Bellevue Hospital NYC

Introduction
Instituted forty years prior to the US’s formation, the Bellevue Hospital of New York City is the first public hospital of the nation, constructed even before medicine became a profession, on the piece of land presently housing the City Hall. Currently situated along a First Avenue stretch, its first building accommodated six beds. The hospital’s history reflects the city’s ongoing transformation, besides recording the nation’s medical education. With regard to illness, the major part of US public health policy may be traced directly back to Bellevue hospital. While its name is ‘infamous’ for mistreatment and mental treatment- related horrors, Bellevue has, at all times, cared for patients presenting with more physically apparent illnesses. Typically the last resort for those at the end of their tether, this hospital has endured outbreaks of tuberculosis, typhus, pneumonia, HIV, polio, yellow fever, and the flu, carried by its poverty- ridden patients. New York City has contributed significantly to how hospitals function in the present day, being the entrance point for migrant waves (Gordon, 2016). In this paper, a detailed SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis of the city’s Bellevue Hospital will be undertaken.
STRENGTHS
BHC (Bellevue Hospital Center) represents the earliest continuously operating healthcare center of the nation, first instituted in the year 1736. It enjoys an illustrious history of making groundbreaking public health, health education and medical science contributions. A member of NYC’s HHC (Health and Hospitals Corporation) which is the biggest system of public hospitals in America, Bellevue is affiliated with New York University’s medical school and delivers a variety of out- as well as in- patient medical, psychiatric and surgical services. Moreover, other healthcare practitioners and clinics across the city widely refer extremely complex cases to this hospital. Dignitaries who visit the city (including UN diplomats and the US President) receive healthcare services at its facilities. Present BHC facilities incorporate an 800- bed, 6- ICU, 24-storey healthcare facility with a 4-storey state- of- the- art Ambulatory Care Pavilion and world- famous Emergency Service and Trauma Center. It is regarded as the HHC’s “flagship”; HHC, a 6.7- billion- dollar public benefit organization and the nation’s biggest municipal healthcare institution, aims at providing superior- quality, holistic healthcare to every patient irrespective of his/her paying capability in an environment of respect and dignity. This integrated system of care delivery offers medical, substance abuse and psychiatric health services via eleven acute care centers, 4 skilled nursing centers, over 70 community clinics and 6 large diagnostics/therapy centers. Further, HHC’s Health and Home Care offers local communities in- home services (Pressman & Bohlen, 2013).
Ever since the days of its humble start as a refuge for New York City’s destitute population, the Bellevue Hospital has served as a globally- recognized, key academic medical organization. Over time, it has functioned effectively as the incubator for important public health, medical education and medical science innovations. Referred to frequently as one of the nation’s ‘treasures’, this hospital effectively defines the best public medicine traditions in the form of a critical public service for societal wellbeing. Bellevue’s competent, high- tech Emergency department, which is one among the biggest in New York City, and its Trauma Center (Level I) offer 24/7 holistic care in pediatric, adult, pediatric psychiatric and psychiatric emergencies, besides the nationally- identified categories of neurology, cardiology, neonatology, and toxicology. The hospital is home to one among the top cardiovascular initiatives of New York State, with its “door to St- Elevation Myocardial Infarction (STEMI)” time going far beyond national recommendations. New York City’s Health + Hospitals/Bellevue has, for long, remained the pioneer when it comes to identification and categorization of mental conditions, and the training of psychiatric nurses and psychiatrists (NYC Health Hospitals/Bellevue, n.d.).
The hospital has effectively defined practice standards for micro- surgically replanting hands, limbs and fingers, besides spinal cord and brain injury microsurgery. Its initiative on Geriatric Ambulatory Care is one of America’s largest, with over 5,000 seniors being cared for on an annual basis. In the area of perinatal care, the hospital represents the Regional Perinatal Center (RPC) for eleven hospitals that form part of the system. It offers up- to- date, advanced medical technology compassionately. Its high- risk obstetrics clinics guarantee top- quality holistic primary, gynecological and obstetrical care to both mom and baby. Its obstetrics services include rooming- in, midwifery- based deliveries in low- risk cases, and high- risk obstetrics area for dealing with highly complicated child- birth cases (NYC Health Hospitals/Bellevue, n.d).
