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Breakdown of the Downstate Sustainability Plan

Provided by the Cobble Hill Association Prepared by Jeff Strabone Date: May 29, 2013

As always, we are hard at work gathering facts about LICH and SUNY and distributing them to the public in a manageable form. SUNY released its Sustainability Plan for Downstate yesterday. Rather than wait for the release of our next version of the Factbook, we thought it would be timely to provide a breakdown of the Plan now while its fresh.

Contact Roy Sloane, President of the Cobble Hill Association:

Tuesday, May 28, 2013 -SUNY releases its Downstate Medical Center Sustainability Plan as a Power Point document. The document is detailed, complex, and not easily summarized. We encourage interested parties to consult the document in its entirety: int.pdf SUNY frames the stakes of the crisis this way on page 2: SUNY Downstate Medical School educates more minority physicians than almost anyplace else; it educates large numbers of new physicians who stay in New York City; and it is critical to meeting the shortage of primary care physicians needed for an aging and chronically ill Brooklyn population. LICH is barely mentioned in the document. SUNY Downstates problem is now identified as a crisis at University Hospital of Brooklyn, as on page 3: The pressing financial difficulties of SUNY Downstates clinical enterprise at University Hospital of Brooklyn (UHB) have reached the point where they imperil the future viability of Downstates academic enterprise and SUNYs prescribed mission to provide the people of New York educational services of the highest quality. To be absolutely clear, this is how Downstates website defines UHB: University Hospital of Brooklyn is the teaching Hospital of SUNY Downstate Medical Center, the only academic medical center providing patient care, education, research and community services for the nearly 5 million people living in Brooklyn, Queens and Staten Island. Opened in 1966 University Hospital of Brooklyn is an 8 story, 376-bed facility in central Brooklyn. The Hospital has 8 intensive care and step-down units, 12 operating rooms,an emergency services department,a diagnostic and ambulatory surgery facility,an ambulatory care center with some 75 clinics,plus 3 satellite Health Centers and a nearby Dialysis Center. Page 4, consisting entirely of quotations, suggests that the intellectual lineage of the Downstate Sustainability Plan is the November 2011 report issued by the Brooklyn MRT Health Systems Redesign Work Group, headed by Stephen Berger. Page 5 enumerates four options that were considered: 1. UHB is restructured with Part Q Flex Legislation and provided State support.

Breakdown of the Downstate Sustainability Plan Prepared by the Cobble Hill Association

2. SUNY exits hospital operations at Downstate and a 501c3 public-private entity is formed for the narrow purposes of being a hospital operator in the UHB facilities. 3. UHB is restructured with Part Q Flex Legislation, and a Brooklyn-based public benefit corporation is established to support, in part, the development of an integrated academic and clinical provider consortium for managed care contracting, improving quality and reducing the cost of care. UHB will become a smaller, more efficient hospital. 4. Another hospital or hospital system acquires UHB in whole or in part or absorbs clinical services. The key words in these four options are: restructured; SUNY exits; public-private entity; narrow purposes; public benefit corporation; managed care contracting; smaller. Option four reiterates the theme of page three: that clinical services is the weight on Downstates neck dragging it down. Additional points on this page include bullet points calling for stakeholder input, an implementation period of 24-36 months, and support from New York State. There is also an opaque reference, without elaboration to good progress reported to-date. Page 8 outlines The SUNY Plan, a pair of requests now being made by SUNY: 1. A transition period for a restructured UHB to continue to operate under SUNY auspices, with benefits offered by the new Flex legislation, and continued State support; and 2. The creation by the State of a new Brooklyn Health Improvement public benefit corporation that will 1) support, in part, the formation of a Brooklyn-based provider network to position member organizations for the changing healthcare environment; 2) serve as a strong academic network for Downstate Medical Center; and 3) allow UHB to become a smaller, more efficient hospital. Page 9 is dense with bullet points outlining the Suggested Role for a Brooklyn Health Improvement Public Benefit Corporation (PBC). Here is a selection of the points that seem to say the most about the nature of the proposed PBC entity and its potential malleability: The corporation will not operate hospitals. [] The PBC would not be the operator of the network. [] A vehicle for capital formation (not contemplated at this time but may be a goal in the future).

