Hospitals and Capacity

[WestCoastPerspective]

Interesting read from the NYTimes....

Half-Empty Hospitals in a Shrinking City
By LISA W. FODERARO

BUFFALO - In the last half century, this city has been hemorrhaging residents, with a weak economy and municipal turmoil cutting the population in half to just 292,000 people. But even as Buffalo's citizens have fled, eight of the city's state-licensed hospitals remain open, with 2,425 beds, as well as five open-heart-surgery programs.

On average, nearly half the beds are empty in those hospitals and four others in suburban Buffalo that draw from the same population. Their occupancy rate is 54 percent, below the state average of 61 percent and considerably lower than New York's goal of 90 percent, according to the State Department of Health.

Even in New York State, which ranks in the top third nationally in terms of beds per capita, that rate reflects an extraordinary amount of excess capacity.

All of this should make Buffalo ripe for the kind of shrinkage and belt-tightening that New York officials say is finally inevitable. Even some city and hospital officials concede that at least one and possibly two hospitals here should close, if only to shore up the remaining ones.

But closing hospitals remains a challenge in New York, and it is no different in this city, where fierce community loyalty to neighborhood hospitals, the high cost of paying off debt and a lack of cooperation have kept things in an excruciating limbo.

"Debt is the principal obstacle to closing hospitals," said William D. McGuire, the chief executive of Kaleida Health, which owns three hospitals in Buffalo and two in the suburbs.

"But an awful lot of the obstacle is C.E.O. ego," he said. "We're kingdom builders as a group: 'I've got to have more beds than you do. I've got to have more hospitals than you do. I've got to have the biggest empire.' "

With Gov. George E. Pataki and state lawmakers ready to appoint a commission to recommend hospital closings, as a way to rein in the state's rapidly rising Medicaid expenditures, Buffalo would seem to be a good place to start.

The eight hospitals - ranging from squat, yellow-brick centers to sleek concrete-and-glass towers - include a money-losing county hospital; a highly regarded cancer institute; a cluster of hospitals run by a savvy nonprofit corporation; two Catholic hospitals; and a 40-bed center struggling to emerge from bankruptcy. (There is also a Veterans Administration hospital in Buffalo, which is under federal control and is not state-licensed.)

In a city of strongly defined communities, laid out along ethnic, racial and religious lines, the eight have managed to stay open despite recording huge losses as a group in recent years.

One tentative proposal in 2002 to shut Women and Children's Hospital of Buffalo met with a rally downtown that drew thousands of protesters. One of the speakers was the former Buffalo Bills quarterback Jim Kelly.

"Everybody in Buffalo is very neighborhood-oriented," said Sheila K. Kee, chief executive of Sheehan Memorial, the hospital in bankruptcy. "If it's beyond 20 minutes, forget it. To Buffalonians, that's a big deal."

Within those hospitals are many duplicative services. "It's an area where a tremendous amount of money is wasted," Mr. McGuire said. In addition to the five heart programs (three of which belong to Kaleida), there are two kidney transplant programs, two neonatal intensive care units and several oncology services.

Although the occupancy rates in Buffalo are among the worst in the state, the health care picture has slightly improved, because of some self-imposed downsizing. (State officials would like to see the state occupancy rate close to 90 percent, said Rob Kenny, a health department spokesman.)

Since 1998, Catholic Health System has closed two hospitals in the suburbs, a move that prompted outcries but strengthened its four remaining hospitals, including two in the city. Roswell Park Cancer Institute dynamited its old 200-bed hospital and built a new one, with expanded outpatient services but with half the number of beds.

Kaleida Health has taken a different tack: decertifying, or eliminating, 634 beds - about a third of its total - and preparing to sell off or demolish 750,000 square feet of space. Mr. McGuire has made it known that he would like to serve on the governor's hospital-closing commission. And, he said, he is willing to consider shutting one of his three city hospitals.

The downsizing, along with management improvements, has already paid off. Until recently, Kaleida and Catholic Health lost $125 million and $100 million, respectively, over several years. But both are now posting slight surpluses of several million dollars a year.

Mayor Anthony M. Masiello points to the reduction of beds, as well as three closings of small city hospitals in the early 1990's, as proof that Buffalo is ahead of the curve.

"This city and region have been in the forefront of making tough decisions," he said. "Can we afford to do some more retrenchings? Probably so. But while the governor should be applauded for trying to do this responsibly, it has to be done on merit and in the context of overall quality."

