Major NYC Hospital Plans To Downsize

emtb2rn, BSN, RN, EMT-B · May 19, 2016

And yet posters on an who work nyc ers talk about insane ratios, 10:1. Are there fewer pts overall or what?

All4NursingRN · May 19, 2016

Major things are going on here in NY health care. North Shore LIJ (now Northwell health) and NY Presbyterian are scooping up smaller hospitals left and right. I don't think hardly anyone is not part of or affiliated with a major system right now. My own hospital just got re-affiliated to a new also large system but is toeing the line financially and may or may not be able to re-birth or reinvent itself. Through much Internet searching I've found a lot of documents from ny state and their plans for Healthcare in nyc. The general theme seems to be that reducing duplication of services throughout the city will increase quality and reduce waste. I see it as corporate and wall street privatizing business for corporate gain. For every hospital that has gone under in this city a handful of privatized urgent cares/amb centers have gone up. The idea is to increasingly move people into the ambulatory/non-hospital space in order to reduce cost. The idea is probably a good one but doesn't address the fact that this city has large poor/underserved, highly comorbid health population that gain nothing from overcrowded EDs, less hospital inpatient beds, or specialized service in their neighborhood.

The Healthcare quality disparity in this city is also a big secret. Wealthy Manhattan and parts of Queens/ long island are served by top tier hospitals, with small ratios of population density per inpatient bed, while poorer medicaid/medicare heavy areas have seen dozens of hospitals close, downsizing of services and in patient beds. Manhattan with about 1 million residents has numerous hospitals, most all the best in the country, while specific parts of the outer boroughs rife with poverty and chronic disease sufferers experience overcrowding and shuttering of hospitals. I've worked at top tier institutions and also bottom of the barrel in this city and the difference is sharply palpable. It's the difference between the "how best can I serve you today???" And ..."this is all we got take it or leave it!!!" Mentality.

To be honest I'm surprised BI is having issues, looks like it may be going the way of St vinces. I think I speak for many Healthcare workers in the city that thought this would never happen. And all the people who will and have lost jobs.

All4NursingRN · May 19, 2016

This is why I gave up working ED in nyc, the ratios are insane. 15:1, 20:1, and yes it can get higher. My last ED was a trauma 2 tiny 70k a year ED which felt like double the number almost every day , before that trauma 1 120k visits a year, some days me and a team of 12-14 nurses cranked out 200-250 patients a shift!!!! and both depts with sky high acuity ...arrests, strokes, stabbings, bleeds.... While I loved the rush, it was just getting too risky for my license. One day I was the triage nurse and all of the about 8 main ED RNs were sunk with either a cardiac or respiratory arrest with atleast 10 other patients, when I told my ED director I had about 6 chest pains and other possible high acute pts in my waiting room of 50 he just scratched and shook his head in sheer amazement. Needless to say he left nyc, running an ED was a challenge for him here.

DoGoodThenGo · May 19, 2016

And yet posters on an who work nyc ers talk about insane ratios, 10:1. Are there fewer pts overall or what?

Quite honestly it is difficult to get a straight answer as to what is going on.

The whole story started when nurses "leaked" an alleged plot by the new owners of Beth Israel (Mount Sinai) hospital to shut down and or dramatically shrink the place. Beth Israel Hospital set to close soon: Staff | The Villager Newspaper

If you read the comments from above according to professionals/workers (physicians, nurses, etc...) units are being shut down, buildings closed and so forth.

Comments posted on other websites covering this story come from patients who were at BIH's ER or had family members there claim waits for inpatient beds reached a day or longer.

Meanwhile back at the ranch the head of Mount Sinai healthcare systems informed the City of New York last year that things aren't so wonderful at Beth Israel and various options are being explored ranging from downsizing to shutting down the large (and old) campus and replacing it with a new modern (but smaller) hospital. Mount Sinai informs City Hall of possible Beth Israel downsizing | POLITICO

That sort of talk is what we heard before when Saint Vincent's Medical Center and Long Island College Hospital were in trouble; both subsequently closed and were replaced with stand alone urgent care centers.

DoGoodThenGo · May 21, 2016

Highly doubt BI is going the way of Saint Vincent's. However that huge campus and barn of a building are another matter. \

Rightly (or not) Mount Sinai is looking at the nature of healthcare in NYC going forward, and that most surely means less focus on inpatient beds in favour of outpatient and or ambulatory care.

Also with the newly acquired three hospitals (Beth Israel, Saint Luke's and Roosevelt hospitals) Mount Sinai surely must be looking to cut duplication of services, especially where average census counts show less than optimal usage. That is does BI need say an NICU when on average such beds are always available at Mount Sinai on the UES.

There are three full service hospitals in that part of the East Side; Beth Israel (16th Street and First Avenue), NYU (33rd and First Avenue) and Bellevue (26th and First Avenue). Now that is three more than on the West Side below 34th Street in the absence of Saint Vincent's but a case could be made perhaps that that part of the East Side is over bedded.

Just like another institution busy closing down and selling off properties (the Roman Catholic Church) many hospitals here in NYC in particular Manhattan are sitting on very valuable real estate. Not just the main hospital but the entire campus and out buildings which often stretch well beyond into the surrounding area.

The Rudin family fought hard and fast to protect their interests in getting the Saint Vincent's campus and it is paying off very well. Greenwich Lane apartments and other housing built on the former STV's site is breaking all sorts of records.

