CIR residents overwhelmingly work in safety-net hospitals, and it is the patients of safety-net hospitals who suffer the most in and economic downturn. Given the current financial slump and existing and planned cuts to Medicare and Medicaid services, New York’s Governor Andrew Cuomo has empowered his Medicaid Redesign Team (MRT) to assess the long-term financial viability of Brooklyn safety-net hospitals with the goal of controlling anticipated failures. One option the MRT is exploring includes the possible closure of some struggling hospitals in North and Central Brooklyn.
CIR residents have stood behind their patients and their hospitals, lobbying the government, signing petitions, and speaking at public MRT meetings, arguing that simply closing safety-net hospitals—which have a high percentage of Medicaid and uninsured patients—won’t save money, but will only redistribute the problem and disproportionately affect low-income and minority populations.
“A huge proportion of spending in health care is for the treatment of preventable chronic diseases, like hypertension, diabetes, and lung and heart disease, and especially their avoidable complications,” Dr. Jeff Wuhantu, an Emergency Medicine resident at Methodist Hospital, told the MRT taskforce. “A smart, sustainable healthcare system will invest in preventing and managing these diseases. This can only be accomplished by ensuring that medically underserved populations have affordable, accessible primary care options here at home.”
CIR residents have felt the impact of hospital closures before. Based on how patient flow and hospital admissions were affected after safety-net hospitals closed in Queens and Manhattan, CIR modeled several Brooklyn hospital closure scenarios and found that the impact on increased travel times, Emergency Department wait times, ambulance deferrals, and excess bed capacity could potentially be catastrophic, even if only half the struggling hospitals closed, and neighboring hospitals would be pushed to nearly 100 percent average occupancy of inpatient beds. Furthermore, 88.5 percent of affected patients would be people of color, and questions arise about patients receiving culturally competent care if they’re forced to seek treatment outside of their communities.
CIR analyzed the career paths of New York residents and determined that safety-net hospitals disproportionately train more primary care physicians who go on to practice in Health Professional Shortage Areas like North and Central Brooklyn than non safety-net hospitals, meaning that preserving safety-net hospitals is vital to producing safety-net physicians.
“Looking out for the patients of Brooklyn isn’t just about making sure health services are adequate now—it’s about making sure we have physicians, nurses, and other health providers who are up to the task of caring for the local needs of our community well into the future,” said Dr. Sheena Punnapuzha, an Emergency Medicine resident at The Brooklyn Hospital Center.
The Brooklyn Work Group tasked with assessing the viability of Brooklyn hospitals is expected to release its recommendations on November 1, 2011.