Hospitals in the ER: Resuscitating NY’s public health system

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A costly system

(BAONA/GETTY IMAGES/ISTOCKPHOTO)

A new physician will shortly be attending at the city’s financially hemorrhaging public hospital system, and not a moment too soon. Dr. Mitch Katz, late of Los Angeles, must act aggressively to save New York Health + Hospitals — not by funneling ever more money into a failing model, but by transforming the way hidebound institutions deliver care.From Bellevue to Woodhull, the network of 11 hospitals and myriad community clinics is in deep, deep trouble.

Patients are fleeing as people newly covered under the Affordable Care Act make appointments elsewhere.

That leaves the public hospital system and its 45,000 employees increasingly caring for the uninsured and chronically sick, notably undocumented immigrants and people with severe mental illness.

Resulting budget deficits exceed $1 billion a year and growing. Those would be far worse if not for massive recent infusions of cash from the mayor and City Council and the system’s takeover of jail health care, together amounting to $1.8 billion a year.

The core problem: In the new health care economy, H+H can’t possibly survive unless more New Yorkers choose to direct their care dollars there. Yet by and large, the hospitals are unresponsive to most patients’ needs.

And the quality of care they provide remains alarmingly subpar. At Kings County, the average wait in the emergency room before seeing any health care professional is 1 hour, 41 minutes. At private NYU Langone, it’s 13 minutes.

At Lincoln Hospital in the Bronx, 15% leave the ER without being seen by anyone at all. That’s what staff figured had happened to Angel Rivera, who’d arrived with a head injury; as the Daily News reported last week, he was actually dying in the waiting room.

A politician’s credo should be “first, do no harm,” but Mayor de Blasio made matters worse. First he took too long to acknowledge the crisis.

Only when forced to budget for a bailout last April did he announce a rescue plan — vague on crucial details, dependent on Albany and Washington to come to financial rescue, and highly specific on two non-negotiables.

One: No hospital buildings will close. Two: No layoffs.

But state and federal aid are not coming. In fact, come Sunday, the already wounded H+H will stand to lose more than $300 million to scheduled cuts in federal funds used to pay hospitals to care for to the uninsured.

And the mayor’s two conditions prevent the system’s long-overdue evolution to meet patients where they are.

It falls to Katz to finally engage in the strategic rethink that has eluded the system for years.

Some hospitals may well remain full-service health-care megamarkets. Others must be totally overhauled, their real estate likely repurposed to raise revenue.

And where they don’t fit into the future vision, staff cannot be kept on the payroll simply because the mayor made an unrealistic promise.

Save the system’s life by curing its disease.

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