Brooklyn Health Care System in Crisis

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Brooklyn’s health care system is in crisis. Several local hospitals — Interfaith Medical Center, Wyckoff Heights Medical Center, Brookdale University Hospital and Medical Center, Kingsbrook Jewish Medical Center and Brooklyn Hospital Center — are in extreme debt. Brookdale, Interfaith and Wyckoff are in eminent danger of financial collapse. Earlier this year, Gov. Cuomo convened the Brooklyn Work Group to devise recommendations for the restructuring of Brooklyn’s hospital system as part of an effort to overhaul the state’s Medicaid system. In a proactive strategy to have Brooklyn speak for itself, Sen. John Sampson convened the Brooklyn Healthcare Working Group in collaboration with the Borough President’s Office and the Department of Health.
“This past March amidst a budget crisis in Albany, we faced a crisis of our own here in Brooklyn,” said Sen. Sampson. “At the risk was our most vulnerable population: those in need of quality healthcare whose Brooklyn health care system was failing.”
Brooklyn Healthcare Working Group, a coalition of health care providers, administrators, advocates and stakeholders, came together “to take a hard and honest look at the direction in which Brooklyn’s health care system is headed and how we (collectively) right the way,” said Sampson. They held two health care summits at Borough Hall and numerous subcommittee meetings. The purpose was “to restore the credibility of the Brooklyn health care network by brainstorming for new strategies to address an ailing system”, Sampson said. “There needs to be a strong infrastructure capable of providing care to more than 2.5 million residents of Kings County.”
The report proposes three top priorities: increase the capacity of our primary care infrastructure so that Brooklyn residents visit doctors not the emergency room for primary care; an active coordinated care model that would streamline collaboration and partnership among providers across Brooklyn; and to ensure that community-based organizations that offer wellness resources to Brooklyn residents are strategically integrated into our health care network as well as engaging the community. “Implementing these recommendations will go a long way to alleviating some of the long-standing issues that Brooklyn health care has,” said Sampson. “Hospitals are seen as community institutions. If one hospital fails, there will be a ripple affect felt across the entire borough which may take years and billions of dollars to correct.”
Explaining why he convened the Brooklyn Healthcare Working Group consisting of Brooklyn health service providers, Sampson said, “We cannot have organizations that don’t know much about our community and our health care system in Brooklyn to make certain recommendations. We need to be pro-active.”
Deputy Borough President Yvonne Graham said, “We are very confident that these recommendations can make our institutions more streamlined and sustainable while ensuring the highest quality health care for all our residents. It is our hope that the state’s Medicaid redesign team will take the recommendations in this report seriously and work to create a health care system that, along with being financially viable, also offers quality health care services to each and every Brooklynite.” Graham is leaving her position as Deputy Borough President to join the Cuomo Administration as Associate Commissioner with the New York State Department of Health, serving in the Office of Health Disparities Prevention.
Ngozi Moses, Executive Director of Brooklyn Perinatal Network, served on the Emergency Room Overuse Team sub-committee. “There was a need for a more sensible approach to financing health care in poor communities like north and central Brooklyn,” said Moses. “Voluntary safety net hospitals are crumbling under the pressure of sustained over-use and a very poor care mix of residents mainly consisting of Medicaid, which pays about 40% less than it costs to deliver a service, the uninsured, self-pay, and no way-to-pay people, and the wealthier newcomers who still go back to Manhattan to receive and pay for their services so that their money is not invested into the health care system in Brooklyn.”
Moses said 83,000 admissions, 325,000 ER visits, 760,000 clinic visits were provided in one year by the five hospitals that are now the center of the Brooklyn study.
Moses has an emphatic rejection of one proposal floated by Stephen Berger, an investment banker Cuomo appointed to head his Brooklyn Work Group. A recent NY Times article reported that central Brooklyn hospitals were called “toxic assets” that needed a government bailout funded by taxpayers first and then transferring these now-clean assets to private investment bankers who would make a profit on health care. “That is one of the recommendations we have to make sure does not even get to the governor’s office,” Moses said. There is a fear that turning hospitals over to private investors would encourage the elimination of “toxic people” in order to make a profit.
“We are asking the public to join forces with the Save Our Health care Safety Net and elected officials to demand that the state Health Department and the governor recognize the need for the safety health care network in Brooklyn,” said Moses. “Policies should be developed to protect facilities in low-income communities, include accountability and transparency in public funding, develop programs to target funds don’t go to financially vulnerable service providers and health care institutions, and to protect those institutions from the usual across-the-board cuts of Medicaid.” Specifically, she urges support for changes in the distribution of charity care money, almost $900 million annually, so that the money follows the low-income patients to the providers that serve them. “Right now the formula does not do that and many hospitals that do not serve majority poor people get it. Currently, the proposal regarding charity care money is before the Medicaid Review Committee,” said Moses.
In some areas of Brooklyn there are only 11 full-time primary care physicians for a population of approximately 80,000 individuals. Mark Krocansky, past President of the New York State Academy of Family Physicians, a group of 4300 physicians, medical residents, and medical residents said, “We train young residents in Brooklyn in medical school and other institutions and we try to keep them in Brooklyn. Some of them are international medical school grads. Others are students who have incurred big debt in college and medical school and cannot afford to practice in Brooklyn so they go to more lucrative areas where the salaries are higher. The system rewards specialists. We have to devise a system to train more family and primary care physicians and get them to stay in the community.”
Brooklyn Multiservice Family Health Center President and CEO Harvey Lawrence said, “Everybody is entitled to health care. The hospitals and the health care network in Brooklyn are critical not just to keep people well, but to keep them alive.”
Sen. Sampson recommends that anyone concerned about access to quality health care regardless of ability to pay, should contact their elected officials who will carry the message to the Berger Commission. In addition, he recommends reaching out to the Department of Health to encourage serious consideration of the Brooklyn Health care Working Group’s policy recommendations.