The New York state Commission on Health Care Facilities in the 21st Century on Tuesday released a report recommending nine hospital closures and the reconfiguration of 48 additional hospitals, Long Island Newsday reports (Ochs, Long Island Newsday, 11/29). New York Gov. George Pataki (R) and the state Legislature formed the commission last year to recommend changes to the state's health care system, which is the most expensive in the country (Gallagher/Carter, Rochester Democrat and Chronicle, 11/29). The state Department of Health last year estimated that about 20,000 of the 63,000 licensed hospital beds in New York are not needed. The Healthcare Association of New York State estimated that there are 7,000 unnecessary hospital beds (Pérez-Peña, New York Times, 11/29). Surplus beds increase costs for the state because hospitals are "inclined to fill beds by keeping patients longer than necessary," the New York Post reports. The average hospital stay is 6.1 days in New York, compared with 4.8 days nationally (Campanile/Lovett, New York Post, 11/29). The commission estimates the plan would increase revenue at the remaining hospitals by $720 million per year and save Medicare, Medicaid and other insurers $800 million annually. The commission recommends the closure of nine hospitals, including five in New York City. The recommendations would reduce the number of hospital beds in the state by at least 4,200, or 7%. In addition, the plan would close or downsize several nursing homes, reducing the number of beds by 3,000, or 2.6% of the state's total.

Restructuring Recommendations
The commission's chair, Stephen Berger, said that other aspects of the plan could have a greater impact than the closures, including proposals to redesign hospitals through mergers, downsizing and eliminating some services while adding others. "The reason this is a big deal is the 48 reconfigurations," Berger said. For example, the commission recommends that government-owned hospitals in Buffalo and Syracuse merge with private hospitals, despite different unions and governing structures. The commission also recommends that a hospital on Long Island close its medical and surgical beds and focus solely on the treatment of mental illness and alcoholism, and a nearby hospital "is instructed to do the reverse," the Times reports.

Force of Law
The commission's recommendations will have the force of law unless they are rejected by Pataki or the Legislature (Pérez-Peña, New York Times, 11/29). The recommendations are being handled much like those of federal military base-closing commissions. Pataki has until Tuesday to either pass the recommendations to the Legislature or allow them to expire. If they are passed on, the Legislature can either accept or reject them in their entirety. If no action is taken, the recommendations would go into effect on Jan. 1, 2007 (Rochester Democrat and Chronicle, 11/29). Pataki is widely expected to approve the recommendations, the Albany Times Union reports (Benjamin, Albany Times Union, 11/29). The Legislature cannot modify the recommendations, although lawmakers "could reject them and then adopt their own set of closings," the Democrat and Chronicle reports (Rochester Democrat and Chronicle, 11/29). The Legislature also has the ability to extend the statutory deadline for approving the plan by passing new legislation. However, $1.5 billion in federal aid would be lost if there are "statutory impediments" to implementing the plan by the end of January 2007 (Albany Times Union, 11/29). Hospitals targeted by the report would have until June 2008 to make mandated changes. The hospitals would be eligible for $1 billion in state aid and $1.5 billion in federal aid "to help some closing hospitals retire debt and cover other financial obligations," Newsday reports (Long Island Newsday, 11/29).

Additional Hospital Details
Most of the hospitals slated for closure are "relatively small facilities with about 150 beds and are typically situated within a few miles of other, usually larger, medical centers where the commission said patients could easily find care," the New York Times reports. Most of the hospitals that would be closed "do not serve poor populations, and the commission's report said one of its primary goals was to protect health care for the poor," according to the Times. A number of the hospitals also have financial troubles, including two that have filed for bankruptcy (Williams, New York Times, 11/29). Six criteria were used to grade each hospital and nursing home: the amount of services it provides to low-income, minority and elderly patients; the presence of other providers in the area; the quality of care; the amount of patient usage; financial health; and the local economic impact of closure or downsizing (Pérez-Peña, New York Times, 11/29).

Reaction
Berger said, "The system is broken. You can patch and patch it or fix it" (Long Island Newsday, 11/29). Pataki, who was traveling, in a statement said that he plans to study the recommendations. The plan would have to be implemented by Gov.-elect Eliot Spitzer's (D) as-yet-unnamed health commissioner. The governor-elect said he would review the report and announce whether, if he were the active governor, he would accept the report and send it to the Legislature. Spitzer said, "Our state's broken health care system requires drastic reform, and it is critical that we consider these recommendations seriously." New York City Mayor Michael Bloomberg (R) said, "When I skimmed it, it looked like they were perfectly reasonable decisions," adding, "[W]e have to address the issue that if we want good, quality medical care, and we don't want to go bankrupt paying for it, we're going to have to have the resources that we need in the places we need them and not continue to have resources that we don't need where they're not used" (Cooper, New York Times, 11/29). Jack O'Connell, head of the Health & Welfare Council of Long Island and a regional commission member, said, "I was very much impressed with the deliberations of the commission, especially with their sensitivity to the needs of the indigent population" (Long Island Newsday, 11/29). However, Greater New York Hospital Association President Kenneth Raske and Services Employees International Union Local 1199 President Dennis Rivera in a statement said, "This is a sad day for New York's health care community" (Rochester Democrat and Chronicle, 11/29). Raske added, "The closures could be readily anticipated. But the restructuring is so sweeping, I was just flabbergasted." Hospital executives and elected officials from around the state "denounced the ... plan and vowed to fight in the Legislature and in court," the Times reports. Berger and the commission's executive director, David Sandman, said they did not expect the changes to result in any net loss of health care jobs, although some labor and industry officials expressed skepticism about that prediction. Commissioners also "acknowledged that they were tempted to go further in closing or downsizing hospitals and hinted that another round of reductions would be called for in a few years," the Times reports (Pérez-Peña, New York Times, 11/29).

The final report is available online.

Editorial
Commission members appear to have "had the right instincts," emphasizing "the concerns of patients rather than the state's political favorites," a New York Times editorial states. The editorial adds that commission members "have tried to make basic health care facilities more available to give better and less costly care to those who now go to emergency rooms instead." The editorial concludes, "If the recommendations can survive a Legislature ... they will provide an excellent way for [Spitzer] to start quickly addressing one of his top priorities: rebuilding a better health care system for all New Yorkers" (New York Times, 11/29).

Broadcast Coverage
APM's "Marketplace Morning Report" on Tuesday reported on the commission's report. The segment includes comments from Howard Berliner, a professor of health policy at the New School for Social Research, and Jim Unland, editor of the Journal of Health Care Finance (Palmer, "Marketplace Morning Report," APM, 11/28).

A transcript and audio of the segment are available online.