Je devine pas mal les taux d'occupation de nos salles d'urgences Mais quel sont nos taux d'occupations aux �tages ??? (95% ?)
------------------------------------------------------------ April 25, 2005 Half-Empty Hospitals in a Shrinking City By LISA W. FODERARO UFFALO - In the last half century, this city has been hemorrhaging residents, with a weak economy and municipal turmoil cutting the population in half to just 292,000 people. But even as Buffalo's citizens have fled, eight of the city's state-licensed hospitals remain open, with 2,425 beds, as well as five open-heart-surgery programs. On average, nearly half the beds are empty in those hospitals and four others in suburban Buffalo that draw from the same population. Their occupancy rate is 54 percent, below the state average of 61 percent and considerably lower than New York's goal of 90 percent, according to the State Department of Health. Even in New York State, which ranks in the top third nationally in terms of beds per capita, that rate reflects an extraordinary amount of excess capacity. All of this should make Buffalo ripe for the kind of shrinkage and belt-tightening that New York officials say is finally inevitable. Even some city and hospital officials concede that at least one and possibly two hospitals here should close, if only to shore up the remaining ones. But closing hospitals remains a challenge in New York, and it is no different in this city, where fierce community loyalty to neighborhood hospitals, the high cost of paying off debt and a lack of cooperation have kept things in an excruciating limbo. "Debt is the principal obstacle to closing hospitals," said William D. McGuire, the chief executive of Kaleida Health, which owns three hospitals in Buffalo and two in the suburbs. "But an awful lot of the obstacle is C.E.O. ego," he said. "We're kingdom builders as a group: 'I've got to have more beds than you do. I've got to have more hospitals than you do. I've got to have the biggest empire.' " With Gov. George E. Pataki and state lawmakers ready to appoint a commission to recommend hospital closings, as a way to rein in the state's rapidly rising Medicaid expenditures, Buffalo would seem to be a good place to start. The eight hospitals - ranging from squat, yellow-brick centers to sleek concrete-and-glass towers - include a money-losing county hospital; a highly regarded cancer institute; a cluster of hospitals run by a savvy nonprofit corporation; two Catholic hospitals; and a 40-bed center struggling to emerge from bankruptcy. (There is also a Veterans Administration hospital in Buffalo, which is under federal control and is not state-licensed.) In a city of strongly defined communities, laid out along ethnic, racial and religious lines, the eight have managed to stay open despite recording huge losses as a group in recent years. One tentative proposal in 2002 to shut Women and Children's Hospital of Buffalo met with a rally downtown that drew thousands of protesters. One of the speakers was the former Buffalo Bills quarterback Jim Kelly. "Everybody in Buffalo is very neighborhood-oriented," said Sheila K. Kee, chief executive of Sheehan Memorial, the hospital in bankruptcy. "If it's beyond 20 minutes, forget it. To Buffalonians, that's a big deal." Within those hospitals are many duplicative services. "It's an area where a tremendous amount of money is wasted," Mr. McGuire said. In addition to the five heart programs (three of which belong to Kaleida), there are two kidney transplant programs, two neonatal intensive care units and several oncology services. Although the occupancy rates in Buffalo are among the worst in the state, the health care picture has slightly improved, because of some self-imposed downsizing. (State officials would like to see the state occupancy rate close to 90 percent, said Rob Kenny, a health department spokesman.) Since 1998, Catholic Health System has closed two hospitals in the suburbs, a move that prompted outcries but strengthened its four remaining hospitals, including two in the city. Roswell Park Cancer Institute dynamited its old 200-bed hospital and built a new one, with expanded outpatient services but with half the number of beds. Kaleida Health has taken a different tack: decertifying, or eliminating, 634 beds - about a third of its total - and preparing to sell off or demolish 750,000 square feet of space. Mr. McGuire has made it known that he would like to serve on the governor's hospital-closing commission. And, he said, he is willing to consider shutting one of his three city hospitals. The downsizing, along with management improvements, has already paid off. Until recently, Kaleida and Catholic Health lost $125 million and $100 million, respectively, over several years. But both are now posting slight surpluses of several million dollars a year. Mayor Anthony M. Masiello points to the reduction of beds, as well as three closings of small city hospitals in the early 1990's, as proof that Buffalo is ahead of the curve. "This city and region have been in the forefront of making tough decisions," he said. "Can we afford to do some more retrenchings? Probably so. But while the governor should be applauded for trying to do this responsibly, it has to be done on merit and in the context of overall quality." Bruce A. Boissonnault, president of the Niagara Health Quality Coalition, a nonprofit group that publishes the New York State Hospital Report Card, insists that the Buffalo