WEAKNESSES
Hospitals offer wide- ranging outpatient care. However, each year, several thousand individuals, a large number of them underinsured and poverty- ridden, continually seek medical assistance at emergency departments providing hardly any personalized attention to patients and barely skimming the surface of social issues which result in their ending up in those situations. Obamacare brought about an increase in the number of insured as well as lowered uncompensated care costs for hospitals including HHC. Still, roughly 700,000 inhabitants of New York remain uninsured. Taking into account its mission, the HHC will probably continually contribute in a significant manner to caring for uninsured populations. The financial approaches adopted for supporting its mission include retention of existing sources and promotion of reasonable division of responsibility for uninsured groups between voluntary facilities and the HHC. The latter ought to advocate for existing state funding sources and tax exemptions that are conditioned on increased voluntary hospital engagement in uninsured patients’ care (Kellermann, 2015).
A second weakness is: an absent rational financial bond with New York City. Municipal leaders and the HHC ought to come up with more stable, reasonable HHC financing guidelines. The novel strategy ought to bring about improvements in the financial stability of HHC, its long-run fiscal planning capability, and its economical service delivery incentives. Some of the possibilities are capitated payments in case of uninsured patients reflecting care provision costs and paying incentives for adopting up- to- the- minute models of care management. HHC constitutes a highly salient resource for NYC, rendering its financial sustainability critical. For enjoying success in the swiftly evolving healthcare landscape, the HHC’s operations require modernization. Service restructuring for financial stabilization ought to be one among the top priorities for local and state leaders (Kellermann, 2015).
Though the HHC mission’s financial burden has forever been a constant challenge, Obamacare and the 2008 economic crisis have negatively affected its financial health. Non- paid care reimbursements by the federal government have been cut down heavily, leading to a five- hundred- million- dollar worth loss in only the last few years. On the whole, the HHC has, up until now, experienced an over- 554- million- dollar loss in annual Medicaid financing due to state budget actions in the last 5 years. Massive federal and state funding cutbacks, accompanied by sharp growths in healthcare expenditure and increasing numbers of uninsured and unemployed patients, have led to the creation of a forbidding fiscal burden for the HHC. Other elements that affect it financially are the sharp increase in pension costs which are currently over 435 million dollars annually, and the close- down of a large number of area hospitals that used to treat the same underprivileged population the HHC caters to, resulting in a considerably greater demand for the services Bellevue Hospital offers (New York City Health and Hospitals Corporation, 2014).
OPPORTUNITIES
Over two decades back, the HHC started making use of EMRs (electronic medical records) for tracking patient data. In the last ten years, IT has served as a valuable instrument in improving how staff members – among and within facilities – collaborate and share information relating to patient care with one another. But the present EMR system increasingly lacks advanced functionality vital to sharing organization- wide information broadly and meeting the current provider and patient needs. In the year 2012, HHC’s executive board sanctioned EPIC’s purchase (EPIC is a powerful novel EMR system and the leading EMR system provider in the industry). EPIC’s adoption will serve to bring about patient care improvements through providing comprehensive, timely patient EMR access and supporting provider engagement in more informed decision- making whilst simultaneously safeguarding patient confidentiality. Additionally, EPIC will encompass clinical reminders and notifications, improve choice of therapeutic approach, improve quality improvement monitoring and research, and offer inbuilt safeguards against therapies potentially linked to adverse events. HHC’s clinical workers, including physicians, can access precise patient records whenever they desire; even patients themselves can access their EMRs on the internet. EPIC implementation will be sufficiently flexible and accessible to comply with changing health IT standards, besides facilitating interoperability with health information exchanges and external systems, among others. When installed fully this year, EPIC will aid in improving almost all patient experience aspects, making patients the focus of care whilst improving efficacy and productivity (New York City Health and Hospitals Corporation, 2014).
