Breakdown of the Sustainability Plan

7/28/2019 Breakdown of the Sustainability Plan

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Breakdown of the Downstate Sustainabili ty Plan

Provided by the Cobble Hill AssociationPrepared by J eff StraboneDate: May 29, 2013

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

ContactRoy Sloane, President of the Cobble Hill Association: [email protected]


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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 partiesto consult the document in its entirety:

http://www.suny.edu/Board_of_Trustees/webcastdocs/Downstate%20Sustainability%20powerpoint.pdf

SUNY frames the stakes of the crisis this way on page 2:

SUNY Downstate Medical School educates more minority physicians than almostanyplace 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 agingand 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 ofSUNY Downstates clinical enterprise at UniversityHospital of Brooklyn (UHB) have reached the point where they imperil the futureviability of Downstates academic enterprise and SUNYs prescribed mission to providethe 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 andStaten 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.

http://www.downstate.edu/uhb/

Page 4, consisting entirely of quotations, suggests that the intellectual lineage of the DownstateSustainability Plan is the November 2011 report issued by the Brooklyn MRT Health SystemsRedesign 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.


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Breakdown of the Downstate Sustainability PlanPrepared by the Cobble Hill Association

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2. SUNY exits hospital operations at Downstate and a 501c3 public-private entity isformed 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-basedpublic benefitcorporation is established to support, in part, the development of an integrated academic

and clinical provider consortium formanaged care contracting, improving quality andreducing 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 orabsorbsclinical services.

The key words in these four options are: restructured; SUNY exits;public-private entity; narrowpurposes;public benefit corporation; managed care contracting; smaller. Option four reiteratesthe theme of page three: that clinical services are the weight on Downstates neck dragging itdown.

Additional points on this page include bullet points calling for stakeholder input, animplementation period of 24-36 months, and support from New York State. There is also anopaque 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 SUNYauspices, 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 benefitcorporation that will 1) support, in part, the formation of a Brooklyn-based providernetwork to position member organizations for the changing healthcare environment; 2)serve as a strong academic network for Downstate Medical Center; and 3) allow UHB tobecome a smaller, more efficient hospital.

Page 9 is dense with bullet points outlining the Suggested Role for a Brooklyn HealthImprovement Public Benefit Corporation (PBC). Here is a selection of the points that seem tosay the most about the nature of the proposed PBC entity and its potential malleability:

The corporation will not operate hospitals.

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The PBC would not be the operator of the network.

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A vehicle for capital formation (not contemplated at this time but may be a goal in thefuture).


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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 healthcareenvironment.

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 ofsaying 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 formationof a Brooklyn provider-based network.

With support from the State, work with providers to plan the model for a Brooklyn-based network to achieve a critical mass of providers to improve quality of care throughclinical integration, for managed care contracting, and to support the teaching programsat SUNY Downstate.

Engage the community and other stakeholders.

We note that the community and other stakeholders will be engaged in phase two, not in phaseone 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 careconsulting:

Implement a staged plan for the network for IT linkages and the data analytics to supportclinical data reporting and benchmarking and clinical staff to drive change management.

With the expansion of the academic network, Downstate can expand its clinicalaffiliated sites to other locations and UHB can become a smaller, more efficient hospital.

With clinical integration established, launch managed care contracting to increaserevenue to network members.

Page 11, also quite dense, provides a diagram of the Integrated Network and AcademicConsortium that the proposed Brooklyn Health Improvement PBC would create. It is clearerhere than elsewhere in the document that the proposed Consortium would consist of variousentities under different ownership:


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BHI will not operate hospitals. It will support the formation of a clinically integratednetwork that will allow the expansion of clinical training sites for Downstate and improvequality and value

UHB and Other Hospitals in the proposed consortium will engage in Joint managed carecontracting, among other shared activities like Cultivating shared network goals (whileretaining 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 theenvironment changes; BHI would not operate the network.

Page 12 answers the question What would the Network Do?:

Principal Network ActivitiesCommon clinical pathways, cost protocols, outcome monitoring, education andpromotion of practice pattern changesAn academic network and GME consortium

Principal Network BenefitsManaged care contracting and increased revenue, improved quality of care and increasedefficiency (cost reduction), alignment of hospitals and physicians for quality and costgoalsA strong academic network to support SUNY Downstates Educational programs

Page 13 provides a timeline for three phases through Fiscal Year 2017 with projected costs yearby year. (The amounts of money are in the thousands. We suspect they meant millions.) Thefuture of LICH is addressed, for the first time in this document, in a footnote:

2. SUNY will review all responses received to the request for information and determinethe most expeditious and financially responsible course of action to enable Downstate toexit 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 ofthe benchmarks not spelled out elsewhere in the document:

Pursue every action possible to restructure UHB into a smaller, more efficient hospitalthat is more financially sustainable; this will include significant workforce reductions.

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As UHB becomes smaller, there may be vacated space that can be considered foralternative uses including a Healthcare Worker Training and Retraining Center at UHB.


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Page 17 breaks down the transition funds needed from NYS for the proposed restructuring yearby year through Fiscal Year 2017. The proposed outlays on this page equal $457 million overfour years with other costs TBD. The costs forLICH are $129 million over the four years,with no other detail provided. Meanwhile, UHBs cash gap over the same four years will equal$225 million.

Breakdown of the Sustainability Plan

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