Bruce A. Boissonnault, president of the Niagara Health Quality Coalition, a nonprofit group that publishes the New York State Hospital Report Card, insists that the Buffalo region needs to eliminate hospitals, not just beds. "Hospitals are high fixed-cost factories," Mr. Boissonnault said, referring to expenses like real estate, computers and utilities. "It's only after you get over that fixed-cost barrier that you can start putting money into imaging equipment, new doctors and bedside staff."

Yet which hospital or hospitals should close or restructure in Buffalo remains a source of tension.

Catholic Health, which already closed two hospitals, offers colorful PowerPoint charts comparing its patient discharges, number of births and inpatient surgical procedures with Kaleida's, to show that its four remaining hospitals are alive and well. In every instance, Kaleida's numbers were flat or falling, while Catholic Health's rose.

And while the Western New York Healthcare Association is forming a committee to guide the governor's hospital-closing commission, efforts to form a Buffalo committee have lagged.

Ms. Kee of Sheehan said the strain resulted from too few patients for too many beds. "Everyone has their own little silo," she said of the hospital chiefs. "When you're in a dying economy and someone stands on the roof of the building and throws a bone on the ground, everyone fights over it."

Buffalo's weak economy means that any closing will be acutely felt. The city's streets are pocked with boarded-up apartment buildings, and the police investigate dozens of homicides each year. The city's average unemployment rate was 7.3 percent last year, compared with the statewide average of 5.8 percent.

"Our economy has already taken a big hit from hospital closings and downsizing," Mayor Masiello said.

But most agree that a well-chosen commission has the potential to work objectively and for the good of all.

"In light of all the complexities of closing hospitals, a commission may actually be what has to happen as we begin to look at the entire state," said Joseph D. McDonald, the chief executive of Catholic Health. "We need regional clarity about what we really need in terms of health care infrastructure, and not just right now, but over the next 15 years."

Hospital officials say a commission has an additional benefit: political and financial cover. It could provide a desired financial incentive as state officials try to secure $1.5 billion in federal aid. That could smooth the way toward a smaller system by, among other things, helping hospitals pay off their long-term debt.

Some hospital officials who have pushed through difficult closings without such safety nets are sure to be resentful. "We did it without anybody flying cover for us in terms of a base-closing commission," Mr. McDonald said.

One challenge facing the commission will be to figure out which hospitals are underused. While the state uses the total number of certified beds to calculate occupancy, Catholic Health and other hospital networks prefer to focus on the number of operational beds, meaning the ones they actually staff.

At Sisters of Charity Hospital, for instance, there are 413 certified beds, but only 227 are in use. In fact, many exist only on paper, with patient rooms converted into administrative offices. Mr. McDonald said he was reluctant to relinquish the potential beds at Sisters, as Kaleida did, because he could not predict future demand, especially given possible closings elsewhere in the city.

On a recent weekday morning, the emergency room at Mercy Hospital of Buffalo appeared to be going at full tilt, with several patients waiting on gurneys in the halls, despite a doctor's insistence that it wasn't that busy. During flu season, which can seem interminable during the long Buffalo winters, Mercy's emergency room is often swamped.

"The metro area is known for having emergency departments on divert, when they can't accept patients," said Dennis McCarthy, a Catholic Health spokesman.

While Governor Pataki has said the commission will consider restructurings as well as closings, getting rid of redundancies could prove tricky. Catholic Health is particularly proud that it won permission from the State Department of Health two years ago to start an open-heart-surgery program at Mercy.

"Why wouldn't a system of this size and strength have an open-heart program?" Mr. McCarthy asked, pointing out that the network has 800 beds across four hospitals.

But some administrators hope a state commission will spend as much time considering ways for hospitals to restructure as it does recommending their demise. Ms. Kee said Sheehan had cut its certified beds to 40 from 109 as it shifts its inpatient focus exclusively to drug and alcohol detoxification and rehabilitation.

"I'm willing to say that we will restructure," she said. "We're changing our emphasis, maybe changing licensure. I do intend to be a poster child for that."

David C. Hohn, the chief executive of Roswell Park Cancer Institute, agreed that restructuring should be an important component of the commission's work. "This will turn into something more complex than simple closure," he said.

More than anything, Dr. Hohn said, the trend toward outpatient care in recent years had accelerated the need to revamp the entire health care system. "A lot of this is painful," he said, "but it's the price of progress."

