Diagnosing Brooklyn's Hospital Crisis

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Photo by: Pearson Scott Foresman

Nineteen months after Gov. Andrew Cuomo assembled a team of health care administrators and one financier to radically revamp Brooklyn’s faltering health care system, and three months after the governor wrote the federal Department of Health to report that four of the borough’s 15 hospitals were in real danger of closing without an infusion of Medicaid funding, the governor’s State Department of Health is watching the lights go out in Brooklyn.

As of this writing, there are nine patients left in Long Island College Hospital in Cobble Hill; despite a temporary restraining order from state supreme court, SUNY Downstate Medical Center—which partnered with LICH in 2011—is in the process of shuttering and selling the ailing facility. Hospital staff complain that security guards lock the doors to the ER on weekends to discourage walk-ins, divert ambulances to other hospitals and follow workers around the hospital as part of an ongoing practice of intimidation.

Four miles away in Bedford Stuyvesant, the 287-bed Interfaith Hospital filed notice this week that it was closing for good – handing out termination letters to 1,540 employees and making its own plans to divert patients from the facility – which serves a catchment area stretching from East New York to Gowanus, beginning on August 15. Barring a miracle, the hospital will cease all patient services by November.

Over in Bushwick, Wyckoff Medical Center remains on financially shaky ground. Two years ago, Wyckoff agreed to merge with Interfaith and Brooklyn Hospital in Downtown Brooklyn to shore up its ailing finances, but later backed out of the merger plan, insisting it could survive on its own. This September, Wyckoff, a teaching hospital, will officially end its family residency program. The hospital is currently vetting private doctors' groups anxious to take over the family clinic operations. A spokeswoman for Wyckoff said part of the reason for ending the residency program “is to get the best possible service for our community. The best possible way to serve our community is to have private entities do better and more cost effectively what the hospital would be doing.”

At the same time, Brooklyn Hospital, which also initially agreed to a merger with Interfaith—going so far as to sign an MOU in February to work on a merger plan—refused to go forward. Both hospitals have accused the other of intractability on issues of merging hospitals systems and resources.

With so many of Brooklyn’s residents relying on hospitals for their primary care—a 2011 survey by SUNY Downstate Medical Center found that of the nearly 12,000 people they interviewed in ERs across the poorest neighborhoods, 43 percent of patients were in the ER for non-emergent conditions and a full 77 percent of them had insurance—shutting hospitals in Brooklyn means cutting off the primary-care lifeline for low-income and poor New Yorkers. Ironically, this is occurring just months before the Obama Administration’s Affordable Care Act—which will shift reimbursement practices to favor primary care—goes fully into effect.

Brooklyn hospitals are collapsing in a dog-eat-dog maelstrom of plunging Medicaid reimbursements, failed action plans and exhausting rounds of recriminations while the state Department of Health watches and waits.

Bad math

It’s not news that hospitals in Brooklyn are in financial straits. What is news is the speed with which the borough’s health care network – comprised of three public hospitals and 12 nonprofit hospitals—is collapsing under the combined weight of mismanagement, drastic cuts in Medicaid funding, as well as unfair allocation of federal money that is supposed to go to hospitals that overwhelming serve the poor.

It’s a no win situation. Two-percent across the board Medicaid funding cuts have slammed hospitals that overwhelming serve low-income and poor people—so far, Medicaid cuts at Interfaith cost it 40 percent of its revenue, say hospital officials. The cuts, combined with the movement of patients with commercial insurance out of the borough, have further increased the deficits.

According to the governor’s health care task force on Brooklyn, of the roughly 2.5 million people who live in Brooklyn, 40 percent are on Medicaid, nearly one quarter are living in poverty and 15 percent are uninsured. Of the residents who do have commercial insurance—like Blue Cross/ Blue Shield or Aetna—35 percent elect to go outside the borough for care.

Since 2003, four hospitals have closed in Brooklyn: Victory Memorial Hospital in Bay Ridge, St. Mary’s Brooklyn Hospital in Crown Heights, Brooklyn Hospital Center’s Caledonian Division, on the south side of Prospect Park, and Interfaith Medical Center’s second hospital campus on Prospect Place and Classon Avenue in Crown Heights. Today, along with LICH and Interfaith, more hospitals in Brooklyn are on shaky ground, including Brookdale Hospital in East New York, Kingsbrook Jewish Medical Center, as well as SUNY Downstate Medical Center itself.

The situation, for many Brooklyn hospitals, is untenable. Unless they partner with stronger hospitals, they will go under. Last month, Mt. Sinai and Continuum—two large networks of hospitals and clinics—agreed to merge. At the same time both organizations are expanding their footprint into Brooklyn. This past year, Mt. Sinai opened up a doctor’s practice in Brooklyn Heights, grabbing a toehold in a well-heeled neighborhood, while Continuum’s claim extends out along Kings Highway to Beth Israel Hospital. With bigger hospital chains teaming up, stand-alone community hospitals, like Interfaith, serving majority Medicaid, Medicare and uninsured patients, can’t survive.

A candidate's plan

Attempting to fill the gap, Public Advocate Bill de Blasio, a mayoral candidate, has proposed creating a Brooklyn Health Authority, with members appointed by the mayor and the governor, which would have sweeping powers, including dispersing federal and state Medicaid monies, enacting mergers, reforming payment methods, expanding primary care and going so far as to be able to remove recalcitrant hospital presidents. A similar plan was proposed by the governor days before the legislature went on recess in June—but failed to gain any traction or support.

De Blasio, who has warned that the closing of LICH and Interfaith would affect nearly 175,000 people, has also called for a state hospital construction fund to help finance and revitalize primary care, ambulatory and urgent care facilities.

While the plan is too late to save LICH and Interfaith, it has received support from the New York State Nurses Association (NYSNA) as well as 1199, support that would be crucial in getting the de Blasio plan enacted, as it would need approval from the state legislature.

Not everyone loves the plan. Judy Wessler, formerly of the Commission on the Public’s Health Care System, says the plan fails to address the overburdening of community hospitals with Medicaid patients, cuts in reimbursements and the misallocation of charity-care dollars (federal monies meant to go to hospitals that serve a majority of Medicaid patients). “A much better plan would be a locally organized consortium of central Brooklyn hospitals and health centers to work on planning and rationalizing of services,” wrote Wessler.

For now, the public advocate is working to secure loans to keep some sort of health care operations in LICH while SUNY Dowstate mulls the proposals that have been submitted by private investors to revamp the hospital site, whose estimates of worth are now ranging around $500 million.