Hospital system deficiencies impeded coronavirus response, Stringer says
The COVID-19 pandemic has magnified the troubles of New York City’s public hospital system — long a problem unit — city Comptroller Scott Stringer said.
In a letter to Gov. Andrew Cuomo, who requested the review, Stringer highlighted the need for improved coordination across all parts of the healthcare system and better planning and preparedness.
“The lack of preparedness forced all players to improvise responses, sometimes successfully, sometimes not — but inevitably at a cost in human lives,” Stringer said.
City officials have confirmed 18,787 coronavirus-related cases as of Monday. They listed 4,624 deaths as COVID-19 or equivalent but with no positive laboratory test.
H+H, the largest municipal healthcare system in the U.S. and the city’s safety-net system, operates 11 acute-care facilities, five skilled nursing facilities and dozens of community-based health clinics.
Even before the pandemic hit, the system was facing a multitude of challenges. Its mandate is to serve all New Yorkers, regardless of ability to pay, strains the system. Because H+H’s patient revenues do not cover expenses, the system relies on government support. In addition, the city backstops its debt.
About 70% of H+H patients are insured by Medicaid or have no insurance, compared with 40% for private hospitals in the city. As of the beginning of FY 2020, revenues from patient insurance or payments covered just 61% of H+H’s expenses; with public subsidies providing the balance.
The $8 billion city unit is long renowned for inefficiency, union pushback, scandals and management fiascoes.
“Our system is full of Catch-22s,” its president, Mitchell Katz, said at a City Council hearing last year.
Hospitals throughout New York State will receive nearly $700 million of the $150 billion the federal CARES Act earmarked for hospitals nationwide, U.S. Sen. Charles Schumer announced Sunday.
According to Stringer, preparedness and execution deficiencies occurred at all levels, from the federal government down to individual hospitals, including inadequate access to needed supplies and equipment, confusing and medically inappropriate guidance, a lack of systems and procedures for managing patient loads across hospitals, and insufficient protocols for deploying staff.
Stringer also cited insufficient support, assistance, and guidance from the city, state and federal governments. The adopted state budget includes $2.2 billion in annual cuts against baseline Medicaid growth that could affect H+H’s bottom line.
“Things like schools, Health + Hospitals, transportation, these are areas that are really relied upon by the poorer residents in the city, the ones most vulnerable to the pandemic,” Howard Cure, director of municipal bond research for Evercore Wealth Management, said on a Bond Buyer podcast. “And not investing in that is a real social issue and a real problem.”
To better prepare for and manage a potential resurgence of COVID-19 patients, as well as future public health emergencies, Stringer recommended establishing formal coordination and guidance mechanisms among all parts of the healthcare system; improved protocols for staff training and deployment of resources; and identifying and remedying supply chain weaknesses.
“Certain operational deficiencies we identified can be addressed in the short term, but the deeper problem of inequitable access to healthcare must be considered equally urgent, even though it will take more time and resources to address,” Stringer said.