tearing the safety net: the devastating impact of losing brooklyn's largest private psychiatric...

7/27/2019 Tearing the Safety Net: The Devastating Impact of Losing Brooklyn's Largest Private Psychiatric Provider

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Interfaith Hospital is the Brooklyns largestprivate provider of in-patient psychiatriccare. Right now, it is in bankruptcy, andteetering at the brink of closure. According tofilings with the Federal bankruptcy court,Interfaith will close its Emergency Room onSeptember 14th, and end inpatient programs onSeptember 15th.1

A closure of Interfaith would be a grievous blowto psychiatric care in Brooklyn. It would placeBrooklyns psychiatric safety net dangerouslyovercapacity. It would deny access topsychiatric and quality mental health carebased entirely on where a person lives, not thetype of care they need.

This is a City responsibility. Mayor Bloombergs silence on hospital closures is untenable. Losing Interfaith would

have a devastating impact on psychiatric care in Brooklyn and Queens, and threatens to overwhelm City psychiatricservices at public hospitals already burdened by crowding. The State has a moral and legal obligation to considerand minimize the dire consequences of a closure that does not retain net psychiatric capacity and ensure thatpeople seeking psychiatric care in Brooklyn are not left on their own.2

Interfaith Serves a Population In Particular Need of Psychiatric Care

The people who live in the area surrounding Interfaith and who use it as their community hospital (the catchmentarea) are particularly in need of psychiatric services, compared to those in other boroughs, or even other Brooklynneighborhoods.

Brooklyn residents are more likely to use inpatient psychiatric services than the statewide average, 5.8 per 10,000versus 5.0 per 10,000.3 At Interfaith in particular, those admitted to the hospital for injuries or physical illness areoften also suffering from psychiatric health issues requiring special care or admission to inpatient psychiatricservices. Sixty percent (60%) of all patients discharged from Interfaith hospital have a psychiatric condition as eitherthe principal diagnosis, or as a comorbidity, compared to 27% across Brooklyn.4

Interfaith is the Largest Voluntary Provider of Inpatient Psychiatric Care in Brooklyn

This closure would have serious consequences for the provision of psychiatric care in Brooklyn. Interfaith is the

1Nina Bernstein, Interfaith Medical Center Plans to Close, NY Times, July 31, 2013.

2New York State Department of Health Regulation 709.1(6), outlining that a determination of a public need in the case of the reduction orelimination of a serviceshould be guided by the extent to which need will be met adequately and the effect of the reduction, elimination, orrelocation of the service or facility on the ability of the low-income persons, racial and ethnic minorities, women, handicapped person, and otherunderserved groups, and the elderly, to obtain needed health care. See also, NY Public Health Law 2801-g, requiring the Commissioner toconsider and receive public input on the anticipated impact of the general hospital's closure on access to health care services by members of thesurrounding community, including but not limited to recipients of medical assistance for needy persons, the uninsured, and underservedpopulations, and options and proposals to ameliorate such anticipated impact.

3Medicaid Redesign Team Brooklyn Health Systems Redesign Working Group, At the Brink of Transformation: Restructuring the HealthcareDelivery System in Brooklyn, November 2011. Available athttp://www.health.ny.gov/health_care/medicaid/redesign/docs/brooklyn_mrt_final_report.pdf.

4 Ibid.
http://www.health.ny.gov/health_care/medicaid/redesign/docs/brooklyn_mrt_final_report.pdfhttp://www.health.ny.gov/health_care/medicaid/redesign/docs/brooklyn_mrt_final_report.pdf


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largest private provider (and third overall largest provider) of inpatient psychiatric care in Brooklyn, with more than1750 annual psychiatric discharges, and 120 inpatient beds devoted to psychiatric care. 5 These beds account for13.5% of the total inpatient psychiatric capacity in the borough.6 The hospital also handles approximately 67,000outpatient psychiatric patients each year. 7

Two public hospitals operated by the City of New Yorks Health and Hospital Corporation, Kings County HospitalCenter and Woodhull Medical & Mental Health Center, have 452 and 435 beds, respectively. These hospitals arefull: on an average day they operate at 96% (Kings County) and 94% (Woodhull) capacity.

Losing Interfaiths Psychiatric Capacity Would Overburden Surrounding Hospitals.

91% Capacity on an Average Day Would Rise to 107% Overcapacity.

Without the services available at Interfaith, Brooklyns psychiatric in-patient capabilities would go from strained todangerously over-capacity. An analysis of 2011 data by the Public Advocates Office shows that, on an averageday, Brooklyn inpatient psychiatric beds are 91% full. If Interfaith were to close, a thin surplus of beds would turninto a deficit with the total number of inpatients seeking care on an average day equal to 107% the number ofavailable inpatient beds available.8

On an average day, 714 people are receiving inpatient psychiatric care in Brooklyn hospitals, a total of 10,141psychiatric discharges each year. In 2011, Brooklyn had 889 inpatient psychiatric beds with approximately 810people receiving inpatient psychiatric care at any given day, an occupancy rate of approximately 91.2%.

In the past year, Brooklyn has already lost over 100 psychiatric inpatient beds at Coney Island Hospital, as a resultof damage from Superstorm Sandy, and at Long Island College Hospital (LICH), as a result of contentious closureof that institution by the State University of New York.

A loss of Interfaiths additional 120 inpatient psychiatric beds, which are currently operating at 95.7% occupancy,would mean the number of people needing inpatient psychiatric care in Brooklyn would be equal to 107% the

available 2011 capacity, and 122% the available capacity assuming the patients who were once psychiatricinpatients at LICH and Coney Island are currently seeking care in Brooklyn as well.

