Make hospital plan work; Closing facilities will cause pain, but restructured health care is needed (editorial/Buffalo News)
Finally, a start. The state commission charged with fixing hospital care in New York this week released a report that was clear-eyed and ambitious yet avoided the trap of overreaching.
The Commission on Health Care Facilities in the 21st Century called for the outright closures of nine hospitals and seven nursing homes statewide, far fewer than it was expected to target. Two of those hospitals and three nursing homes are in Erie and Niagara counties--where, the commission found early in its review, about half of existing hospital beds stay empty and capacity utilization is twice as bad as an already-low state average.
In addition, the report endorsed mergers, conversions and downsizings for dozens more, including several hospitals in Erie and Niagara. In all, about a quarter of the state's hospitals are affected, and the outright closings cluster in the state's two largest cities--five in New York, two in Buffalo and one each in the Hudson Valley and Schenectady areas.
As difficult as a closing is, it is largely a self-contained process. Mergers can be much trickier, especially when Catholic and secular hospitals are directed to join. That is the prospect faced by Niagara Falls Memorial Medical Center and Mount St. Mary's Hospital in Lewiston, which previously tried and failed at consolidating.
But difficult is not impossible, and the array of changes proposed is, in the aggregate, the right medicine for health care in New York. This state has too many hospitals for its population and stays in them are longer than in other states.
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Because perfection is unattainable, critics can pick apart any plan ever created. And as advocates have pointed out, some criticism is little more than turf protection. But flaws in this plan aren't the main point; the main point is that hospital care in New York will collapse under its own weight unless changes like those proposed are undertaken.
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. . . [Courts must] reject the challenges that are already in the pipeline. The Catholic Health System, in full turf-protection mode, has already filed suit to prevent the closing of St. Joseph Hospital in Cheektowaga.
That's a shame, but lawsuits were inevitable in a matter as consequential as this. Pain and resistance go together, but this pain is necessary if the region and state are going to get a grip on health care.
Governor, you're up.
Unfinished medical business; Panel wants ECMC, Kaleida to talk on equal basis in merger of Buffalo General (Henry Davis/Buffalo News)
The state hospital commission recommendations aimed at reordering health care in New York left a big piece of unfinished business: What to do with Erie County Medical Center and Kaleida Health.
The proposal by the Commission on Health Care Facilities in the 21st Century, unless rejected by the State Legislature, threatens to shut down ECMC or Kaleida's Buffalo General Hospital unless they merge.
But like a shotgun wedding between an unprepared couple, no one knows if the commission has sent them off on a path to happiness or disaster.
To Kaleida Health's surprise, the commission wants it and ECMC to negotiate their merger vows on an equal basis, even though Kaleida is a much larger business and not dependent on a taxpayer subsidy.
ECMC is about the same size as Buffalo General, but Kaleida Health also owns four other hospitals: Millard Fillmore, Millard Fillmore Suburban, DeGraff Memorial and Women and Children's.
By threatening to close Buffalo General, the commission also raised the possibility that an anchor of the Buffalo Niagara Medical Campus could be eliminated. Kaleida Health wanted and expected a commission proposal that endorsed consolidation of specialty services on the downtown medical campus.
Can the two work out their differences?
"The question now is how much bargaining power each side has, and it looks like the commission gave ECMC a little more," said Lewis Mandell, a UB professor of finance and managerial economics.
The stakes are high. Hanging in the balance are thousands of jobs, the location of the community's medical services, the training of doctors and the future of the medical campus some see as a cornerstone of Buffalo's future economy.
There's much more.
Population loss hits home for hospitals (David Robinson column/Buffalo News)
[A shrinking population] can be painful and expensive, leaving the region with an inefficient web of governments and school districts that now are costly reminders of what used to be.
Last week's report by a state commission that called for an overhaul in the region's bloated hospital system, including the shutdown of St. Joseph Hospital in Cheektowaga and Millard Fillmore Hospital in Buffalo, was a rare attempt to pare some of that excess.
