WhiteCoat

Effects of Saving Money

In 2008, St. Johns Hospital and Mary Immaculate Hospital in Queens had a total of 119,883 outpatient department visits.
In February 2009, the two hospitals went bankrupt and closed.
In June 2009, the New York City Office of Policy Management published a paper showing that once St. Johns and Mary Immaculate Hospitals closed their doors, the patients that previously went to those hospitals didn’t just vanish. Instead, the patients flocked to other nearby hospitals which were already operating at capacity.
Guess what happened?
Those nearby hospitals – such as Jamaica Hospital in Queens, are now “overwhelmed.” According to the report, Jamaica Hospital’s daily census went up 50% — from 350 visits per day to “well over” 500 visits per day. On May 27, 2009, Jamaica Hospital had 663 visits – more than double its usual number. Other area hospitals such as Elmhurst Hospital, Queens Hospital Center and New York Hospital Queens noted increases of at least “an extra 100 patients a day.”
The number of patients being boarded in the Emergency Department of nearby hospitals also “soared.” Jamaica Hospital, Queens Hospital Center, and Long Island Jewish Hospital all noted dramatic increases in the numbers of patients being boarded in their EDs.
One emergency physician with twenty years of experience was quoted as saying “the state of emergency medicine in the borough of Queens is the worst I’ve seen it in my career.”

At the heart of the hospital closures was funding.
New York City was subsidizing St. Johns Hospital and Mary Immaculate Hospital to the tune of $61 million over the years leading up to the hospital closures. The City was unable to sustain that commitment. Without the city’s support, the hospitals went bankrupt.
Availability of ambulance services is also now in question. When St. Johns and Mary Immaculate hospitals closed, the ambulance services operated by the hospitals also ceased operations. None of the remaining hospitals was interested in providing ambulance services to the area served by Mary Immaculate Hospital, so ambulance service in that area was temporarily taken over by New York City Fire Department EMS. NY City is cutting the budget for the EMS service by $3 million which will result less ambulance availability. One mother noted that it took 25 minutes for an ambulance to reach her home after her son had a seizure. A $60 million Medicaid reimbursement reduction anticipated in the near future will likely result in even less care being available.

Whatever health care reform package that is chosen will necessarily involve an attempt to cut this nation’s health care costs. This country simply can’t sustain its current level of health care spending.

But we need to be very judicious in where spending cuts are made.

Many hospitals are not “rolling in the dough.” Cut funding for health care too much and we risk further hospital closures. The decrease in the quality and availability of care in Queens, NY is just one example of the impact hospital closures can have on the medical care in a community.

Remember this point in the health care debate: We can talk all we want about providing health care insurance to everyone in this country. Health care insurance means nothing if there is no one available to provide the care for you.

20 Responses to “Effects of Saving Money”

  1. throckmorton says:

    I think you have hit a critical point that strikes both reality and public perception. In our area people think the hospitals are just raking in the money while infact they are operating in the red. So much so in fact that they are having to restrict services. The patients that are now flooding Jamica Hospital are not uninsured. In fact most of them are covered by Medicaid which highlights the fact that hospitals can not survice on what is paid for by government programs such as Medicaid. So, as we shift these patients to other hospitals, they will go down as well. As a a wise person said ” sure we lose money on every patient but we make it up in volume!”

  2. Max Kennerly says:

    Whatever we do, it’s important we not increase taxes on the wealthiest 0.1% of Americans. To do so would be socialism.

      • Max Kennerly says:

        A nice analogy, but let’s make it match income distribution in the United States.

        Ten men are in a restaurant. Four eat only bread. Three eat bread and a hamburger. One eats bread, a hamburger, and dessert. One eats bread, a hamburger, dessert, and has a coffee. The last one eats six baskets of bread, fourteen hamburgers, twelve chocolate cakes, and sixteen gallons of coffee.

        When the bill comes, the first four quietly pay $1, the next three quietly pay $4, the next quietly pays $6, the next quietly pays $8, and the last pays $15 and throws a hissy-fit about how no one is paying their fair share but him.

        Of course, were we to consider anyone in the Forbes 400, we’d have to raise those food portions by several orders of magnitude.

