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From the NY Times (no link, because you have to log in)
A long-awaited plan to shrink New York States hospital industry landed yesterday with force, with proposals that could effectively eliminate 20 or more hospitals and thousands of jobs, and make dozens of other hospitals shrink, merge or take on new roles.
The recommendations by the Commission on Health Care Facilities in the 21st Century go far beyond the nine hospital closings and downsizings that state officials reported late Monday, after being briefed by the commission. Several other hospitals would cease to exist through mergers or conversion to new uses, and more could be eliminated if they refuse to merge.
In addition, the commission reached deep into the particular operations of many individual institutions, ordering them to eliminate specific numbers of beds, telling some to eliminate psychiatric, substance abuse or maternity wards, and in some cases directing others to take on those functions.
The changes would mark an epochal shift in an industry that, person for person, is much bigger in New York than in other states, and traditionally has fiercely resisted shrinkage. But hospitals are also in worse financial shape in New York than in any other state, having lost money for eight consecutive years.
Unless they are rejected by Gov. George E. Pataki or by the Legislature next month, the commissions recommendations will have the force of law, and most must be carried out by the end of next year. The law does not allow the governor or the Legislature to accept some recommendations and not others; they must accept or reject the plan as a whole. State officials said they would study the plan, and leaders in the Senate and the Assembly said they would hold hearings on the proposals before deciding what to do. [News analysis, Page B5.]
In all, the plan would reduce the number of hospital beds statewide by at least 4,200, or 7 percent. It would also close and downsize several nursing homes, mostly upstate, eliminating 3,000 beds, or 2.6 percent of the total.
The reporta?Ts release rippled across New York State yesterday, as cities and towns grappled with the possible closings of some of their most dependable employers. From Long Island to Niagara Falls, hospital executives and elected officials denounced the commissiona?Ts plan and vowed to fight it in the Legislature and in court.
We will do everything possible to defend our ministry, said Joseph McDonald, chief executive of the Catholic Health System in Erie County. One of his hospitals, St. Joseph Hospital in Cheektowaga, near Buffalo, is among those marked for closing.
In Forest Hills, Queens, 150 people, including several politicians, gathered outside Parkway Hospital to protest its planned elimination, despite the hospitals dire financial problems. Closing this hospital is the equivalent of treating a head cold with an amputation, said Representative Anthony D. Weiner.
Mayor Michael R. Bloomberg and fiscal watchdog groups offered cautious praise for the plan.
But the reaction from the major hospital and nursing home lobbying groups, and 1199 S.E.I.U. United Healthcare Workers East, the biggest hospital workers union, was muted. They took a year and a half to put it together, so we want to take a few days to go through it and not be flip about it, said Dennis Rivera, president of the union.
The nine hospital closings, with five of them in New York City, have received the most attention, but other elements in the plan could have greater effects. Stephen Berger, the commission chairman, said at a news conference that far more significant were the commissions proposals to reshape dozens of other hospitals through mergers, downsizing, the elimination of some services and the addition of others.
The reason this is a big deal is the 48 reconfigurations, he said.
Industry officials agreed with that assessment, and said they were taken aback by the number and detail of changes that some described as micromanaging.
In Buffalo and in Syracuse, government-owned hospitals would merge with privately owned ones, despite different unions and governing structures. In Port Jefferson, on Long Island, one hospital is ordered to drop all of its basic medical/surgical beds and devote itself only to treatment of mental illness and alcoholism, while its neighbor is instructed to do the reverse. In Auburn, in central New York, a hospital must eliminate its obstetric ward.
The closures could be readily anticipated, said Kenneth E. Raske, president of the Greater New York Hospital Association. But the restructuring is so sweeping, I was just flabbergasted.
The commission estimated that its plan would increase revenue at the surviving institutions by $720 million a year, as they take on patients from the places that have closed or changed missions. It also predicted that increased efficiency, in particular, in the form of shorter hospital stays would save insurers, including Medicaid and Medicare, $800 million a year.
The commission said that where possible, hospitals should pay the costs of making the changes by selling unused real estate in some cases. But the state has offered $1 billion of its own money, and up to $1.5 billion in federal money, to aid the transition.
Under the plan, the state could end up with many fewer hospitals through actions that the commission does not label as closings. For example, in the Rockaway Peninsula in Queens, two hospitals would be consolidated into one by building a new site. Eight hospitals, mostly upstate, would cease to be general hospitals, losing all of their medical/surgical beds. Some would still admit patients for specialized services in psychiatry or substance abuse, while others would become strictly outpatient treatment centers.
The commission said the hospitals and nursing homes marked for outright closing employ 7,000 people, including 4,200 in New York City. A similar number of jobs could be lost in mergers, consolidations, elimination of wings and other steps, mostly upstate.
