Right now, New York’s hospitals are no longer operating as independent facilities. Under the plan announced this week by New York Gov. Andrew Cuomo, there is effectively one big New York state hospital system fighting off the coronavirus.
As one VoxCare reader who works in health insurance put it to me, “This verges on the socializing of the entire system.” To be clear, they were being descriptive, not pejorative — and while that is a little hyperbolic, it’s not as far off as you might think.
Cuomo announced that he had met with New York hospital leaders and come up with a plan to, in effect, merge them into one operating system with many different locations. From Buffalo to NYC, hospitals will be sharing staff, patients, and supplies for the foreseeable future, with Albany overseeing the distribution of resources.
“It’s not unusual for a time of an emergency for regulatory authorities to basically say, ‘Hospitals, you must do this.’ Usually there are provisions in state law that enable that to happen,” Susan Dentzer, a senior policy fellow at Duke University’s Margolis Center for Health Policy, told me. Hurricane Katrina is one recent example she gave.
But the plan is still remarkable. There are about 200 hospitals in New York state, totaling 53,000 beds before Cuomo told them to double their capacity. About 20,000 of those beds are in New York City.
It is a matter of necessity, as New York has already seen more than 100,000 Covid-19 cases and 1,500 deaths — with the peak still projected to be a week away, according to the Institute for Health Metrics and Evaluation’s estimates, requiring as many as 100,000 beds.
“This is on a scale that has not happened in the United States ever, with the possible exception of 1918,” Dentzer said of the New York strategy. “Nothing on this scale has ever happened in at least 100 years.”
I asked Peter Viccellio, associate chief medical officer at the Stony Brook emergency department in Long Island, about the New York hospitals plan. I want to share his response in full:
We’re in an almost apocalyptic crisis, which requires cutting through the bullshit. If hospital A has resources and hospital B doesn’t, it’s in the best interest of the patient that hospital A and B work together. Protective equipment should be available to all health care providers, not just those who work at a place with a better procurement officer. We ALL need the proper equipment to treat the patient, and adequate space. Fighting against each other for resources — this isn’t the time. Resources need to be distributed in a rational way. The current rugby scrum is nonsense.
The top priority in Cuomo’s plan is moving staff from less affected hospitals to those buckling under a surge of Covid-19 cases. Doctors and nurses from upstate hospitals will be transferred to NYC facilities. Likewise, hospitals will try to send patients from overcrowded hospitals to those with available beds. Ventilators, which support critical patients’ breathing, could also be shuffled between hospitals based on need.
The New York state department of health will manage the movement of staff and resources, in conjunction with hospitals. It will set certain thresholds for the number of occupied ICU beds or ICU Covid-19 cases that would trigger some of these transfers. The state will also coordinate the distribution of the protective gear that helps keep doctors and nurses healthy and able to work from the various state and hospital stockpiles.
(You’ve probably seen the news about the hospital ships and Central Park tents and Cuomo calling for medical volunteers, but the rest of the state has a lot of existing capacity that can be put to use without requiring new construction or traveling across the sea.)
It is an unprecedented organizing challenge — but we are dealing with an unprecedented crisis.
“My impression is that now more than ever, we need to recognize that health is a public good,” Karen Joynt Maddox, assistant professor at the Washington University in St. Louis School of Medicine, said. “It’s not just an individual state of being. And it’s to everyone’s benefit to work together to try to get people healthy.”
Joynt Maddox said that in St. Louis, the three big hospital systems have been holding frequent calls to share data on admissions and ICU transfers so they can better plan how to increase their capacity when and if cases surge there.
This kind of coordination is relatively commonplace within a single hospital system that has multiple facilities. What’s unique here is the scale: an entire state merging all of its hospital systems into one.
And that will present plenty of challenges both logistical (what happens when patients move from an in-network hospital to an out-of-network one?) and personal (are patients going to be moved far away from their families?). A few more questions, via the Kaiser Family Foundation’s Larry Levitt: What are the payment rates and who is paying? Do hospitals have to pay each other when one sends another resources?
“I do think it’s going to be incredibly messy and complicated to sort out reimbursement of all this on the back end,” he said.
Another one: Is Congress going to provide more funding to bail out hospitals in New York and elsewhere, which have taken a brutal financial hit as they cancel elective surgeries to free up more beds and staff to battle Covid-19?
We’ll need answers to those questions. But the time for radical action is here. As Joynt Maddox put it, “If not now, when?”
“This is the kind of organization we need in a pandemic, with very clear guardrails around the scenarios under which it’s put into place and under which it no longer applies,” she said. “I can see plenty of potential problems, but plenty of upside too.”
New York is the first state to take such a dramatic step as the coronavirus takes its toll there. But it may not be the last.
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