded plan for Brooklyn's health care crisis has been circulating among Brooklyn politicians and state officials for the past few weeks. The project has the backing of doctors on the faculty of SUNY Downstate who have agreed to try to gain support for the project among their counterparts in emergency, urgent and ambulatory care from 14 other Brooklyn hospitals. The goal is to have a blueprint for using the funding set aside for Brooklyn from the proposed Medicaid waiver.
Drafted by consultant Dr. Fred Hyde, the proposals (online at http://www.brooklynhospitalplan.org) lay out a plan to use the capital to create a business model where care is more accessible, and institutions can reconfigure as they employ fewer workers in an inpatient setting. Doctors can be trained in ambulatory care and FQHC settings.
Dr. Hyde wants the waiver to fund grants—not hospital debt—so that institutions can develop ambulatory care networks. "I'm asking the state to look at the Medicaid waiver money as equity, not debt, so we don't set up another generation for failure," said Dr. Hyde.
The effort to retrain workers in non-hospital settings and help hospitals transition to ambulatory care must be led by physicians at Brooklyn institutions—not by Albany—so the process isn't pulled by politics, he writes. Doctors see their emergency departments overwhelmed and "are concerned there are not enough settings for patients with less urgent problems," he said.
"If you can help these hospitals decant inpatient staff and retrain them in an ambulatory care setting, not in an ER or a hospital, that is the key missing ingredient," said Dr. Hyde.
Dr. Hyde's report is packed with financial, demographic and other data pertinent to the debate on how to fix Brooklyn's health care crisis. But his analysis is controversial. "Brooklyn is not 'overbedded' with an inappropriately large number of hospital inpatient beds," he writes.
He places blame for the crisis on the underpayment of Brooklyn hospitals and doctors. There is "no evidence to support a charge that Brooklyn hospitals are managed any more or less competently than those in the other boroughs of New York City."