Not surprisingly, the recommendations, which include a threat to close either Erie County Medical Center or Buffalo General Hospital if they don't agree to merge by the end of next year, set off a howl of criticism from the region's hospital operators and health care workers, among others.
To be sure, further job losses in a region where good-paying jobs already are a vanishing commodity could mean another blow to a local economy that already has taken more than its fair share of hits.
But while the consolidation would hurt, it would pay off in the long run.
The Business Council of New York State estimates that the commission's statewide recommendations will save $249 million a year in Medicaid costs and a similar amount for employers and others who buy private health insurance. Hospitals and other service providers would save $721 million a year. Think about that the next time you renew your health insurance and complain about how rates have shot up. Roughly $2.5 billion in federal and state money would help pay for the consolidation.
"The status quo doesn't work, and isn't an option," says Andrew J. Rudnick, the president of the Buffalo Niagara Partnership, which has long been an advocate for reforming the health care delivery system in the region.
After all, almost half of the region's hospital beds are empty because of the area's declining population and changes in medical services that have reduced the length of hospital stays and spawned more outpatient treatments.
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Tarren Bragdon, an analyst for the conservative Empire Center for New York Policy, argues that the commission doesn't go nearly far enough, trimming 4,200 hospital beds when the state has 20,000 too many. "This is barely a flesh wound," he says.
Still, it's a step in the right direction, especially in a region where, despite the complaints about high taxes, there has been precious little done to cut back and consolidate our bloated maze of village, town, city and county governments. And if we're really serious about cutting costs, there are the more than two dozen Erie County school districts that are ripe for consolidation, too.
How much WNY hospital execs earn; CEO compensation is high, but lags national median (Jonathan Epstein/Buffalo News)
Top administrators at the region's largest nonprofit hospitals and hospital systems are earning huge salaries at a time when New York State is pushing hospital consolidation to control spiraling health care costs.
Seven local hospital executives--mostly at Kaleida Health--earned more than $500,000 in salary and benefits in 2005, including two who earned more than $1 million, according to the most recent state and federal regulatory filings available.
Another 11 made between $300,000 and $500,000 at seven hospitals, ranging in location from Lewiston to Buffalo to Olean.
Yet the pay range varies widely. More than two dozen senior administrators at the region's 17 hospitals and systems earned less than $200,000, including seven chief executive officers. Two CEOs barely broke the $100,000 mark.
In all, the median pay for local hospital CEOs was $248,266--more than four times the median family income in Erie County.
Hospital officials and directors insist the pay levels are appropriate and even necessary to attract and retain the talent to run highly complex health care organizations.
There's much more, including details on many executives' comp packages.
Hospital closure proposal is blasted (Jay Gallagher/Gannett News Service)
Rx for hospitals; A commission report on closings and mergers deserves support in the Legislature (editorial/Albany Times Union)
. . . Gov.-elect Eliot Spitzer took the right approach by joining with Gov. Pataki in supporting the plan. Mr. Spitzer's position is hardly surprising. He is counting on overhauling the Medicaid system to produce big savings.
Now it will be up to the Legislature to either accept or reject the report without changes, much in the same way that Congress either adopts or rejects recommendations from a military commission on base closings. If it does not act by Dec. 31, the plan will become law.
There's no denying that the report by the Commission on Health Care Facilities in the 21st Century, headed by Stephen Berger, will cause pain in the communities that stand to lose services. For example, the commission proposes closing Bellevue Woman's Hospital in Niskayuna and merging two other hospitals, Ellis and St. Clare's, in neighboring Schenectady.
But the pain must be measured against the savings that would result in reducing excess beds. The commission estimates that savings to be hundreds of millions of dollars a year, although some observers say that much more must be saved to bring costs in line.
