By ANEMONA HARTOCOLLIS Published: September 2, 2010, NYT
New York City’s public hospital system is embarking on a long-term attempt to gain more control over running its 11 hospitals by renegotiating longstanding affiliation contracts with some of the city’s most powerful medical schools.
For decades, many of the city’s public hospitals have had contracts with medical schools allowing the schools to hire and fire doctors, imposing a buffer between the city’s Health and Hospitals Corporation and thousands of employees.
Under these contracts, the Health and Hospitals Corporation pays hundreds of millions of dollars to medical schools like those of Columbia, Mount Sinai, New York University and the State University of New York Downstate, as well as to some private professional corporations. The contracts give them the authority to manage the doctors in the city’s public hospitals, pay their salaries, and work with the hospitals corporation to make crucial decisions on how to deliver health care services to a huge portion of the city’s poor and working-class patients.
In return, the public hospitals have benefited from the prestige and talent conferred by the medical schools’ role as training and research centers.
But officials from the Health and Hospitals Corporation believe that to a large degree the public hospital system has outgrown the need to cede control over its physicians to universities. They said the goal was to centralize and streamline the administration of the city’s hospitals and the delivery of services, and to gain more control over which services are delivered at which hospitals.
They believe that they can negotiate agreements that weaken the hold of the large universities, putting the day-to-day management of the physicians into a small number of private corporations, or even one “super” corporation, yet continue to attract and retain qualified physicians.
“If you go back 50 years, I think it was the notion that having a brand-name entity equated with quality and would be more attractive for physicians,” Alan D. Aviles, the Health and Hospitals Corporation’s president, said in an interview this week in which he described the proposed overhaul. “I think things have changed dramatically. We are not the system we were 50 years ago.”
The proposal has raised alarms among doctors at Harlem Hospital Center, whose affiliation agreement with Columbia University has been extended until Dec. 31. Some doctors say that N.Y.U. and Mount Sinai are less likely to lose control of their hospitals because of closer connections between their leadership and the hospitals corporation.
Doctors in at least one Harlem Hospital department — neurology — have threatened to quit en masse at the end of the year if the Columbia affiliation is severed. Both Columbia and the hospitals corporation have been trying to reassure them that their jobs and salaries will be maintained and that they will still have faculty appointments at Columbia.
But officials said some issues, like benefits, including college tuition benefits for physicians’ children, were still being negotiated.
Some physicians also worry that without a strong connection to Columbia, the quality of care at Harlem Hospital might decline.
Dr. Lee Goldman, dean of the College of Physicians and Surgeons at Columbia, said Thursday that even if Harlem Hospital’s doctors were no longer Columbia employees, they would be expected to keep standards at Harlem Hospital high.
“We don’t use the name Columbia lightly, and a relationship is a relationship,” Dr. Goldman said. “We expect this to be a very strong relationship, and we’re very committed to the people of Harlem, their health and welfare, and working with H.H.C. to maximize that.”
Mr. Aviles said the hospitals corporation would do the same. “To the extent that faculty members have an ID that says they’re a faculty member at Columbia, they’ll still have it,” he said. “For most of our patients, I don’t think they ask where their doctors are affiliated.”
Dr. Goldman said that the new relationship would be more like the ones with private hospitals, like St. Luke’s-Roosevelt in Manhattan, where Columbia also now sends doctors for training.
The restructuring, Mr. Aviles said, would give the corporation more power to direct services to hospitals that could become what he called highly specialized “centers of excellence,” while other hospitals would be more oriented toward basic medicine.
For instance, he said, Harlem Hospital is a center for bariatric surgery, and patients from other hospitals could be directed there, rather than having the corporation trying to offer bariatric surgery at every hospital.
“Communities, even more than the affiliates, like the idea that their local hospital can do everything,” Mr. Aviles said. “But that’s not the reality of the way health care is evolving.”
He said the overhaul was critical to meeting the demands of federal health care reform.
“The pendulum right now is swinging somewhat towards more centralized control of the system because of these demands of the outside environment,” he said.