-By Arthur Schwartz
The “Dispersal” of Health Care Doesn’t Work
Our community is again mobilizing to stop a hospital closure, this time at New York Eye and Ear. And its no secret that despite promises to the contrary after the COVID Pandemic Mt. Sinai Hospital would love to downsize Beth Israel Hospital. At New York Eye and Ear we are told that “no services will be lost”; they will simply be moved to smaller local facilities, similar to Urgent Care centers.
Crains Magazine recently studied the impact of the closure of Kingsbrook Jewish Medical Center in Brooklyn in the summer of 2021 (Yes, last summer, right in the middle of the COVID Pandemic!). Kingsbrook served a largely Caribbean American community on the border of Crown Heights and Flatbush, where the majority of residents are people of color. Its patients were largely uninsured or relied on Medicare or Medicaid. That typically spells financial trouble for hospitals, which depend on relatively higher private insurance payments to stay afloat. A 2016 analysis of five struggling Brooklyn hospitals by Northwell Health, the state’s largest health care provider, projected that Kingsbrook would need $50 million in state funding that fiscal year just to stay open. Sounded a lot like St. Vincents Hospital before it closed in 2010.
The State, which regulates and helps fund private hospitals, announced Kingsbrook would close its beds and transfer patients to nearby Interfaith and Brookdale medical centers. The trio would then unite under a new system, One Brooklyn Health. Kingsbrook would become a shell of its former self, whittled down to an emergency room and a few other services.
Lawmakers and hospital executives for decades have touted consolidation as a solution to cut costs and increase the quality of care. Their allies argue that cutting unnecessary beds will reduce health care spending by redirecting patients from hospitals to doctors’ offices, where care is less expensive, more consistent and more focused on prevention.
Instead, the consolidation strategy has given rise to increasingly flush megasystems of hospitals concentrated in whiter, wealthier areas of the city. During the past 25 years, 20 hospitals have closed across the city, amounting to a loss of about 5,800 beds, the Crain’s analysis found. Twelve were in communities that tend to bear the highest burdens of disease: poorer neighborhoods where the majority of residents are people of color. Six districts, including four where the majority of residents are non-white, now have no hospital at all. Meanwhile, wealthy hospital systems build expansive care networks and amass hundreds of millions of dollars in profits.
The modern orthodoxy of hospital consolidation traces back to the Berger Commission Report, as it became known, came at the behest of Gov. George Pataki to cut health care spending by “rightsizing” the state’s hospitals. Its chairman, investment banker Stephen Berger, had gained his cost-cutting bona fides as an architect of New York’s response to the 1970s fiscal crisis.
Hospitals rely heavily on the State for funding, whether through capital grants or New York’s Medicaid program. That money comes with strings—ones that lawmakers often pull in their ceaseless quest to cut costs and balance budgets. The Berger report claimed its recommended consolidations would cut health care costs by more than $1.5 billion annually, or $15 billion over a decade, all without compromising patients’ access to care. “The repercussions of hospital closures on public health are nonexistent or minimal,” the report said, arguing that little is lost because hospitals that close “have been in trouble for extended periods of time” and had already “gradually withered away.”
The assumption was that a hospital in financial distress was better closed than rescued, at least from a fiscal standpoint. But the Berger Commission did not account for the harm that closures would incur on the impacted communities, particularly on those who were underinsured or uninsured.
Alan Sager, a professor at the Boston University School of Public Health who has studied the causes and effects of hospital closures in American cities, wrote in a paper titled, Closing Hospitals in New York State Won’t Save Money But Will Harm Access to Health Care,” “Hospitals and doctors are mainly symbiotic. Each is needed to sustain the other. Because hospitals need doctors to refer, admit, and care for patients, hospitals are motivated to recruit and sustain doctors who practice nearby. Some hospitals are located in areas where physicians are in short supply, and are therefore motivated to recruit physicians into the area, but these tend to be the very hospitals that lack the money to do so—and are the most likely to be closed. “Health care is a network of relationships that take years to establish, and once they’re uprooted they die, like a plant.” “You make hospitals better by fixing them, not closing them,” he added.
Deborah Socolar, a health policy researcher an activist who protested Kingsbrook’s closure and consulted with local activists who, for now, have prevented the closure of Beth Israel/Mt. Sinaia Hospital, said research indicates as many as a third of patients whose hospital closes will not reappear at other hospitals for some time—or potentially at all. When a community hospital such as Kingsbrook closes, its neighbors lose more than beds. They lose a hospital that is likelier to understand their racial, ethnic and cultural identities. That kind of personalized care, called cultural competence, has been shown to improve patient outcomes and reduce health disparities by fostering trust and effective communication.
The fight to save New York Eye and Ear is a fight to save a community hospital. The mega-giant behind the closure is Mt. Sinai, which also owns Beth Israel. A year ago, after Beth Israel reopened 400 beds to address the COVID Pandemic, Mt. Sinai announced that it wouldn’t be closing, and shifting its remaining services to a new 70 bed hospital built adjacent to New York Eye and Ear. But for those of us who have been fighting hospital closures, it is clear that if we lose at New York Eye and Ear, Beth Israel will be back on the chopping block. In defending the New York Eye and Ear closures, Mt. Sinai said, “Mount Sinai Health System has embarked on a multimillion dollar plan to strengthen and modernize all NYEE programs and services by moving them into new and newly renovated ambulatory settings,” said Mount Sinai spokesperson Jason Kaplan. “And not a single current NYEE service – clinical, educational, and research — will be closing as a result of this transformation.”
They said the same thing about Beth Israel. Join the fight to save New York Eye and Ear!
Photo: Mt. Sinai’s original plan was to envelope NY Eye and Ear with the new 70 bed Beth Israel Hospital Credit: Mt Sinai Hospital Press Release