February 6, 2013 Brooklyn Eagle Staff
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On Wednesday, Stephen Berger — whose panel last year recommended sacrificing the Downstate Medical Center facility in East Flatbush in favor of Long Island College Hospital in Cobble Hill —  sent a letter to SUNY board chairman H. Carl McCall, in which he endorsed the planned closing of LICH in order to save Downstate.

The Brooklyn Eagle is reproducing Berger’s letter in its entirety.

This is in response to your request that I comment on the present situation regarding LICH Hospital and the plan outlined by Dr. Williams in his comments to the SUNY Board of Trustees. In particular you asked that l do so in light of the comments made in the MRT Report of the Brooklyn Working Group. 

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Dr. Williams approach is one I truly support. It is a response to the reality of emerging changes in Brooklyn and problems which have accelerated since we issued our report. As a reminder, we began working and gathering data for the report almost two years ago, issued the report over a year ago and while the recommendations were aimed at stabilizing the health care environment in Brooklyn and creating a platform for beginning a redesign which would emphasize available access to primary care and a reconfiguration of the existing infrastructure none of our recommendations have been in fact put in place.

With regard to the specific recommendations regarding the Downstate Medical School, UHB, and LICH we came to the obvious conclusion that a single  campus was the only viable option. Our recommendations were based to a large extent on the proposals and plans outlined by your then existing Management Team in Brooklyn. Unfortunately as we have seen the assumptions underlying their plan proved to be unattainable and frankly was based on assumptions and conditions which we now know did not exist or were rapidly changing.

The plan assumed increases of patient volumes from both recovering additional patient volumes that were leaving Brooklyn for care and from tertiary business from the high cost inefficient UHB campus could be steered to the lower cost LICH campus and drive sufficient marginal profit to create a sustainable business model at LICH. However, once these business were migrated the UHB campus would have had even less volume and much less revenue as the more intense DRGS would have been migrated to LICH. 

As a result IUHB would have become the operational equivalent of a high cost community hospital with oversized teaching programs, effectively an unsustainable business model. The logical conclusion then would be to close UBH, salvage LICH and restructure SUNY Downstate’s GME programs, while redistributing and upgrading GME in other surviving or thriving Brooklyn Hospitals. The Brooklyn MRT report reflected that logic. 

Unfortunately, that was not the result of the LICH acquisition. While some tertiary volume, most notably Neurosurgery moved to LICH, very little volume actually moved. In fact, one the problems is that UHB does not have much tertiary volume to move in the first place. Essentially UHB has the CMI (case mix index) of a community teaching hospital. Though several years ago, UHB did about 100 kidney transplants and several hundred open heart surgery cases each year, UHB now does about 35 kidney transplants and relatively few open heart procedures. In summary, this aspect of the plan failed because, very simply, there wasn’t much business to move to LICH and there were various obstacles in moving, frankly, any business at all to LICH, which is after all in a completely different market.

While this aspect of the plan failed, there was also the compounding effect created by the fact that LICH has also been steadily losing market share, even in its own community. Utilization levels make clear that the residents of Cobble Hill and Brooklyn Heights do not consider LICH their hospital of choice. This is a very difficult trend to reverse, particularly in an upscale community, where many residents probably get their care across the river.

Other factors that challenged the Plan were overall declines in inpatient discharges in the Brooklyn market and State support for SUNY hospitals. For all the reasons above, LICH has become a diversion of energy, talent and precious resources for SUNY Downstate. The marketplace has essentially told us it is best to focus on building a better system around UHB and The Medical School as Dr. Williams recommends and to develop a plan which will be defined over the course of the next year or so.

The Brooklyn MRT report also asked for an exploration of new ways to access capital for health care and the Commissioner of Health began the process with his forum on public-­private partnerships last year. The Executive Budget proposes pilot programs that might assist in raising capital for Brooklyn and include an academic affiliation which could be SUNY. This could clearly become a part of a long term credible and financially responsible Brooklyn solution. That solution needs to include increased investments in primary and urgent care which will reduce reliance on emergency rooms and continue to drive down unnecessary inpatient utilization.

If Brooklyn is to emerge with a health care system that provides appropriate care for its residents, refocusing dollars, energy and planning on the future rather than desperately trying to keep unnecessary cost centers alive is imperative. For SUNY, a plan that focuses on the role Downstate Medical School must play as an educational and clinical center is clearly its most appropriate path and it emphasizes Dr. Wi1liam’s description of Downstate Medical School’s mission and commitment to meet the needs of underserved communities in Brooklyn. The academic and medical training role of SUNY can, if necessary, be separated from the ownership and operation of a hospital and I assume that the study that will be undertaken will fully address this option.


Stephen Berger

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