nypost.com
 September 9, 2013
Why NYC needs hospitals to close By Stephen Berger 5-7 minutes

It’s painful to see a hospital close its doors for good. Painful
for patients, painful for workers and painful for the community it
has long proudly served. But that pain, and the public outcry that
always accompanies a hospital closure, doesn’t change the fact that
sometimes hospitals simply reach a point where their survival is no
longer financially tenable and their services are no longer essential.

That’s why the highly publicized efforts to save two Brooklyn hospitals
that have struggled for years and are drowning in red ink — Long
Island College Hospital, or LICH, and Interfaith Medical Center — are
so misguided.

In addition to ignoring economic reality, the multiple court decisions
and public demonstrations to keep these facilities open do nothing to
improve care and everything to prevent true health-care reform.

Health-care delivery in America is evolving into a system marked by
fewer hospitalizations and more community-based primary care, as well as
myriad public-health innovations. As the decline of LICH and Interfaith
so starkly demonstrate, the time has come for New Yorkers, especially
those in vulnerable, low-income neighborhoods, to overcome their reliance
on hospitals and embrace the rapidly shifting health-care landscape.

The change has been a long time coming.

In 2005, Gov. George Pataki created the Commission on Health Care
Facilities in the 21st Century — better known as the Berger Commission,
after me, its chairman. As chair, I was tasked with making recommendations
to stabilize, improve and restructure New York’s health-care delivery
system. Our ultimate goal was to begin a series of difficult steps and
decisions to ensure that all New Yorkers have access to high-quality care.

The commission’s work confirmed what many health-care stakeholders
long knew: New York had more hospital beds and physical plants than it
needed. As our final report noted, “Health-care services are migrating
rapidly out of large institutional settings into ambulatory, home and
community-based settings.”

Our hospital “right-sizing” recommendations included “48
reconfiguration, affiliation and conversion schemes, and 9 facility
closures.” We called for the hospital community to downsize by more
than 4,000 beds.

In 2011, as part of Gov. Cuomo’s Medicaid Redesign Team, or MRT,
initiatives, I headed the Brooklyn Health Systems Redesign Workgroup to
assess the strengths and weaknesses of the borough’s hospitals and their
future viability. In a summary letter to the state health commissioner,
I wrote that six Brooklyn hospitals (including LICH and Interfaith) “are
not currently positioned to seize the opportunities and manage the risks
associated with the changes under way at the state and federal levels.”

All the while, hospitals in New York — especially “safety net”
facilities that serve a disproportionate number of Medicaid and uninsured
patients — have been losing money year after year. Too many New Yorkers
were (and still are) using hospital emergency departments for routine
primary care. Medicaid costs were skyrocketing. The system was rupturing.

We’ve come a long way. Since the Berger Commission formed, 18 hospitals
across the state have closed, including 12 in New York City — yet
health-care access hasn’t worsened.

The Affordable Care Act (a k a ObamaCare) and MRT reforms are helping
New York pursue the “triple aim” of improving population health,
enhancing the patient experience and reducing health-care costs.

As part of this transformation, New York state has requested a 5-year, $10
billion federal Medicaid waiver to enable hospitals and other providers to
expand primary care and invest in public-health innovations. Ironically,
this will give hospitals the resources to keep more patients out of
their facilities.

Yet we’ve still got a long way to go, as the decline of LICH and
Interfaith make clear. That’s why the developments in Brooklyn are
so counterproductive.

Why are judges and politicians keeping these hospitals open when
there’s no money to operate them? Whatever their motives, they’re
ultimately harming the very communities that LICH and Interfaith can
no longer effectively serve — communities that desperately need more
primary care, not more inpatient beds.

They are also willfully ignoring the fact that Brooklyn and the rest of
New York will always have enough high-quality hospitals to care for the
patients who need them.

Their actions will also have a chilling ripple effect. Other hospitals
on the financial brink will put off necessary downsizing or outright
closure simply to avoid the chaos unfolding in Brooklyn, and healthier
hospitals nearby will be reluctant to step in and help.

It is the human condition to be wary of change, and the loss of a longtime
hospital is certainly an unsettling experience. But New York’s recent
history has shown that allowing hospitals that have outlived their
usefulness to close is a necessary step in the transformation of our
health-care system.

For the good of all New Yorkers, let’s hope that certain judges and
politicians recognize that soon.

Stephen Berger, the chairman of Odyssey Investment Partners, has advised
the city and state on fiscal issues in a series of positions since 1976.