[buffy]

IMO, Sheehan should have closed a long ago, ECMC is capable of absorbing its population. Millard Gates is the other logical choice, seeing that it is sitting between Buffalo General and Sister's Hospital. There used to be a task force addressing this issue but it broke off after the Catholics pulled out. The Catholic Health System seemed to be the only ones making the hard decisions to close one of its hospitals and felt that any further concessions on thier part would jeopardize its bottom line.

[WestCoastPerspective]

I agree- Sheehan is too small and close behind is Sisters. MF Gates Circle is another one. It was surprising to read that Kaleida is willing to discuss closing one of their hospitals!

Sheehan, Gates Circle and Sisters are in locations that could easily be reused too, not that it should be the deciding factor, but its something to consider.

[CaRaisin]

Congressman Brian Higgins (NY-27) announced his plan for covering the uninsured in Western New York. In conjunction with "Cover the Uninsured Week," Congressman Higgins was at Kaleida Health's Judge Joseph S. Mattina Community Health Center, where he was joined by William McGuire, CEO of Kaleida Health.

I find myself disappointed with Brian Higgins' actions thus far during "Cover the Uninsured Week". The Congressman seems to have already forgotten the people who have supported his entire political career thus far, as well as the principles of his own party. While Kaleida talks of "improving the health of our community," is finally "recognizing the increasing population of the uninsured and the underserved," and is busy with a program which offers patients and their families a convenient way to learn about available health insurance programs in the community, guess who is actually taking care of and meeting the healthcare needs of those truly in need - the ERIE COUNTY MEDICAL CENTER. ECMC is not thinking and talking, they are doing! No one at ECMC is asking anyone what, if any, insurance they have prior to administering treatment. No one at ECMC is refusing a transfer or admission because the patient is uninsured or on Medicaid. Delivering the very best medical care is first and foremost on everyone's mind at ECMC. Yet, now that he's in Congress, where does Brian Higgins hold his press conference this week to introduce his new plan, at a Kaleida Clinic. I seem to recall the Congressman co-sponsoring the bill that turned ECMC into a PBC, but now he's turning his back on the hospital? There is indeed more campaign money to be had from those within the Kaleida system. I fear this is just another sign of the nails going into ECMC's coffin. With the enormous debt that the new PBC began with, I imagined the corporation going belly-up, reverting back to the County and Joel saying that he had done all he could to save the hospital, but there was nothing left to do other than close it or sell it. Why should Joel get blamed for dismantling one more thing in our great County. Instead, Joel gets his buddy George Pataki to put together a commission that will more than likely recommend closing healthcare facilities. Kaleida's CEO is already all over the place exclaiming that ECMC should be looked at closely by the commission for closure. Plus, it's a commission that's not even needed. The Executive Branch already has statutory authority to, not only recommend, but act. Chapters 76 of the Laws of 1976 and 77 of the Laws of 1977 provide the Commissioner of Health with the authority to close hospitals and nursing homes because he or she finds there is no longer public need for the facilities. The laws also provide for downgrading the type or status of a facility or part of a facility. Because the Commissioner already has the legal authority to force closure or conversion, we can presume that the notion of a commission is SOLELY FOR POLITICAL COVER!!! Joel & Co. have wanted to rid themselves of ECMC since day 1 and this will be the way to do it and point the finger instead at a BS commission for having done it. Unfortunately, we won't see public outcries like we did when Children's was recommended for closure and there won't be any politicians trying to save ECMC (we already saw that in Brian Higgins today). ECMC is not seen as a warm and fuzzy place like Children's. Although ECMC is an absolute safety net offering the highest level of care for not only the most seriously ill, but for everyone, this community and its politicians rarely act as if they know this or care. What will happen to us all without ECMC? What will happen to those that no one wants to talk about because it's too uncomfortable - the working poor, the AIDS patient, the drug addict, the mentally ill, the elder who has nothing & no one, the homeless, the prisoner, the alcoholic, the victim of abuse and assault, the trauma victim, the stricken traveler in the middle of the night... I can go on. Where will our entire community be without ECMC? What is happening to the greatness of our community? And by the way, the entire debt stays & has to be paid off, in addition to the lawsuits & Workers' Comp claims, but in return, we'll have a closed facility that we're paying for even though Kaleida's government subsidy is higher than ECMC's.

[buffy]

thank you for posting this

[WestCoastPerspective]

It almost seems like a foregone conclusion that either Sisters or Gates Circle will be closed and ECMC will have a bullseye on it. You're sooo right that there will be little to no public outcry over any of those hospitals closing.

