Mount Sinai Beth Israel Update
Get the latest update on Mount Sinai Beth Israel, a world-renowned integrated health system, facing challenges with outdated infrastructure, declining inpatient census, and financial losses. Explore the reality and the need for change.
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- integrated health system
- outdated infrastructure
- declining inpatient census
- financial losses
- healthcare model
Presentation Transcript
Mount Sinai Beth Israel Update November 28, 2023 1
Mount Sinai Health System at a Glance
Mount Sinai Health System: Who We Are Overview: Mount Sinai is an integrated Health System of 8 hospitals and more than 200 community locations, anchored by a world-renowned medical school. Impact: Last year, MSHS services spanned more than 150,000 inpatient admissions and over 5 million outpatient visits. Staff: MSHS is made up of 47,000 employees, including 2,000+ residents the largest teaching program in the country. Patients: MSHS provides significant care for Medicaid, Medicare, and patients eligible for financial assistance (68% government payor) and we are committed to serving all our patients regardless of their financial situation. 5+ million patient visits Largest Teaching Program in the U.S. 3
The Reality at Mount Sinai Beth Israel Existing 16thStreet Infrastructure: - MSBI has a 50+ year old, outdated infrastructure - Leaks, boilers, antiquated rooms/halls and unable to modernize Antiquated Healthcare Model: - Local and national trends move to outpatient and non-hospital settings - MSBI is currently running at approximately 20-25% capacity - ~80% of the hospital s medical-surgical licensed beds are unoccupied - Declining inpatient census (decrease of 73% acute care admissions since 2012) - Volume is needed to maintain high quality for key programs Financial Losses: - Operating losses of $100 Million annually over $1B total - Trend continues to grow: $150M in losses in 2023 ~The issues are long-term and systemic; the status quo cannot hold.~ 4
Inpatient Bed Count Averages Sources; US Census Bureau (Population Estimates as of July 1, 2022); Kaiser Family Foundation (US Beds as of 2021); https://health.data.ny.gov/ (Certified Beds by Hospital as of September 2023) 5
10 Years of Analysis: Every Option Considered 2013 Mount Sinai mergers with Continuum Health Partners and takes over Beth Israel 2016 After 3 years of analysis and review, Mount Sinai announces plan for a new, modern hospital on the NYEE site 2016-2020 Public review which included over 80 meetings with elected officials and labor and community leaders and half a dozen public forums 2020 After 4 years of debate and review, DOH approves new MSBI plan aborted due to COVID-19 impacts 2020-2023 Every plan and possibility re-evaluated and reviewed, and every effort to reduce costs, enhance revenues, and requests to state for financial assistance were attempted but ultimately unsuccessful ~Significant changes in care delivery for health systems and increases in labor and supply costs have created an insurmountable fiscal hole and an urgent existential threat to the entire Mount Sinai system.~ 6
Health System Financials: At-A-Glance Nationally All hospitals are struggling. In fact, according to the AHA 2022 was among the most financially challenging year the hospital field has experienced Statewide The fiscal pressures in New York are especially acute. According to HANYS report: - 49% of hospitals report a reduction or elimination in service - 27% of hospitals at risk of defaulting on existing loans - 64%, report negative operating margins - 21% of hospitals say their operating margins are unsustainable Mount Sinai For Mount Sinai, MSHG is operating at a significant loss - Moody s downgraded MSH s rating due to decreasing operating margin - Projected loss for MSBI is $150M for 2023, a significant increase in recent years. - MSH s operating margins can no longer offset system losses We face immediate cost pressures: Recent labor contracts will add costs over the next 3 years (increases of hundreds of millions per year). Supply inflation has added $100M per year (15% since 2019) and is still rising. 7