In complexity and urgency, variety and volume, BHC provides a rich range of human and medical challenges, resulting in a unique, rewarding healthcare setting to train medical interns, residents and students.
Occupying a central position in New York University’s teaching program, BHC is the prime clinical instruction site for university house staff and medical college students, in addition to being a major research hub. New York University’s students acquire the major part of their clinical clerkship education in the third year at BHC, with several 4th – year pupils completing sub- internships and engaging in clinical electives at BHC. The hospital’s emergency room, which is the sole Level- I Trauma Center below NYC’s 68th street, is a world- famous emergency medical development model, functioning as the training site for university resident physicians in the areas of psychiatry, emergency medicine, pediatrics, internal medicine, and surgery (New York University, n.d).
In the year 2015, 10 of BHC’s doctors featured on the list of top NY metropolitan area doctors in a New York Magazine- published peer survey. In its “Best Doctors” publication that comes out once a year, Bellevue hospital’s doctors featured among a total of 1,282 doctors regarded as superior in Connecticut, New York, and New Jersey and in a web- based licensed physician poll. The names that appear on the list of “Best Doctors” represent the best ten percent of New York’s doctors in a total of sixty- seven medical specialty and subspecialty areas for the treatment and care of over 1,800 health conditions and diseases. Bellevue Hospital is home to a superiorly- skilled and competent physician pool in all healthcare service areas. It treats patients hailing from all backgrounds with all mental and physical health needs. All patients receive compassionate expert care of the very same level (NYC Health + Hospitals, 2015).
Bellevue’s emergency room is thoroughly-staffed and receives ambulances for treating non-critical, non-traumatic injuries. Additionally, it has increased its ancillary services and specialty clinics (which include radiology, mammography and nuclear medicine). It contributes significantly to the community, with its management pleased at its capacity of delivering necessary emergency room services. A huge amount of the credit for this goes to its committed doctors and staff who do not shirk away from providing round-the-clock service. The hospital has closely collaborated with ambulance providers like the New York City Fire Department Bureau of Emergency Medical Services (FDNY/EMS) for ensuring only those who are non-critically injured are taken to the hospital. Patients arriving via other means and requiring surgery or hospitalization will, if required, be stabilized and redirected to another accredited facility providing the necessary service (NYC Health + Hospitals, 2012).
THREATS
The massive federal and state funding cutbacks, accompanied by sharp healthcare cost increases and increase in numbers of uninsured and unemployed patients, has led to a forbidding fiscal burden for BHC. Other elements that affect it financially are the sharp increase in pension costs and the close- down of a large number of area hospitals that used to treat the same underprivileged population the HHC caters to, resulting in a considerably greater demand for the services Bellevue Hospital offers. Though Obamacare ACA has led to several uninsured patients being covered by 31st March, 2014, the law fails to cover the several thousand undocumented migrants BHC caters to per annum. There are several other aspects that contribute to an uncertain financial picture for Bellevue. The federal budget sequestration in 2013 caused a two-percent Medicare cut that has been extended until the year 2024 (New York City Health and Hospitals Corporation, 2014).
The healthcare sector encounters a number of challenging problems. Increased competition has an unclear effect on systems costs and healthcare quality. Moreover, there is a lack of extensive evidence pertaining to the link between healthcare provision costs and healthcare quality offered to customers. For competing in terms of value, providers need to fulfill patient needs more cost- effectively or better as compared to their rivals, or both. However, such competition has arrived slowly, on the account of 4 interconnected obstacles barring the path. Providers have largely failed to receive financial rewards when have delivered value, and haven’t even penalized in a meaningful manner for their failure to deliver value. A large number of hospitals can meet their fiscal targets through competing on marketing messages and brand strength (e.g., by claiming they possess state- of- the- art technology, top magazine rankings or the best facilities). Provider brands are typically not linked to their real performance in terms of outcome; however, it may enhance provider capability of negotiating favorable rates of reimbursement with insurers. As provider revenues do not depend on care delivery value, they lack the incentive to vie with one another on this basis. Even where better value has been worked for, providers have failed to receive sufficient rewards in terms of greater market share. Healthcare consumers have mostly been insulated from care costs, thereby not needing to hunt for the best bargain (insurers have also not done so) and thus, lowering costs seldom brings in a flood of new consumers. Further, providers have also not acquired market share through improving quality. The majority of publicly-accessible quality metrics are cancer screening rates, mammography rates and other process measures which barely vary among different providers (Lee, Dafny, Kaplan, Porter & Lee, 2017.