[biker]

At a community meeting Lynn Marinelli held last month, a lady who worked in a hospital (not ECMC) said that ECMC was operating at 45% capacity.

CA-is this true?

While she said it, I figured that she wasn't unbiased (which is why she clearly stated she didn't work at ECMC) and I guessed that none of the hospitals was at 100%.

So I had some reason to be sceptical that this was as bad as it sounded.

But who would tell the average taxpayer if that was as bad as it sounded? Not the hospital workers. Lynn didn't speak up to say yea or nay.

I can remember back when Ned Reagan tried to close it. ECMC was kept open because of raw political muscle. Roger Blackwell firgured (correctly) that a few hundred ECMC workers would be more energized than the general electorate.

So is ECMC this underutilized?

If all those people you spoke about could be taken care of by giving half of ECMC's subsidy to the remaining hospitals (to make it worht their while) would you be in favor of that?

[buffy]

Biker wrote

At a community meeting Lynn Marinelli held last month, a lady who worked in a hospital (not ECMC) said that ECMC was operating at 45% capacity.

ECMC has 550 licensed beds, of which 440 are staffed. the hospital consistantly runs at 85-90% capacity. I don't know where the lady who didn't work there got her figures, but I got mine from a high ranking physician at ECMC. I think what the Commission will find if it "looks closely at ECMC" is a very high level of care and a savvy new CEO who is not going down without a fight!

[biker]

Which hospital does he work at?

[WNYresident]

When they talk stalfing levels and such are they refering to the ratio of patience versus employees? If a hospital was running at 50% capacity would there still be 100% of the employees even though only half are doing something?

[biker]

Don't know.

That's what I'm trying to find out.

That would certainly be the worst outcome.

[moonshine]

I'm glad I'm young and healthy.

Not one person has expressed outrage at the fact that the GOVERNMENT is making decisions about healthcare availability. All I see is so-and-so hospital should be closed because their services are duplicitous. Have you people lost your collective minds? Do you realize that these problems don't exist in most other states because people are allowed to make their own decisions regarding healthcare? My father is the director of a nursing home in pennsylvania and cannot find enough qualified medical professionals to staff his facility. Yet, true to form, New York is regulating another industry out of business and forcing the skilled pros to move to other states to maintain a career.

At the cost of sounding like a broken record, the government has no business being in the healthcare business. The BBC had a "talking point" article today regarding the degredation of socialized healthcare in their country. Elderly people are being denied surgical proceedures because the "resources" are reserved for younger citizens. Ladies and gentleman, this is socialism at its finest. Supply and demand has been suppressed to a point where market prices are impossible to calculate. There is no silver lining to the UK healthcare cloud. It's only gonna get worse. Eastern europeans are moving to the UK in droves to sponge up the welfare dollars available and drive the country into further economic distress. As one great economist once said, "The welfare state and open borders are incompatible".

http://news.bbc.co.uk/1/hi/talking_point/4516091.stm

And now, in your own back yard, the government is in full attack mode, but nobody is questioning the motives of the government. The state has detailed the supposed "problem" and presented a series of dead-end solutions that us sheeple are expected to debate, yet the real solution is the removal of government from the healthcare industry.

[biker]

Moonshine:

Someone on this MB described Medicaid as the promise to pay all medical costs for poor people forever.

The naive among us think that this is a program to help out our neighbors who have fallen on some hard times. Difficult to argue with that.

The reality is that it is a magnet drawing people from all over.

And, like our other welfare programs, it is killing us.

We are approaching the point where the costs of jails and social services is forcing us to close all our parks and libraries.

Is that what we came together to fund through voluntary taxation?

[buffy]

Biker:

We are approaching the point where the costs of jails and social services is forcing us to close all our parks and libraries.

This should have been in bold caps

WE ARE APPROACHING THE POINT WHERE THE COSTS OF JAILS AND SOCIAL SERVICES [AND UNION CONTRACTS] ARE FORCING US TO CLOSE ALL OUR PARKS AND LIBRARIES!!!

[granpabob]

if any business keeps losing money it should close down. ECMC the county NFTA or what ever else they cant stay in the black they should close.and be replaced by something that can work and why not expect a profit ,thaT should be reguired befor any raises are given. if they cant stay within their budget they should not get a raise, instead of retirement give them profit sharing no profit no pension ..gee that sounds like the private secter ,no profit no business = no pension
If ECMC cant make it why bail them out they're are plenty of other hospitals out there .I cant remember if I have ever even been to ECMC. But I do know there is room in other hospitals