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Communities build hospitals, just as they do houses of worship. I grew up in Brooklyn, N.Y., which some referred to as the borough of “bars and churches.” I choose not to do a headcount of those institutions, but from afar I sure can see how shutters are being pulled on neighborhood hospitals in Brooklyn and New York City as a whole.
Why? Some explanations jump out of a report from the so-called Berger Commission in 2006, and from knowing the Big Apple.
The biggest: Too many inpatient beds. That’s a byproduct of a bygone era, before outpatient clinics, specialty hospitals and technological and pharmacological innovations. Too many beds translated into intense financial competition among doctors and hospitals that invited longer hospital stays – and now governments are tamping down on payments and ramping up audits on length of stay, over-ordering of tests and coding in ways that heighten payments.
Other excesses: inflated salaries and lavish perks to some hospital execs who rarely, if ever, lived anywhere near the communities they served; union contracts that sometimes made it impossible to dismiss incompetent or feather-bedding employees; political cronyism built on currying favor with donors at the expense of patient care and fiscal reasonableness; and, sadly, sizable numbers of uninsured or under-insured patients who delayed seeking care until they were at their sickest and most costly to treat condition.
The idea of hospitals having too many empty beds is mind boggling to folks who work at places like Community Medical Centers, regularly stretched to capacity and beyond in our Emergency Departments and with all inpatient beds fully occupied.
The downsizing in New York City and elsewhere is likely to continue, with the occasional catastrophe like Superstorm Sandy dealing crushing blows to hospitals – some of whom were strangely glad to have some extra bed capacity in the system to offset those literally underwater.
The Affordable Care Act, or Obamacare, a title the president has embraced, is already turning the care delivery model on its ear. And that’s not a bad thing in many ways – a focus on prevention, management of chronic conditions in locations outside the hospital, education/education/education, pay for quality performance (the mantra is metrics) rather than for “heads in beds” and volumes of tests performed, and cost and billing transparency.
Reading about what’s occurring in my hometown is a bit sad because although it’s been decades since I visited my Brooklyn neighborhood, I still recall the edifices – hospitals, bars and churches -- and their "feel."
Seeing the glut of patients, the shortage of hospital beds and the enormity of socioeconomic and health needs in the San Joaquin Valley where I’ve spent the last 30 years of my life, I force myself to compare the two worlds. Neither one makes much sense. The only thing that does, is the tumultuous change that the healthcare world – patients and providers -- is now navigating. We are going to a far different place. And we must.