      • ndenunz says:

        Max, are you implying that the people that pay the most in taxes consume a proportionate share of governmental services?

      • Lori says:

        Which reminds me of my favorite Margaret Thatcher saying “The problem with socialism is that you eventually run out of other people’s money”

      • To Max Kennerly,

        It seems you regard restaurants as institutions of capitalist imperialism. They charge you for the food, and you pay more when you order more. I’ve never heard anyone complain that they ordered more than others, but expected to split the bill evenly. It is a straw-man example.

        How would you ideally set up a restaurant? Who would pay what?

        ——
        Have the rich come by their money illegally or immorally? For instance, do they owe you a share of their wealth, personally? When a rich man goes to a restaurant, should he be forced by law to buy everyone else a round?

        If I think you are rich, by my standards, does that mean that you owe me money? Or, might you owe money to the poor people who I might designate in African villages?

        Why isn’t your own lifestyle and privilege an immoral act when compared to the economic condition of billions of humans. Why shouldn’t I act to equalize your income with theirs by distributing your “excess”?

        If that is unfair of me, then why do you want to equalize your income with the rich by taking and distributing their income in a way that benefits you or those Africans?

      • hard working tax payer says:

        Holy @$%*!! What Max just said is the dumbest analogy ever. In healthcare just the opposite is mostly true. The most irresponsible, self abusing, gluttonous consume the MOST healthcare and DON’T pay for it.

        Very telling of his philosophy as a trial lawyer. Someone who has something more than him must have obtained it illegitimately, and therefore it is up to him to steal it back for fairness sake.

      • Max Kennerly says:

        ndenunz,

        You suppose we spent a couple trillion to prop up financial markets for the poor? That we kept a “strong dollar” policy for 20+ years to help workers? There’s good odds the Supreme Court will this year recognize the “right” of corporations to directly assail all but the most favorable of political candidates.

        Of course, that’s aiming too broadly. Stop looking at the top 10, 5 or even 1 percent. Look at the top 0.1%. Recall Warren Buffet’s challenge: “I’ll bet a million dollars against any member of the Forbes 400 who challenges me that the average (federal tax rate including income and payroll taxes) for the Forbes 400 will be less than the average of their receptionists.”

        No one took him up on it.

        So, yes, just for one example, when I think of the massive government subsidies — from the government-built interstate system the use extensively each day, to the government paying most of their employee healthcare, to state and federal law enforcement protecting their property across the country, to direct state and federal subsidies of their merchandise, to direct state and federal subsidies in builing their stores — that continue adding to the wealth of the Walton family, none of whom worked a day in their lives, I do think they take a disproportionate amount of resources for what they pay back.

        People like to forget that the bulk of civilization — from its roads, to its sewage, to its cops — was built by and is maintained by the government, and that all major wealth today relies very heavily on that initial investment and continued support. They should pay adequately for it.

      • WhiteCoat says:

        So did WalMart rip you off on a pair of shoes – fail to give you a markdown or something?
        How did the conversation shift from cuts in funding for medical care to a diatribe against the Walton family?
        It never ceases to amaze me how these comment sections take on a life of their own.

      • Matt says:

        Personally I believe in a flat tax on consumption for all those above the poetry line, but i think some of you miss th point of Max’s post on the restaurant. While you can certainly point to lots of stats on how much the wealthy pay in income taxes and how much more it is than the rest of us, the benefit they receive from those taxes is also much greater than the rest of us.

        Most people think of tax benefits as dollars in our pockets from things like welfare. But it’s far more than that. It is the interstates, it’s airports, it’s ports, it’s even the department of commerce and te innumerable federal agencies which promote trade on our dime. The benefits of those go disproportionately to the wealthiest among us. You know why the tax code is so complex? Because every line in it just about benefits some industry or another and it’s a hell of a lot less conspicuous for a politician to pay their donors off in there than have McCain call out their more direct pork.

        This isn’t a matter of one political party either. They both have their paymasters and they share many (wall street for example).

        Max highlighted Wal-Mart but the truth is they are nodifferent than any company. Remember the famous Kelo eminent domain case of a couple years ago? The beneficiary was Pfizer. We get the government we pay for, and if you’re not paying you ain’t getting. If you do benefit from govt action and you’re an individual who doesn’t give big dollars to a politician them that benefit was a happy accident, nothing more.

