NYC Hospital Crisis

In 2008, New York City hospitals spent $3 billion more on care than they took in. And, they operated at an average of a 6% loss versus the national average of operating at a 4% profit. One of the little discussed consequences of federal health reform and its related significant reductions in Medicare reimbursement will be the absence of any margin that can be used for capital investment.

Speakers included:
- Dr. Ralph de la Torre, President & CEO, Caritas Christi Health Care (recent name change to Steward Health Care)-- not a big fan of pharma companies; quite proud of himself for his work in Massachusetts, which has become, by default, the pilot for the National 'universal care' model advanced through the Health Care Reform Act.

- Stephen Berger, Chairman, Odyssey Investment Partners and Chairman, Commission on Healthcare Facilities in the 21st Century -- made a bunch of recommendations to the governor about 5 years ago as to which hospitals should be closed and which should be left open; his recommendations were largely ignored, which is testament to the politics of change; perhaps the fact that his recommendations were largely ignored is why he reacted so negatively to Annette's effort to discuss his ideas on wellness (something he brought up while speaking) and that he has no use for the media.

- Ken Raske, President, Greater New York Hospital Association -- very comfortable in his position and enjoys teasing republicans; pro-union.

- Richard J. Zall, Chair, Healthcare Practice Group, Proskauer LLP and Chair, Executive Council Health Care Board: like everyone else on the supply side, looking for a way to turn this chaos into consulting revenue.

- Mark Wagar, President & CEO, Empire BlueCross BlueShield/Wellpoint -- from what I could gather, this is a person who prefers things to be kept exactly the way they are and is banking on the Republicans dismantling this Obamafolly post haste.

- Brian Fortune, Marwood Group -- most interesting speaker on the two panels; very astute and reasonably objective; looks at the whole thing as another chapter in an intellectual exercise.

- Adam Rogoff, Partner, Kramer Levin and Lead Counsel, St. Vincent’s -- Adam somehow managed to make Chapter 11 sound like a great feature film; I guess Chapter 11 is exciting/appealing if it comes with a boat load of legal fees (he's a lawyer); unfortunately, his emphasis on the positive nature of Chapter 11 demonstrated a complete lack of sensitivity to those in the audience that can't bear the thought (or aren't in any kind of immediate financial straits) of shutting their revered hospitals down.

- Pam Brier, President & CEO, Maimonides Medical Center -- failed to show up; too bad, the few women in the audience wouldn't have felt quite as disenfranchised since all of the speakers were men.

- Jim Tallon, President, United Hospital Fund of New York -- I actually knew this guy when he was an assemblyman in Albany; spent my final semester as an undergrad working as a NYS Assembly Intern; anyway, Jim rattled off a whole bunch of interesting hospital statistics; he made an excellent point as well -- that basically any hospital infrastructure investment going forward will be in areas where the demographics yield middle and high income wage earners; this is a long-term pattern that should continue and will continue to put more and more distance between sick poor people and any kind of timely health care delivery.

- Dr. Herb Pardes, President & CEO, New York-Presbyterian Healthcare System -- it's funny, there must be a hospital CEO prep school somewhere; they all pretty much act like fundraisers/cheerleaders and caution us against the stoppage of money going into medical research; again, an emphasis on status quo. And what should not be overlooked is the disconnect between internal operations and the CEO "vision." From what I have seen, CEOs have very little connection with their internal environments; their focus is external (i.e., big money donors/new pavilions). The implication? That if you rely on the CEO to lead internal change, you are wasting your time; the only way to create organization-wide change is to acknowledge the CEO/Department Head disconnect and then work around it. (We have a number of strategies to either close the gap, or acknowledge it and then proceed under a more realistic game plan.)

- Christopher Vanuga, Principal, Deloitte Health care -- see Zall comments -- same thing.

Anyway, what this whole health care crisis is about, from my standpoint, is the evolution of greed. Not enough to go around for everyone; not enough money to keep everyone in the game; and everyone in the game today wants desperately to stay at the table. No one expresses it this way. Better to express it in segmented ('here's what it means to me') form. Once the real story (greed/I am not letting go of my piece) is dealt with, then meaningful change will occur. Until then, brace yourself for an endless stream of segmented, self-serving arguments presented as sweeping or universal. And since they are segmented by self-interest, you will hear many versions of the 'real story.'