But Mr. Berger, who was appointed by Mr. Pataki to lead the effort, and the commissions executive director, David Sandman, said they did not expect there to be any net loss of health care jobs. Some hospitals are eager to hire because of a shortage of workers in fields like nursing, and, they said, surviving institutions would gain patients from the institutions that close, and so would take on new workers.
Labor and industry officials said they were skeptical of the prediction that no jobs would be lost. Still, Mr. Raske said the downstate hospitals have already pledged to Mr. Rivera that any of his unions members who are laid off because of downsizing will be placed in new jobs within six months.
Commission members acknowledged that they were tempted to go further in closing or downsizing hospitals, and hinted that another round of reductions would be called for in a few years. Even so, they said, the proposed recommendations would make hospitals more efficient.
But Mr. Berger argued that many other changes in health care must be made before further cuts, particularly in the way Medicaid pays for services. Additional opportunities to remove excess capacity do exist, he said. But to try to do more upfront would have been massively destabilizing.
Last year, the State Department of Health estimated that of the 63,000 beds New York hospitals are licensed for, they actually operate thousands fewer, about 20,000 were unneeded. The Healthcare Association of New York State, a major industry group, put the figure at 7,000, still far above the 4,200 the commission seeks to eliminate.
The commission used six criteria to grade each hospital and nursing home: the amount of service it provides to poor, minority and elderly patients; the availability of alternatives in its area; the quality of care; how heavily it is used; how well it is doing financially; and the local economic impact of closing or shrinking it.
The hospitals it recommended for closing or conversion to other uses are mostly small, underused, losing money, and near other hospitals that could take their patients, but there are some exceptions. Most are in middle-income districts, not in poorer neighborhoods as some had feared.
As expected the academic medical centers that are closely tied to medical schools would not close, and only one, in Syracuse, would shrink significantly.
Dozens of hospitals have closed in recent years, a few are in bankruptcy, and many more are bleeding cash daily. Mr. Berger warned that failure to trim the industry would leave all hospitals in much worse condition, requiring a much more painful restructuring in a few years.
He said the crisis sent his mind back more than three decades, recalling his service on a state panel that investigated New York Citys finances. In 1974, that commission predicted that New York City was going to go broke, and nobody listened, he said. That is where we are now in the health care area.
Rebecca Cathcart, Sewell Chan and David Staba contributed reporting.
A long-awaited plan to shrink New York States hospital industry landed yesterday with force, with proposals that could effectively eliminate 20 or more hospitals and thousands of jobs, and make dozens of other hospitals shrink, merge or take on new roles.
The recommendations by the Commission on Health Care Facilities in the 21st Century go far beyond the nine hospital closings and downsizings that state officials reported late Monday, after being briefed by the commission. Several other hospitals would cease to exist through mergers or conversion to new uses, and more could be eliminated if they refuse to merge.
In addition, the commission reached deep into the particular operations of many individual institutions, ordering them to eliminate specific numbers of beds, telling some to eliminate psychiatric, substance abuse or maternity wards, and in some cases directing others to take on those functions.
The changes would mark an epochal shift in an industry that, person for person, is much bigger in New York than in other states, and traditionally has fiercely resisted shrinkage. But hospitals are also in worse financial shape in New York than in any other state, having lost money for eight consecutive years.
Unless they are rejected by Gov. George E. Pataki or by the Legislature next month, the commissions recommendations will have the force of law, and most must be carried out by the end of next year. The law does not allow the governor or the Legislature to accept some recommendations and not others; they must accept or reject the plan as a whole. State officials said they would study the plan, and leaders in the Senate and the Assembly said they would hold hearings on the proposals before deciding what to do. [News analysis, Page B5.]
In all, the plan would reduce the number of hospital beds statewide by at least 4,200, or 7 percent. It would also close and downsize several nursing homes, mostly upstate, eliminating 3,000 beds, or 2.6 percent of the total.
The reporta?Ts release rippled across New York State yesterday, as cities and towns grappled with the possible closings of some of their most dependable employers. From Long Island to Niagara Falls, hospital executives and elected officials denounced the commissiona?Ts plan and vowed to fight it in the Legislature and in court.
We will do everything possible to defend our ministry, said Joseph McDonald, chief executive of the Catholic Health System in Erie County. One of his hospitals, St. Joseph Hospital in Cheektowaga, near Buffalo, is among those marked for closing.
In Forest Hills, Queens, 150 people, including several politicians, gathered outside Parkway Hospital to protest its planned elimination, despite the hospitals dire financial problems. Closing this hospital is the equivalent of treating a head cold with an amputation, said Representative Anthony D. Weiner.
Mayor Michael R. Bloomberg and fiscal watchdog groups offered cautious praise for the plan.