Hospital closing plan gains momentum; SEIU won't block proposal, leading some lawmakers to expect eventual OK (Jim Odato/Albany Times Union)
A major health care union skipped the first hearing on a proposed hospital closing plan on Friday, raising expectations in the Capitol that the Legislature will embrace the recommendations.
Legislative aides and several lawmakers privately say they think the plan will become law, especially since the influential 1199 SEIU health care workers' union has signaled the plan is palatable.
SEIU officials say the proposed closings, including Bellevue Woman's Hospital in Niskayuna, likely won't trigger the kind of protests the massive, politically influential union has reserved for budget cuts it objected to.
"With 1199 not opposed, that changes things," Sen. Hugh Farley, R-Niskayuna, said after the hearing when asked if a vote on the closing recommendations will be taken up by the Senate.
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The Legislature has until the end of the year to reject the plan, unveiled this week by the State Commission on Health Care Facilities in the 21st Century. It calls for the closure of nine hospitals around the state and the reconfiguration of 48 others, eliminating 4,200 beds in New York's health care system.
The Legislature has to adopt or reject the entire package. If the plan is accepted, it would become law and be implemented by the state health commissioner.
Lawmakers are returning to Albany for a session on Dec. 13. Both Gov. George Pataki and Governor-elect Eliot Spitzer support the plan.
NY hospital closure plan sends shock through medical communities (David B. Caruso/Associated Press)
All 16 facilities would be forced to close by mid-2008 in a bid to reduce a statewide glut of hospital beds. Dozens more would be required to merge, downsize or change the type of care they offer. Close to 7 percent of the state's hospital beds would be taken out of service. At least 6,400 people could be thrown out of work.
The plan is moving fast toward approval; it already has the support of both Gov. George Pataki and governor-elect Eliot Spitzer and will become law if the legislature doesn't vote to block it by the end of the month.
Supporters have hailed the plan as a tough, but necessary change for a state that has waited too long to downsize an oversized industry.
But it has terrified and angered doctors and staff at institutions on the closing list.
Hospital plan foes seek senators' help; Opposition grows to panel's recommendations for state's health care industry (Erik Kriss/Syracuse Post-Standard)
Labor unions and local hospital administrators asked state senators Friday to reject a state plan that would merge, downsize and close Central New York hospitals and nursing homes.
If state legislators don't reject the plan by the end of the month, it becomes law.
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State Assemblywoman Joan Christensen, D-Syracuse, said Friday she would vote to reject the report--if such a vote comes up.
"It's too detrimental to the hospitals here in Syracuse," said Christensen, adding she is "being inundated with calls."
State Sen. John DeFrancisco, R-Syracuse, said lawmakers should try to find a way to amend the report because of what he called nonsensical recommendations involving the Syracuse mergers.
The commission recommended merging Crouse Hospital with University Hospital, reducing the total number of beds and privatizing University.
There's more.
Six local facilities affected (Syracuse Post-Standard )
Merger talk rattles workers; Morale, job security among concerns at Crouse Hospital (Jim Mulder/Syracuse Post-Standard )
Hospital executives dig in against change: One hospital executives argues against the changes proposed for his institution in this piece in the Syracuse Post-Standard. Two others do so here. But there's a strong essay on the case for overhauling our hospital sector in this oped in the Syracuse Post-Standard
The parochial point of view: The Syracuse Post-Standard acknowledges that there must be changes in New York's health-care sector, but then, citing a number of changes that commission would make in the Syracuse region, the paper argues for slowing the process down.
Take a breath; Public needs time to react to health-care panel's recommendations (editorial/Syracuse Post-Standard)
No one doubts that the health-care system needs retooling. There are, indeed, far too many beds. Painful as it will be, many hospitals and nursing homes probably should be closed, downsized, consolidated or restructured.
Naturally, legislators and other politicians would be expected to resist cuts at facilities on their home turf. That's why the "right-sizing" commission, as it's sometimes called, was specifically designed to do its important and sensitive work independent of the narrow political considerations so common elsewhere in state government.
