5:47 a.m. | Oct. 12, 2015
Executives from Mount Sinai Health System met with the de Blasio administration late last month to discuss plans to rebuild Beth Israel Hospital, replacing its aging infrastructure with what could be a smaller facility with fewer in-patient beds.
Ken Davis, Mount Sinai president and CEO, said no final decisions have been made and the meeting with first deputy mayor Tony Shorris was "informational."
"We are in the midst of trying to figure out how to rebuild the hospital, looking at various options to rebuild it and to integrate it better into our system," Davis said. "We know care is moving more to an ambulatory space and we know there will have to be some diminution of inpatient beds."
Davis' desire to keep the de Blasio administration on board and well informed — even during the planning stage — makes sense, given that Mayor Bill de Blasio rose to prominence, in part, by opposing the closure of city hospitals.
De Blasio was arrested protesting the closing of Brooklyn's Long Island College Hospital and attacked Christine Quinn during the mayoral primary for allowing Manhattan's St. Vincent's to close, he was endorsed by both the New York State Nurses Association and 1199 SEIU, and he has handed reporters a list of the dozen hospitals that closed during Mayor Michael Bloomberg's three terms.
Any move to reduce services or beds at Beth Israel, even if it makes fiscal sense for Mount Sinai, could cause political problems for de Blasio.
"Ensuring that the healthcare needs of communities across this city are met is of utmost importance to this administration, and we will be vigilant about protecting the quality health services that New Yorkers need," said Ishanee Parikh, spokeswoman for the mayor, when asked about the Shorris meeting.
The de Blasio administration wants to avoid being boxed in to any one position. A redesigned Beth Israel, even one that is smaller, could conceivably meet the health care needs of communities including the Lower East side, which is already known as bedpan alley. However, too drastic a change, or one that sparks unrest among union employees, could prompt the administration to oppose it.
Beth Israel, an 856-bed hospital that has been located on the East Side for more than 125 years, is one of the several hospitals Mount Sinai inherited in 2013 when it purchased Continuum Health Services, which also owned LICH before selling it to SUNY.
The deal provided Sinai with a couple of hundred primary care physicians, thousands of new patients and much needed physical space as Mount Sinai had outgrown its own campus.
But it also provided hundreds of hospital beds in an era when health systems in New York City and across the country are chasing ambulatory care dollars.
The aging infrastructure is proving costly.
Beth Israel's financial struggles were outlined in a recent Standard & Poor's report, which revised Mount Sinai's outlook to negative and said, "while performance of the flagship [Mount Sinai Hospital] has been maintained, performance at BI has been particularly weak."
In 2014, Beth Israel Medical Center, which includes its Brooklyn campus and other smaller affiliates, posted an operating loss of $90.7 million, largely due to a substantial decrease in revenue from the prior year. That's the kind of loss that can hurt the bottom line of an entire system.
Asked if he had a timeline for when he'd like to see the rebuilding project completed, Davis laughed slightly and said, "My timeline is yesterday."
Mount Sinai also runs several outpatient centers in downtown Manhattan and on the East Side, and the future of Beth Israel will have to take those into account.
"When you take a look at that ring of facilities, we have to figure out how to use them best to integrate the services," Davis said.
Davis' position is not unique. Health system executives everywhere are grappling with declining in-patient numbers and shorter lengths of stay. Many, including the city's public hospital system, are seeking to diversify their revenue base, emphasize out-patient care, become less hospital centric and consolidate their services.
Both the Affordable Care Act and the state's Medicaid reform initiative encourage health systems to admit fewer patients. The U.S. Secretary of Health and Human Services and the state's Medicaid director have both declared their desire for more value-based contracts, which will likely hasten the trend away from in-patient beds.
These economic forces and public pressure help explain why no health system in New York wanted to keep LICH a full-service hospital, and why NYU Langone agreed to keep LICH open only as a freestanding Emergency Room.
It's why public health experts believe if the state wants to rebuild Brooklyn's Brookdale Hospital it should create a new building that embraces ambulatory care.
Mount Sinai is responding to similar pressures.
"We don't have all the answers yet," Davis said. "We have needs in lots of different places … What the community doesn't need is a very old hospital."
--additional reporting by Azi Paybarah
CORRECTION: The original version of this article said that Beth Israel was located on the Lower East Side. Its location on 16th Street and First Avenue puts it north of the generally accepted boundaries of that neighborhood. The hospital is in fact located in an area some locals call Stuyvesant Square.
