New York City's hospitalsthough more costly than evercan no longer claim to offer premier health care. True, the city's big academic medical centers still boast a galaxy of star doctors and can deliver world-class care to those rich enough to pay for it, but the big subsidies haven't stopped a broader decline.
Today, Gotham's big institutions are under challenge not just from those in other cities, like the Mayo Clinic or Johns Hopkins, but from ones in the local suburbs, too, like St. Francis Hospital in Roslyn, now the the country's second-largest cardiac surgery center, or the Hackensack University Medical Center, which has swiped pediatric specialists away from city hospitals and won national acclaim for its nursing programs.
Most pointedly, although New York's institutions long argued that the subsidies were needed to maintain their national preeminence, today these institutions rarely rate well in studies comparing quality of care. N.Y. hospitals, with their long patient stays, high bills and only average mortality rates, simply don't measure up to today's profile of a top hospital.
No N.Y. institution is on the current list of the Top 100 Hospitals in America compiled by the well-respected health-care consulting firm Solucient. "Faced with a long history of regulation, New York's hospitals have been forced to focus on financial issues more than on quality of care," explains Jean Chenoweth, director of the study.
True, many New York institutions care for a troubled population, in which drug use, poverty and unhealthy behavior make treatment difficult, but most hospital-performance studies adjust for such factors. Solucient's Top 100 Hospitals, for instance, treat more Medicaid patients on average than the typical hospital, but still turn in superior performance.
Other studies have reached similar conclusions. A 1999 ranking of academic medical centers by the Center for Healthcare Industry Performance Studies in Columbus, Ohio, placed no N.Y. institution in the top 50, and most of the state's and city's academic centers received C and D grades.
Such results might shock most New Yorkers, but they are no longer so surprising to health-care experts, who view the state's hospitals as out of step with the industry's most progressive trends.
For years, for instance, the state's hospitals, and especially the city's, have kept patients hospitalized much longer on average than other institutions. They've justified this by claiming that longer stays are needed to heal patients properlyan appealing argument in an age when some HMOs release patients too soon from hospitals. But increasingly, experts view long patient stays as a warning sign, possibly signaling hospitals where complications are common or the most current therapies are not administered promptly and effectively.
That is the message underlying a recent federal study that ranked New York state hospitals fourth-worst in the nation in the treatment of pneumonia in Medicare patients. New York institutions, the study found, were slow to administer drug therapies that effectively fight the illness. The state has a higher age-adjusted mortality rate for pneumonia and influenza than the nation as a whole.
"I lecture around the country on the relationship of quality of care to parameters like patient stays," one top health-care consultant says. "But when I came to New York to talk about this, they looked at me like I had two heads. They are dinosaurs there."