        All of which makes me wonder why some of you want to further gut your individual rights.

      • Max Kennerly says:

        Consumption flat tax with a standard deduction of a reasonable amount would be fair and equitable.

        Which is why it won’t happen.

  3. paul says:

    i work in one of the hospitals taking overflow from st. john’s and mary immaculate. things have gotten ugly for sure.

    one of the consequences has been a nosedive in our press-ganeys across the board, due to a combination of higher volume and the department turning into a madhouse, longer wait times, and the new patient population being, for whatever reason, more hostile and inclined to complain about everything.

    the ceo has been threatening to fire all docs that can’t keep their survey scores above a certain threshold. as it turns out, that now applies to half our group. amazing that half of us suddenly became bad doctors!

    good luck staying open with a mass firing of our docs. as it turns out i’m not one of them, but if our staffing gets cut in half i sure as heck won’t stay around either…

  4. SeaSpray says:

    I feel sorry for the people having their health care compromised and for the medical population losing work and for the overload on the remaining hospitals.

    I wish I could help.

    I wish there was a clear cut answer.

    And I wish people would do whatever needs to be done for the good of both medical and patient populations.

  5. sleepyjosh says:

    Haven’t read the full policy paper (yet), but as background it’s also important to realize the fiscal mess that both NYC and NYS are currently in–as part of the backdrop for the story.
    [It's bad in NYC--but in Albany it's even worse--to put it simply]

    IIRC, even before the closure of these two hospitals, which were run by the Caritas group, Queens had a lower number of patient beds per capita than the other boroughs. The closure of these two hospitals + Parkway hospital (also in Queens) only seems to have compounded the problem.

    Just some additional food for thought…

  6. snarkymsw says:

    Sleepyjosh is right. And currently the fiscal situation in NYC is compounded by all the wall street layoffs. While large portions of our country have called for more equitable wages and bonuses for financial executives… the taxes on their bonuses have been paying for city services, such as the fire department and EMS for years. Until there is some recovery in terms of jobs in NYC that bring in significant tax income, its only going to lead to more cuts, more cuts, more cuts. With all the layoffs, everyone is cutting back on everything right now.

    In addition to the closing Mary Immaculate and St John’s, the Berman Commission closed 5 hospitals across the city. Queens is in dire straits, but the rest of the city didn’t gain anything either. NYC also lost Cabrini, St Claire (Aka St Vincent’s midtown), Victory Memorial in Brooklyn, and Parkway Hospital in Queens, and NY westchester in the bronx.

    The federal government offered NY Stated 1.5 billion dollars to help close its hospitals and nursing that “were not performing at capacity” and thereby increasing their debt and losing money… therefore some government commission was set up to decide which facilities needed to be closed.

    • docmomer says:

      It was the BERGER Commission appointed by then Governor Pataki who decided 2-1/2 years ago, with the usual stupid government beaurocratic logic that New York State has “too many” hospitals. The commission forced 7 hospitals to close including one in Fulton, NY serving a rural population which often would be snowed in. This is the consequence of permitting government central planning instead of the free market solve problems involving supply and demand. Wake Up ER doctors. You are being treated like stupid cows in a herd which just needs the right manager. Recognize your value and refuse to provide the sanction of the victim in this government scheme to take over medical care.

  7. sleepyjosh says:

    snarkymsw adds some good points to my post. Without the (tax) revenue from Wall Street and it’s bonuses–the City is in even shakier financial straights.

    One more thing to take into consideration with the numbers in the NYCDOPM report–was during the initial swine-flu outbreak (May-June)–one of the major “epicenters” (for lack of a better term) of the outbreak were schools in Queens. From what I recall (from the news), this led to a significant jump in ED visits.
    [I don't discount the main stats put out in the aforementioned report, it's just to point out what may be a statistical anomaly. There is still a major problem]

  8. Don says:

    I once dreamed of eliminating the income tax with a National Sales Tax that exempted food, clothing items under $100 and medical care.

    Of course, because it doesn’t give politicians enough power to manipulate our lives, it wouldn’t pass.

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