Two other struggling Brooklyn hospitals Brookdale Hospital Medical Center and Kingsbrook Jewish MedicalCenter, for an additional 100 inpatient psychiatric beds. Based on the average daily occupancy of these psychiatricfacilities, the loss of these hospitals (in addition to Interfaith, Coney Island, and LICH) would yield an overcapacity ofapproximately 143% -- a staggering mismatch between people in need of serious psychiatric care, currently offeredby inpatient services, and the capacity to help them.

Other Private Hospitals Rely on Interfaiths Psychiatric Services

to Provide Care to Their Patients

Other providers in Brooklyn without their own psychiatric capacity rely on Interfaith provide care to their patients.For example, in 2012, Interfaith reached an agreement with Wyckoff Heights Medical Center to be the sole provider

5 Psychiatric inpatient discharges, a measure of the volume of inpatient services provided by a facility, was 1773 in 2011, the most recent dataavailable from the New York State Office of Mental Health. Available at http://bi.omh.ny.gov/cmhp/dashboard#tab5 .

6 Based on 2011 data from the New York State Department of Health. Bed capacity for Coney Island Hospital, which closed due to damagerelated to Superstorm Sandy. It also does not include inpatient psychiatric capacity once available at Long Island College Hospital (LICH).

7Nina Bernstein, Brooklyn Hospital Closings a Blow to Psychiatric Care, NY Times August 1, 2013.

8 2011Medicare Cost Reports.


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of behavioral health services, includinginpatient, outpatient, and emergencypsychiatric care, evaluations of patientswith substance abuse problems, andother mental health services.9

Ramon Rodriguez, CEO of WyckoffHeights Medical Center recently saidthat, "When Interfaith closes, we willhave no place where we can send adecompensating mentally ill personfrom our emergencydepartmentInterfaith is the onlyprovider of inpatient behavioral healththat accepted our patients."10

A Free-Fall Closure

Is No Solution

Even if an eventual transformation of Brooklyn mental health would include a reduction in inpatient psychiatric beds,a free-fall post-bankruptcy closure is no way to do it.

A shuttering of Interfaith would not be a smooth and coordinated process envisioned by the 2011 Brooklyn MedicaidRedesign Team. That document identified a need to adequately support the effective management of behavioralhealth conditions in the community by reducing the need for inpatient care, integrating medical and behavioralcare, coordinating along a continuum of care, improve early intervention, and investments in supportive housinghousing, employment and education. 11

The current bankruptcy and shuttering would not accomplish that -- it would eliminate capacity without replacing itwith alternative options, leaving those seeking psychiatric care to go to another, already crowded, Brooklyninpatient facility, or worse, go without any care at all.

The Public Advocate is recommending the following course of action to rescue and reform the provision ofpsychiatric care at Interfaith and across Brooklyn:

The City, State, and Interfaith leadership need to step up to avert a free fall closure and think creatively onsolutions that can retain psychiatric capacity and ensure quality psychiatric care adequate to addressBrooklyns challenges.

We need a Brooklyn Health Authority, empowered through control of Federal Medicaid Waiver finds to guide amaster plan for the equitable reorganization and reform of Brooklyn hospitals and health care. Among theirrecommendations, the Brooklyn Health Authority should encourage existing hospitals with excess beds to

9Wyckoff Heights Medical Center, INTERFAITH MEDICAL CENTER TO PROVIDE WYCKOFF HEIGHTS MEDICAL CENTER BEHAVIORALHEALTH SERVICES, Press Release October 1, 2012. Available at http://www.wyckoffhospital.org/about/news-events/interfaith-wyckoff-behavioral-health-services-collaboration.

10Fred Mogul, WNYC, Kaiser Health News, Cascading Hospital Closures Loom Over Brooklyn, August 5, 2013, available athttp://www.kaiserhealthnews.org/stories/2013/august/05/brooklyn-new-york-hospital-closings-loom.aspx

11 Medicaid Redesign Team Brooklyn Health Systems Redesign Working Group, At the Brink of Transformation: Restructuring the Healthca reDelivery System in Brooklyn, November 2011. Available athttp://www.health.ny.gov/health_care/medicaid/redesign/docs/brooklyn_mrt_final_report.pdf.
http://www.health.ny.gov/health_care/medicaid/redesign/docs/brooklyn_mrt_final_report.pdfhttp://www.health.ny.gov/health_care/medicaid/redesign/docs/brooklyn_mrt_final_report.pdf


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transform some of their beds into inpatient psychiatric beds in order to meet the growing demand for psychiatriccare across Brooklyn.

Interfaith is currently operating under a Federal requirement, known as the Institute for Medical Disease (IMD)Exclusion that prevents them from receiving Medicaid matching funds if more than 51% of their patient rosterconsists of people between the ages of 22 and 64 with severe mental illness. The Federal government shouldchange these rules to exempt those patients covered by a Medicaid Managed Care plan for counting towards ahospitals 51% limit under the IMD exclusion. This common sense change would allow Interfaith to accept morepsychiatric patients, shoring up their balance sheets and stabilizing the hospitals, without increasing the coststo the Federal government (as their payments to the Medicaid Managed Care provider would remain the same).

Finally, we need to explore ways for the Citys Health and Hospitals Corporation to increase their ability tointegrate better into existing health networks, by accepting referrals from voluntary hospitals, and stepping in toprovide services when voluntary hospitals are insufficient or unable to meet community care needs.

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