But automatically enacting changes of such magnitude with little time for public consideration is foolhardy. There are just too many unanswered questions.
How would these changes affect communities? How many jobs would be lost? The closures alone would throw nearly 7,400 people out of work. How many businesses that serve hospitals, nursing homes and their workers would suffer? What would the full cost be to retrain or relocate workers, and who would pay?
The effect of closures on jobs is an especially unconvincing argument for delaying hard choices. That's because this point fails to consider the effect of New York's highest-in-the-nation Medicaid spending in bloating New York's hospital sector and making New York's tax burden the nation's highest --which, in turn, has been driving people and private-sector jobs out of the state for decades.
For background: The Syracuse Post-Standard also provides a brief description of the case for downsizing New York's hospital sector here.
From the commission's leaders:
Hospital proposal looks at realities; State health care in need of drastic restructuring (op-ed by Stephen Berger and David Sandman/Schenectady Gazette)
New York state's health care system is broken and needs fundamental repairs. Bankruptcies and closures of hospitals have become common; more than 25 hospitals have shut in the past decade.
Our state's hospitals as a group have lost money for the past eight years in a row. Our nursing homes are also precarious. Meanwhile, our counties and taxpayers struggle to pay for a Medicaid program whose cost continues to increase. We spend an enormous sum on health care, but our residents are not healthier than those in states that spend far less.
Such turmoil does not serve the needs of patients, who deserve a stable, accessible and high-quality health care system. Our providers lack the financial resources needed to reinvest in their systems and to provide New Yorkers with the latest and best medical technologies and world-class care.
Our system is weakened by excess capacity. We have too many hospitals and beds. As many as one in three hospital beds in the state lie unoccupied on any given day; some hospitals are more than half empty. More and more care is being delivered in doctors' offices and other community settings but we have yet to adapt to these changes in medicine. Excess hospital capacity jeopardizes quality of care, fuels a medical arms race, promotes unnecessary tests and hospitalization and wastes money. OPPORTUNITY OPENS
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New York is doing more than just talking about reform. The state has already committed $1 billion to support system restructuring. The federal government has promised New York an additional $1.5 billion to help redesign our health care system so long as the commission's recommendations are implemented.
These sums are an unprecedented investment to modernize and strengthen our health care system for years to come.
Today's recommendations are one step in what must be a broader agenda for change. We must also fix reimbursement policy, expand health insurance coverage, promote primary care, address mental health issues, and invest in our health care work force to prepare them for increasing uses of technologies in their jobs. Our health care problems did not develop overnight nor will they be solved with a simple solution. Real reform will take constant effort.
All New Yorkers need to come together and make tough choices. It is time to come to grips with the vast changes in medicine that make some facilities obsolete.
By adapting our system and becoming less reliant on an outdated infrastructure, we can assure that New Yorkers' access to essential health care services is preserved and strengthened.
St. Joseph's leaders blast state hospital plan; Catholic hospital officials insist special commission calling for St. Joe's-Arnot cooperation got it wrong (Jeff Aaron/Elmira Star-Gazette)
It seems to us . . .; Albany's job champions, little losses, and a toast to a lucky aristocrat (editorial/Buffalo News)
Among the initial reactions to the "Berger Commission" hospital closing report, from state lawmakers who unanimously approved creating that commission, was one common theme: accusing the commission of putting high-paying jobs at risk.
That came from local legislators in both houses. It would sound a lot more convincing if the State Legislature, the home of taxes and mandates, weren't the number-one job threatening institution in the state.
Used to Big Losses, Schenectady Is Hit Hard by Plan for Hospitals (Paul Vitello/New York Times)
Nursing homes welcome mergers; Administrators agree with state panel's recommendations as role of facilities changes (Cathleen Crowley/Albany Times Union)