But the reaction from the major hospital and nursing home lobbying groups, and 1199 S.E.I.U. United Healthcare Workers East, the biggest hospital workers union, was muted. They took a year and a half to put it together, so we want to take a few days to go through it and not be flip about it, said Dennis Rivera, president of the union.
The nine hospital closings, with five of them in New York City, have received the most attention, but other elements in the plan could have greater effects. Stephen Berger, the commission chairman, said at a news conference that far more significant were the commissions proposals to reshape dozens of other hospitals through mergers, downsizing, the elimination of some services and the addition of others.
The reason this is a big deal is the 48 reconfigurations, he said.
Industry officials agreed with that assessment, and said they were taken aback by the number and detail of changes that some described as micromanaging.
In Buffalo and in Syracuse, government-owned hospitals would merge with privately owned ones, despite different unions and governing structures. In Port Jefferson, on Long Island, one hospital is ordered to drop all of its basic medical/surgical beds and devote itself only to treatment of mental illness and alcoholism, while its neighbor is instructed to do the reverse. In Auburn, in central New York, a hospital must eliminate its obstetric ward.
The closures could be readily anticipated, said Kenneth E. Raske, president of the Greater New York Hospital Association. But the restructuring is so sweeping, I was just flabbergasted.
The commission estimated that its plan would increase revenue at the surviving institutions by $720 million a year, as they take on patients from the places that have closed or changed missions. It also predicted that increased efficiency, in particular, in the form of shorter hospital stays would save insurers, including Medicaid and Medicare, $800 million a year.
The commission said that where possible, hospitals should pay the costs of making the changes by selling unused real estate in some cases. But the state has offered $1 billion of its own money, and up to $1.5 billion in federal money, to aid the transition.
Under the plan, the state could end up with many fewer hospitals through actions that the commission does not label as closings. For example, in the Rockaway Peninsula in Queens, two hospitals would be consolidated into one by building a new site. Eight hospitals, mostly upstate, would cease to be general hospitals, losing all of their medical/surgical beds. Some would still admit patients for specialized services in psychiatry or substance abuse, while others would become strictly outpatient treatment centers.
The commission said the hospitals and nursing homes marked for outright closing employ 7,000 people, including 4,200 in New York City. A similar number of jobs could be lost in mergers, consolidations, elimination of wings and other steps, mostly upstate.
But Mr. Berger, who was appointed by Mr. Pataki to lead the effort, and the commissions executive director, David Sandman, said they did not expect there to be any net loss of health care jobs. Some hospitals are eager to hire because of a shortage of workers in fields like nursing, and, they said, surviving institutions would gain patients from the institutions that close, and so would take on new workers.
Labor and industry officials said they were skeptical of the prediction that no jobs would be lost. Still, Mr. Raske said the downstate hospitals have already pledged to Mr. Rivera that any of his unions members who are laid off because of downsizing will be placed in new jobs within six months.
Commission members acknowledged that they were tempted to go further in closing or downsizing hospitals, and hinted that another round of reductions would be called for in a few years. Even so, they said, the proposed recommendations would make hospitals more efficient.
But Mr. Berger argued that many other changes in health care must be made before further cuts, particularly in the way Medicaid pays for services. Additional opportunities to remove excess capacity do exist, he said. But to try to do more upfront would have been massively destabilizing.
Last year, the State Department of Health estimated that of the 63,000 beds New York hospitals are licensed for, they actually operate thousands fewer, about 20,000 were unneeded. The Healthcare Association of New York State, a major industry group, put the figure at 7,000, still far above the 4,200 the commission seeks to eliminate.
The commission used six criteria to grade each hospital and nursing home: the amount of service it provides to poor, minority and elderly patients; the availability of alternatives in its area; the quality of care; how heavily it is used; how well it is doing financially; and the local economic impact of closing or shrinking it.
The hospitals it recommended for closing or conversion to other uses are mostly small, underused, losing money, and near other hospitals that could take their patients, but there are some exceptions. Most are in middle-income districts, not in poorer neighborhoods as some had feared.
As expected the academic medical centers that are closely tied to medical schools would not close, and only one, in Syracuse, would shrink significantly.
Dozens of hospitals have closed in recent years, a few are in bankruptcy, and many more are bleeding cash daily. Mr. Berger warned that failure to trim the industry would leave all hospitals in much worse condition, requiring a much more painful restructuring in a few years.
He said the crisis sent his mind back more than three decades, recalling his service on a state panel that investigated New York Citys finances. In 1974, that commission predicted that New York City was going to go broke, and nobody listened, he said. That is where we are now in the health care area.
Rebecca Cathcart, Sewell Chan and David Staba contributed reporting.