Recommendations
The development of a public health system responding to and reflecting New York’s vulnerable, poor population groups via a novel community care network (NYC H+H collaborating with the Health and Mental Hygiene department) whilst maintaining a community healthcare facility network that is geographically dispersed is recommended. This needs to encompass maintenance of sufficient public hospital staff and capacity for fulfilling its mission of providing services to adjacent community inhabitants and NYCH+H’s unique populations. The system, in the future, must be reformed on the basis of local needs— a few communities will require more services while others may require less. The majority of information vital to constructing a reasonable system has already been gathered and analyzed, and must now be used. Large private hospitals must assume more responsibility with regard to taking care of city residents’ needs. This necessitates revision of the existing funding formulas and proactivity on the part of the State and City governing authorities (Caress & Parrott, 2017).
The State and City ought to take into consideration whether or not permitting, zoning exceptions, and tax benefits offered to private nonprofits must be founded on an established contribution to taking care of the sick, irrespective of their payment capacity. A transformation strategy concentrating solely on NYCH+H’s hospital system funds, without taking into account its contribution to the wider healthcare system is bound to fail. NYCH+H can’t become a self-sustaining entity as it absorbs costs not shouldered by private providers. Hence, the NYCH+H system’s relationship with private providers is of a symbiotic nature, as it absorbs costs and assumes responsibility for vital services that other healthcare facilities avoid owing to the public system’s role and existence. Considering this dynamic, all reforms of NYCH+H and the path to sustainability need to incorporate maintenance of efforts supporting NYCH+H’s care quality. Not doing so will lead to a vicious downward cutback cycle impacting quality and leading to additional revenue and market share loss, successively leading to more service cuts and losses. The State and City need to collaborate and be more assertive when it comes to shaping the whole private and public healthcare system’s structure. The aim of all restructuring can’t simply be fixing NYCH+H’s finances, but creating a city-wide integrated healthcare system wherein public and private provider systems join forces to deliver health services effectively to New Yorkers (Caress & Parrott, 2017).













References
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Lee, L. S., Dafny, L., Kaplan, R. S., Porter, M. E., & Lee, T. H. (2017, May 18). How to Bring Real Competition to the Health Care Industry. Retrieved July 5, 2018, from https://hbr.org/2016/12/health-care-needs-real-competition
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New York University. (n.d.). Ronald O. Perelman Department of Emergency Medicine. Retrieved July 5, 2018, from https://med.nyu.edu/emergency/patient-care/bellevue-hospital
NYC Health + Hospitals. (2012). Bellevue Emergency Department Receiving Ambulances Again. Retrieved July 5, 2018, from https://www.nychealthandhospitals.org/pressrelease/bellevue-emergency-department-receiving-ambulances-again/
NYC Health + Hospitals. (2015). Ten Doctors from HHC Bellevue Hospital Center Named among Top Physicians in the Tri-state Area by New York Magazine. Retrieved July 5, 2018, from https://www.nychealthandhospitals.org/pressrelease/ten-doctors-from-hhc-bellevue-hospital-center-named-among-top-physicians-in-the-tri-state-area-by-new-york-magazine/
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Pressman, M., & Bohlen, S. (2013). BELLEVUE HOSPITAL CENTER. Retrieved July 5, 2018, from https://www.nychealthandhospitals.org/bellevue/wp-content/uploads/sites/4/2016/08/chna-bellevue-2013-1.pdf