The Plan: Closing 16thStreet Campus Short-Term ED and Hospital Remain Open Until Closure Reduce inpatient bed count to align with our decreasing patient census Longer-Term In-Patient Beds 50% of patients come from outside of Downtown Manhattan (below 42nd) Capacity at other Hospitals: Mount Sinai Health System MSH, MSW, MSB NYU Langone, Bellevue, NYP/Lower Manhattan, etc. ED Absorption ~85% are treat and release Urgent Care is a better option for a majority of these patients Other hospitals: Mount Sinai Health System MSH, MSW, MSM, MSQ, MSB NYU Langone, Lenox Hill Greenwich Village, Bellevue, NYP/Lower Manhattan, etc. Surge Plan Mount Sinai Can Absorb MSBI 2020 COVID Level: 240+ in-patients Rivington, NYEE Mount Sinai System - MSH, MSW, MSB, etc. 8
The Plan: 16thStreet Ramp Down* Unfortunately, due to rapidly decreasing census and significant staff departures we may have to reduce services in advance of closure to ensure the safety of our patients. Specifically, Reducing In-Patient Hospital Beds: Decrease staffed medical /surgical beds in Dec, Jan, Feb to align with declining census Decrease ICU beds to match census Elective Surgical Services Beginning in January elective specialty services will begin to be moved to other Mount Sinai Hospitals. Those patients seeking elective surgeries will be moved to other MSHS hospitals that specialize in that care. We expect surgical services will be reduced completely by March Cardiac Services Beginning in December non-emergency heart patients and those needing medical imaging will be transitioned to other Mount Sinai hospitals (non-inpatient) Any heart attack patient coming to MSBI will receive emergency care until July 12 Stroke Services Beginning in January, stroke patients needing inpatient care will be moved to other Mount Sinai Hospitals that specialize in that type of care after receiving emergency care and being stabilized Any stroke patient will receive emergency care until July 12 Emergency Room Remains open until July 12th Adult, Pediatric and Psych (CPEP) *It is possible that additional adjustments will be needed due to volume and staffing changes. For updates, please visit: 9 https://www.mountsinai.org/locations/beth-israel.
The Plan: What is NOT Closing This plan will ONLY affect the MSBI 16thStreet Campus, it will not impact other MSBI operations and sites downtown. Specifically, this plan will have no impact on the other sites under the Mount Sinai Beth Israel hospital license or nearby: Mount Sinai Behavioral Health Center Mount Sinai Union Square New York Eye and Ear The Martha Stewart Center for Living at Union Square The Mount Sinai National Jewish Health Respiratory Institute Mount Sinai Heart Mount Sinai Thyroid Center The Blavatnik Family Chelsea Medical Center at Mount Sinai And all other BI medical sites. 10
Historic MSBI ED Volumes Volume at the MSBI emergency room has consistently declined for the past 12 years and is now almost half of 2012 volume. 11
Distribution of ED Volume by Type 85% of MSBI ED patients are treat and release Of the remaining 15% of admitted patients, ~4K visits (or 5% of the total) are patients who saw a MSHS provider in the 3 months prior to their ED visit. The remaining 7K visits comprise less than 3% of the over 250,000 annual visit volume of the four remaining Article 28 Emergency rooms downtown 12
Downtown Emergency and Urgent Care Locations Blue: Urgent Care Centers Purple: Art. 28 Emergency Departments Manhattan Below 42ndStreet Over 30 Urgent Care Centers including MSDUS 4 Article 28 Emergency Departments (NYU Langone, Lenox Hill Greenwich Village, Bellevue, NYP/Lower Manhattan, etc.) 13
Our Commitments Our Team Due to our unique agreement with labor, any union employee displaced because of the transformation will be offered other opportunities at equal pay. Since 2016, over 1,000 employees have accepted new positions within the Mount Sinai Healthcare System. Mount Sinai is one of the largest private employers in the City, hiring approximately 2,000 people each year. Our Patients We have never and will never compromise on safe care for our patients. We will always do the right thing for our patients, our team and our community. Our Community Continued elected and community engagement and updates 14
