In an article in New York magazine by Mark Levine entitled, “St. Vincent’s Is the Lehman Brothers of Hospitals,” we are taken on an extremely in-depth and comprehensive review of the sickness and death of one of New York City’s oldest hospitals. It is not my intent to re-create or completely paraphrase this incredible article, but only to select a few of the most poignant facts that literally jumped off the pages and painted a reality for me that was not restricted to the hospitals of New York City.
Mr. Levine’s research revealed that “In 2008, local hospitals spent $3 billion more delivering care than they took in.” He also found that New York hospitals carried twice as much debt in relation to net assets as hospitals around the country, and that, — this is no surprise, as various New York City hospitals close, “the health of low-income and minority residents will be most affected.”
In this commentary, he listed a myriad reasons why these facts represent reality. Included is the $600 per square foot construction costs, outrageous malpractice premiums that are double the national average, 15% higher staffing levels than in other areas, CEO salaries that in some cases have reached nearly $10M per year, daunting demographic challenges, a lack of private physicians living in most communities, lengths of stay that, once again, are at least a day longer than other U.S. hospitals, the 1.4 million New Yorkers who have no health insurance, decreasing Medicaid rates, and a private insurance network that makes considerably more on its New York hospitals than is the case in other geographic areas.
Interestingly enough, as we forged our way through this comprehensive history of how the City system has devolved over the past thirty or so years, we were taken on a journey that is not unfamiliar to many of us in hospital administration. As government swung from socialized (as Mr. Levine states…with a small “s”) medicine to shock-therapy free market, to increased costs in competition, physician recruitment, technology build-up (a build-up that he referred appropriately to as the “medical arms race“), and more movement toward outpatient care, it is very clear that New York City’s hospitals crisis is just one view of a dysfunctional healthcare system that is clearly on a path that could eventually lead to collapse for not only the system, but also for the economy of the country as well.
New York City’s hospitals crisis is just one view of a dysfunctional healthcare system that is clearly on a path that could eventually lead to collapse for not only the system, but also for the economy of the country as well.
This paragraph is one of the most telling paragraphs in the article, “The way forward seems perfectly, if brutally, clear. With private insurers under pressure to cover more patients yet not hike premiums, with federal and state governments facing record deficits, and in a local industry climate with free-market survivalism, many New York (substitute U.S.) hospitals won’t be able to generate sufficient revenue to restore themselves to financial health.”
Interestingly enough, the conclusions reached regarding survival embrace numerous ways of doing business that were not entirely foreign to many hospitals. Included were such concepts as: moving more toward outpatient care in less expensive locations, more follow-up care to keep patients from returning, reduction of unnecessary testing, employment of and profit sharing with physicians, and additional methods of dealing with “the tyranny of insurance companies.”
Steps such as measuring nursing hours, housekeepers per square foot, food service people per meals delivered, and embracing the entire model of industrial efficiency were all suggested contributors to the bottom line.
Mr. Levine also granted partial sainthood to a profoundly bullying management style of one CEO who cut services that didn’t make profits, eliminated catering to the poor and “told doctors where to go.”
All of this plays perfectly into the story that I had lived and am currently telling across these United States and beyond; that dignity, prevention and wellness, attention to human and humane detail, the removal of autocratic leadership, and patient and employee-centered care — all enveloped in a spirit of entrepreneurship — can prevail.
That integrative and holistic medicine practices will contribute to taking us out of the current crisis and into a health care delivery system that will be the design for this century and beyond. Of course, we need malpractice reform; we need more control over big pharma and most importantly, we need to provide some type of safety net for those without coverage, but the path to survival is not simply one of a “business model.” It is a path to a humane model, a creative model that embraces people, embraces wellness, embraces humanness in creative, meaningful ways.
Perhaps hospitals are not being killed, but rather are committing slow suicide by following their “Calf Paths” from the past.