Breakdown of the Downstate Sustainability Plan Prepared by the Cobble Hill Association

An entity with the power to form subsidiary corporations in support of its purposes. An entity that can change its purpose and scope in response to the changing healthcare environment. Page 10 details three phases of the plan. Phase 1 is the most direct: Focus on Restructuring UHB to reach as close to a sustainable operation as possible. It occurs to us, and others will have their own interpretations, that this may be a wordy way of saying UHB will be downsized and lose capacities. Phase 2 is called Plan: Request the State to create a new public benefit organization, a Brooklyn Health Improvement PBC, to support health-improvement initiatives and promote the formation of a Brooklyn provider-based network. With support from the State, work with providers to plan the model for a Brooklynbased network to achieve a critical mass of providers to improve quality of care through clinical integration, for managed care contracting, and to support the teaching programs at SUNY Downstate. Engage the community and other stakeholders. We note that the community and other stakeholders will be engaged in phase two, not in phase one when UHB will be restructured. Does this imply that the restructuring, whatever that entails, will be effected before the stakeholders are engaged? Phase 3, called Implement, explicitly calls for a smaller hospital with managed care consulting: Implement a staged plan for the network for IT linkages and the data analytics to support clinical data reporting and benchmarking and clinical staff to drive change management. With the expansion of the academic network, Downstate can expand its clinical affiliated sites to other locations and UHB can become a smaller, more efficient hospital. With clinical integration established, launch managed care contracting to increase revenue to network members. Page 11, also quite dense, provides a diagram of the Integrated Network and Academic Consortium that the proposed Brooklyn Health Improvement PBC would create. It is clearer here than elsewhere in the document that the proposed Consortium would consist of various entities under different ownership:

Breakdown of the Downstate Sustainability Plan Prepared by the Cobble Hill Association

BHI will not operate hospitals. It will support the formation of a clinically integrated network that will allow the expansion of clinical training sites for Downstate and improve quality and value UHB and Other Hospitals in the proposed consortium will engage in Joint managed care contracting, among other shared activities like Cultivating shared network goals (while retaining separate ownership and management). The least-defined aspects of the PBC appear at the bottom: BHI and the Network may have their purposes and functions expanded as the environment changes; BHI would not operate the network. Page 12 answers the question What would the Network Do?: Principal Network Activities Common clinical pathways, cost protocols, outcome monitoring, education and promotion of practice pattern changes An academic network and GME consortium Principal Network Benefits Managed care contracting and increased revenue, improved quality of care and increased efficiency (cost reduction), alignment of hospitals and physicians for quality and cost goals A strong academic network to support SUNY Downstates Educational programs Page 13 provides a timeline for three phases through Fiscal Year 2017 with projected costs year by year. (The amounts of money are in the thousands. We suspect they meant millions.) The future of LICH is addressed, for the first time in this document, in a footnote:

SUNY will review all responses received to the request for information and determine the most expeditious and financially responsible course of action to enable Downstate to exit from the operation of the Long Island College Hospital facility. Pages 14 through 16 define how the success of each phase will be measured. Here are a few of the benchmarks not spelled out elsewhere in the document: Pursue every action possible to restructure UHB into a smaller, more efficient hospital that is more financially sustainable; this will include significant workforce reductions. [] As UHB becomes smaller, there may be vacated space that can be considered for alternative uses including a Healthcare Worker Training and Retraining Center at UHB.

Breakdown of the Downstate Sustainability Plan Prepared by the Cobble Hill Association

Page 17 breaks down the transition funds needed from NYS for the proposed restructuring year by year through Fiscal Year 2017. The proposed outlays on this page equal $457 million over four years with other costs TBD.

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