As large systems siphon away lucrative, privately insured patients with their capital upgrades, community hospitals like Kingsbrook end up hemorrhaging money serving patients who are uninsured or on Medicare or Medicaid, which tend to pay hospitals below cost for the care provided. The hospitals end up with little money to invest in quality improvements or service expansions, which further perpetuates the cycle.

Kingsbrook garnered mixed quality ratings over the years leading up to its closure, including a C rating for patient safety in spring 2021 from the nonprofit LeapFrog Group. Keefe, the Kingsbrook nurse, acknowledged the hospital was a “little shabby” and needed upgrades. In The weeks before Kingsbrook stopped admitting patients, she said, the hospital had stopped replacing broken equipment. Still, she added, that did not justify its closure.

Northwell’s study said the solution for hospitals such as Kingsbrook is “to catch up with the broader market strategies other providers have been pursuing over the past decade.”

In the same breath, it acknowledged: “The market and financial forces confronting these hospitals make it virtually impossible for them to succeed on their own.”

ROAD MAP FOR THE FUTURE

Experts point to regional health planning as a way to make New York’s health care delivery system more equitable, both within hospitals and outside them.

“There’s nothing to stop the city Department of Health from building up capacity to essentially assess what’s needed in the health delivery system in the five boroughs and advocate for it,” said Lois Uttley, senior advisor of Community Catalyst’s Hospital Equity and Accountability Project.

City Councilwoman Lynn Schulman, who chairs the council’s health committee, wants to tweak the zoning review process to include assessments of how a proposed development will impact local hospital capacity.

The Coalition for Affordable Hospitals, which was convened by Local 32BJ SEIU, a labor union, is pushing for state legislation to bar hospitals from using certain anticompetitive contract terms when they negotiate prices with insurers, weakening their leverage to set high rates.

Advocates notched a win in December, when Gov. Kathy Hochul signed legislation that requires hospitals to file an independent equity assessment when they propose a major project. For the first time, they will have to detail their plan’s likely impact on medically underserved communities.

Experts nonetheless predict that hospital consolidation will continue. New York’s next fight is unfolding just outside city limits, at Mount Vernon Hospital. Montefiore acquired the Westchester County hospital in 2013, when its previous owner filed for bankruptcy, as part of an aggressive expansion into the Hudson Valley. During the next few years, Montefiore eliminated beds and closed department after department.

Then, in 2019, it announced plans to close the hospital. In an echo of hospital consolidations past, Montefiore said it would replace the hospital with a $41 million emergency and outpatient facility funded by a state grant. The following year, in the face of protests and the pandemic, Montefiore said it would reassess the plan. What happens next is uncertain.

But one data point is clear: In the area surrounding Mount Vernon Hospital, three-fourths of residents are Black or Hispanic.