Across the river in Brooklyn things aren't looking much better. The only thing keeping Brookdale Medical Center, Interfaith Medical Center, Wyckoff Heights Medical Center and Kingsbrook Jewish Medical Center, open is hope; that and generous funds from NYS which cannot go on forever. General feeling is sooner or later one or more of the abovementioned places will have to close.

whichone'spink, BSN, RN · May 22, 2016

I would never willingly move to NYC. Wow, this is insane.

LadyFree28, BSN, LPN, RN · May 22, 2016

NYC is going through what another city dealt with down I-95 went through 20 years ago...the merging and closing of hospitals that served communities for years are no longer viable; one became a speciality cancer hospital, one houses several health care services and a LTAC, and the other is large campus mixed with luxury housing, a hospice unit, outpatient pediatric office, and a post-acute pediatric facility.

Several hospitals have merged with bigger, more prestigious or up and coming prestigious hospitals; my own facility may be changing in the coming years.

There has been in fighting against commercial developers and luxury real estate developers; the point is there will be people to live, but where will they work?

NYC seems to have an obsession of this; I wonder what commercial development professionals think about more luxury vs more jobs, especially when the commercial developers I know think healthcare is a great investment and would step in to keep some form of opportunity vs outright closing hospitals, despite the Medicare changes.

Lev, MSN, RN, NP · May 22, 2016

NYC is so huge that what you are seeing is an exaggerated version of what has been happening in every metropolitan area in the country which has been only been accelerated since Obamacare decided to force hospitals out of business. And yes, NYC has probably one of the worst ratios in the countries even in the "better" hospitals. Ratios are partly tied to financial stability of the organization.

DoGoodThenGo · May 22, 2016

NYC is going through what another city dealt with down I-95 went through 20 years ago...the merging and closing of hospitals that served communities for years are no longer viable; one became a speciality cancer hospital, one houses several health care services and a LTAC, and the other is large campus mixed with luxury housing, a hospice unit, outpatient pediatric office, and a post-acute pediatric facility.
Several hospitals have merged with bigger, more prestigious or up and coming prestigious hospitals; my own facility may be changing in the coming years.
There has been in fighting against commercial developers and luxury real estate developers; the point is there will be people to live, but where will they work?
NYC seems to have an obsession of this; I wonder what commercial development professionals think about more luxury vs more jobs, especially when the commercial developers I know think healthcare is a great investment and would step in to keep some form of opportunity vs outright closing hospitals, despite the Medicare changes.

Coming so soon after the loss of Saint Vincent's many dug in their heels and said "no, not this time" when LICH announced a proposal similar to what SV's did at first; a partnership with a large real estate/commercial venture that would see the closing/downsizing of the full service hospital and campus redeveloped into housing with some sort of urgent and or ambulatory care if not a smaller hospital.

That battle waged on for a few years and in the process put then mayoral candidate Bill de Blasio on the map; he even got himself arrested in a protest demonstration. Meanwhile Christine Quinn the supposed anointed next mayor of NYC lost and lost big (to Bill de Blasio) in part because memories of Saint Vincent's (which was in her council district) were still fresh.

Fast forward to after the election and now mayor Bill de Blasio started singing a different tune and almost at once began to back track on promises to keep LICH open. What happened? Every single major hospital/healthcare network in NYC turned down getting involved in any scheme that would keep LICH open as a FS hospital. Only NYU (the original partner of Fortis the commercial real estate venture) was interested; and even then on the original terms; hospital closed, campus developed, urgent care would replace......

A few years of nasty court battles and millions spent bidders who won then withdrew their offers the original plan and its sponsors won; Fortis and NYU purchased LICH and shut the place down. The property will be developed into luxury housing and have a urgent care center. Same exact thing as happened to Saint Vincent's. The mayor and governor got some of their own back by saying (however reluctantly) the market determined there was no need for a full service hospital on the LICH site. The only and main concession won was that NYU must periodically assess the healthcare needs of the community and provide services.

DoGoodThenGo · May 26, 2016

Was I right or was I right?

Mount Sinai announced today that it will close Beth Israel Hospital in about four years. The old 800 bed main facility will be replaced by a smaller hospital of about 80 inpatient beds: Beth Israel Hospital Will Downsize To A Fraction Of Its Current Size: Gothamist

Mount Sinai Beth Israel closing, will return as smaller hospital | New York's PIX11 / WPIX-TV

It has begun.... Gramercy Hospital Will Sell 24-Story Residential Building to Counter Losses - Curbed NY

DoGoodThenGo · May 26, 2016

Press release from Mount Sinai:

Central to the downtown transformation is the new, smaller Mount Sinai Downtown Beth Israel Hospital, which will include approximately 70 beds and a brand new state-of-the-art Emergency Department (ED), located at 14th Street near Second Avenue â€” just two blocks south of the current Beth Israel campus. This ED will accept ambulances and will be able to handle all emergencies, such as heart attack, and stroke, on site. It will also include a pediatric ED. Patients with the most complex conditions will be stabilized and transported to other hospitals in the Mount Sinai Health System. Service at the existing MSBI ED will continue without interruption until the new facility opens, which is expected in about four years. The new MSBI hospital's inpatient beds may be increased in the event the community's healthcare needs require additional capacity. Mount Sinai will also be making a substantial investment in the Phillips Ambulatory Care Center (PACC) on Union Square, where renovations are already under way. At 275,000 square feet, PACC will be New York's largest freestanding ambulatory care center in New York. It currently houses a full range of multispecialty services, including a state-of-the-art same day surgery center, radiology, surgical and medical specialties, pediatrics and obstetrics. PACC's services will be expanded to include endoscopy and additional medical and surgical specialty services. Same day surgery will include 24/7 services for extended recovery. By early 2017, the site will also house a comprehensive urgent care center with weekend and evening hours.