University:
Boston University
Course:
GMS BC 630 | Ethical & Policy Issues in Health and Medical Services Emergency Management
Academic year:

2022
Views:

309

Pages:

16
Author:

eishuma5iuk

Nina Bernstein, “Seeking a Cure for Troubled Hospitals in Brooklyn,” NYT, 9 Nov. 11 “The effort to reduce costs by cutting capacity has often meant closing smaller hospitals. Those hospitals are more likely to be in minority areas. Five hospitals in Brooklyn are now in peril, putting pressure on Kings County, State University of New York Downstate and Woodhull medical centers, the public hospitals.” 29002 San Jose Medical Center - 2004 How Much of 1990s’ Care Capacity Survived to 2010? Closing % All of All Closing Surviving 43,040 167,227 210,267 20.5% 1,389,756 6,138,392 7,528,148 18.5% Admissions, Medicare 407,537 1,676,125 2,083,662 19.6% Admissions, Medicaid 321,768 1,210,903 1,532,671 21.0% Outpatient visits, total Emergency visits Non-emergency visits 14,293,329 3,765,315 10,528,014 62,323,207 14,747,054 47,576,153 76,616,536 18,512,368 58,104,168 18.7% 20.3% 18.1% Beds Admissions, total COST • Fewer hospitals à fewer competitors à less price competition à higher revenue for surviving hospitals à enables them to incur higher costs. • Slight/moderate tendency, decade after decade, for the more efficient—the less expensive—hospitals to close • Teaching hospitals’ growing share of most cities’ hospital beds (great variation x city!) – 44% in 1950 – 77% in 2010 • Major COTH teaching hospitals’ share rises from 46% in 1970 to 56% in 2010 (also great variation by city) • Growing tendency to care for our lower-income urban patients in the world’s costliest teaching hospitals – Puts added cost pressure on Medicaid 15 cities > 70% QUALITY • Were many closed hospitals effectively segregated racially and unequal in quality? • If so, closing of heavily black non-teaching hospitals and relocation of their patients to large teaching hospitals might à more integrated, mainstream care, boosting quality. • But – Do patients with routine problems get good care in large teaching hospitals that focus on complex problems? – And is care at integrated teaching hospitals racially neutral? D. Stabilizing needed hospitals CASE FOR INTERVENTION - 1 1. We lack a free market that could to weed out the inefficient hospitals. 2. Even if we had a free market, it could only ratify purchasing power and doctor location—both maldistributed today. 3. Racial link with closings is very troubling. 4. Bed shortages may loom in many areas. • Average hospital census nationally now about 530,000—could easily rise substantially in coming decades. CASE FOR INTERVENTION - 2 5. Cost of replacing closed beds has surpassed ~ $1M à $2-3M for LAC-USC • $1-2-3 billion / 1,000 beds 6. Hospital today is usually worth more than promises tomorrow, especially when its survival depends on organizing needed care 7. Jobs matter. 8. With so many hospitals closed, burden of proof should shift – No hospitals should be allowed to close without proof that they are no longer needed to protect the health of the public. ACTION STEPS 1. Identify needed hospitals likely to close • Which hospitals (and ERs) are needed to protect the health of the public, today and tomorrow. ü What types of hospitals and where should they be located? ü Only one state has such a list. ü Which hospitals are required to attract and retain needed doctors to each locality? • Identify hospitals that are likely to close in time to intervene ü Track financial ratios annually ü Use long-term predictive model ACTION STEPS - 2 2. Raise public awareness of the risk to a needed hospital – Trustees and CEOs deny problems until it’s too late – They claim that going public would only undermine the hospital prematurely. – They often act as if they thought, “If we can’t save this hospital, we would be embarrassed if someone else bailed us out.” – They often believe that hospitals that can’t compete in the market deserve to close. ACTION STEPS - 3 3. For temporary protection • • • • Enact state hospital receivership laws, allowing officials or citizens to petition a court to take control of a hospital and stabilize its finances. Or urge governors to declare that closing Hospital X constitutes a “public health emergency,” allowing state to seize control of needed hospital and stabilize it. Underpin either legal step with short-term financial relief through state trust fund financed by 0.25 percent of each hospital’s revenue, à about $2 billion yearly in U.S. Consider mothballing instead of delicensing. ACTION STEPS - 4 4. To durably protect each needed hospital, establish all-payer rate setting to guarantee enough money to sustain efficient, highquality operation – – In a free market, each payer would pay the same price Without a free market, only a public structure can protect each needed hospital, regardless of its teaching status, neighborhood demographics, or endowment 5. Seriously address quality problems at all hospitals.