region needs to eliminate hospitals, not just beds. "Hospitals are high fixed-cost factories," Mr. Boissonnault said, referring to expenses like real estate, computers and utilities. "It's only after you get over that fixed-cost barrier that you can start putting money into imaging equipment, new doctors and bedside staff." Yet which hospital or hospitals should close or restructure in Buffalo remains a source of tension. Catholic Health, which already closed two hospitals, offers colorful PowerPoint charts comparing its patient discharges, number of births and inpatient surgical procedures with Kaleida's, to show that its four remaining hospitals are alive and well. In every instance, Kaleida's numbers were flat or falling, while Catholic Health's rose. And while the Western New York Healthcare Association is forming a committee to guide the governor's hospital-closing commission, efforts to form a Buffalo committee have lagged. Ms. Kee of Sheehan said the strain resulted from too few patients for too many beds. "Everyone has their own little silo," she said of the hospital chiefs. "When you're in a dying economy and someone stands on the roof of the building and throws a bone on the ground, everyone fights over it." Buffalo's weak economy means that any closing will be acutely felt. The city's streets are pocked with boarded-up apartment buildings, and the police investigate dozens of homicides each year. The city's average unemployment rate was 7.3 percent last year, compared with the statewide average of 5.8 percent. "Our economy has already taken a big hit from hospital closings and downsizing," Mayor Masiello said. But most agree that a well-chosen commission has the potential to work objectively and for the good of all. "In light of all the complexities of closing hospitals, a commission may actually be what has to happen as we begin to look at the entire state," said Joseph D. McDonald, the chief executive of Catholic Health. "We need regional clarity about what we really need in terms of health care infrastructure, and not just right now, but over the next 15 years." Hospital officials say a commission has an additional benefit: political and financial cover. It could provide a desired financial incentive as state officials try to secure $1.5 billion in federal aid. That could smooth the way toward a smaller system by, among other things, helping hospitals pay off their long-term debt. Some hospital officials who have pushed through difficult closings without such safety nets are sure to be resentful. "We did it without anybody flying cover for us in terms of a base-closing commission," Mr. McDonald said. One challenge facing the commission will be to figure out which hospitals are underused. While the state uses the total number of certified beds to calculate occupancy, Catholic Health and other hospital networks prefer to focus on the number of operational beds, meaning the ones they actually staff. At Sisters of Charity Hospital, for instance, there are 413 certified beds, but only 227 are in use. In fact, many exist only on paper, with patient rooms converted into administrative offices. Mr. McDonald said he was reluctant to relinquish the potential beds at Sisters, as Kaleida did, because he could not predict future demand, especially given possible closings elsewhere in the city. On a recent weekday morning, the emergency room at Mercy Hospital of Buffalo appeared to be going at full tilt, with several patients waiting on gurneys in the halls, despite a doctor's insistence that it wasn't that busy. During flu season, which can seem interminable during the long Buffalo winters, Mercy's emergency room is often swamped. "The metro area is known for having emergency departments on divert, when they can't accept patients," said Dennis McCarthy, a Catholic Health spokesman. While Governor Pataki has said the commission will consider restructurings as well as closings, getting rid of redundancies could prove tricky. Catholic Health is particularly proud that it won permission from the State Department of Health two years ago to start an open-heart-surgery program at Mercy. "Why wouldn't a system of this size and strength have an open-heart program?" Mr. McCarthy asked, pointing out that the network has 800 beds across four hospitals. But some administrators hope a state commission will spend as much time considering ways for hospitals to restructure as it does recommending their demise. Ms. Kee said Sheehan had cut its certified beds to 40 from 109 as it shifts its inpatient focus exclusively to drug and alcohol detoxification and rehabilitation. "I'm willing to say that we will restructure," she said. "We're changing our emphasis, maybe changing licensure. I do intend to be a poster child for that." David C. Hohn, the chief executive of Roswell Park Cancer Institute, agreed that restructuring should be an important component of the commission's work. "This will turn into something more complex than simple closure," he said. More than anything, Dr. Hohn said, the trend toward outpatient care in recent years had accelerated the need to revamp the entire health care system. "A lot of this is painful," he said, "but it's the price of progress." Copyright 2005 The New York Times Company http://www.nytimes.com/2005/04/25/nyregion/25buffalo.html?pagewanted=print&position= --- URG-L Pour quitter URG-L, envoyez un message a la liste ([email protected]) avec, COMME SUJET, le mot REMOVE (rien d'autre).