Continued Commitment to Mount Sinai Downtown Mount Sinai has already invested over $600M downtown to expand access, improve quality, and enhance care: 20 downtown centers across 30 medical and surgical specialties, including: The NEW Mount Sinai Behavioral Health Center The Martha Stewart Center for Living at Union Square Urgent Care at Mount Sinai Union Square The Mount Sinai National Jewish Health Respiratory Institute Mount Sinai Heart Mount Sinai Thyroid Center The Blavatnik Family Chelsea Medical Center at Mount Sinai We aim to keep people healthy, reduce inpatient hospitalizations, and bring services closer to where patients live and work. ~ We are not abandoning the downtown community. In fact, we are doing just the opposite: continuing to invest and grow. ~ 15
10 Union Square East Mount Sinai Union Square 6 200 OPERATING ROOMS PHYSICIANS 30+ SPECIALTIES 325K SQUARE FEET >500KAMBULATORY VISITS PER YEAR 16
COMPREHENSIVE CARE Comprehensive Care Optimizing a Multi Specialty care model to provide seamless access Routine & Preventive Care: and care coordination across multiple specialties. Primary Care Endocrinology Weight Management Cosmetic Dermatology Post Covid Center Pediatrics Geriatrics g Surgery & Procedures Laboratory Ultrasound Radiology Mammography & Women s Imaging Breast Surgery ENT Surgery Plastic & Reconstructive Surgery Therapeutic Infusion Epidural Injections 6 Ambulatory ORs Providing world-class Comprehensive Care tailored to our patients unique needs, all under one roof. 17
Mount Sinai Union Square: Urgent Care Conditions We Treat Allergies and asthma Broken fingers and toes Earaches and eye infections Fevers and flu Headaches Moderate back problems Sinus infections Skin rashes and infections Sore throats and coughs Sprains and strains Stomach ailments Urinary tract infections Vomiting, diarrhea, or dehydration Hours of Operations Weekdays: 8 AM- 8 PM Weekends & Holidays: 9 AM-5 PM 18
Downtown Care Paradigm MSUS Timely Access Our ambulatory platform and hospital-based care creates a full spectrum care paradigm across MSHS MSDFP Expanded Hours of Operation MSDMG Multiple Locations/ Expansive Footprint MS Hospitals MSB, MSH, MSM, MSQ, MSSN, MSW, NYEE Ambulatory Network Extended Services Ambulatory Surgery Cancer Care Physician Practices Lab Testing & Diagnostics Urgent Care Radiology Pharmacy Virtual Care Ambulatory Surgery Center Community Complex Care At Home Services Emergency/ Urgent Care 19
New Programs, Renovations & State of the Art Equipment: 2017- 2023 2017 2018 2019 2020 2021 2022 2023 Renovations: Martha Stewart Center for Living Geriatrics & Palliative Care OBGYN & Maternal Fetal Medicine Primary Care Urology Renovations: Allergy Cystic Fibrosis Cardiology expansion Endocrinology GI Infectious Disease Mammography Nephrology Rheumatology Therapeutic Infusion Thyroid Renovations: Orthopedics New Program: Urgent Care Renovations: Mount Sinai Heart Equipment Upgrades: 4K Laparoscopic Video Diagnostic Ultrasound Digital X-Ray ENT Navigation System Fluoroscopy Renovations Breast Surgery Cytopathology Oncology Otolaryngology Pediatric Neurology Pharmacy Admin Radiation Oncology New Programs: Autoimmune Center Ophthalmology & Optometry Union Square New Program: Mount Sinai National Jewish Respiratory Institute New Programs: Audiology NYEE Ear Institute & Otology Vestibular Rehab New Programs: Nuclear Cardiology Vascular Surgery New Program: Podiatry Equipment Upgrade: Tomosynthesis Mammography New Programs: Center for Post COVID Care Headache Program Lazarus Children s Abilities Center Equipment Upgrades: MRI Upgrade: Software & AI Renovations: Pharmacy Renovations: Oncologic Physical Therapy Ultrasound Equipment Upgrades: MRI High Dose Radiation Brachytherapy Diagnostic Ultrasound Chelsea Center Equipment Pharmacy Kiro Robot Radiation Oncology: Linear Accelerator Renovations: Dermatologic Oncology Plastic Surgery Therapeutic infusion Renovations: Multiple Myeloma Equipment Upgrade: Radiation Oncology CT Simulator Tomosynthesis Mammography Diagnostic Ultrasound 20
The Mount Sinai Behavioral HealthCenter A new, transformational, state-of-the-art, community- oriented destinationfor behavioral health care and a one- stop locationof services for mental health, substance use, physical health, and social serviceneeds. Largest private investment Dignity Compassion Hope Recovery 6
Meeting The Moment We have submitted our closure plan to DOH with a proposed closure date of July 12, 2024. We will be working closely will all interested parties and constituents to ensure smooth and deliberate transition of services and care. In the meantime, the MSBI 16thStreet hospital and Emergency Department will remain open. However, to ensure patient safety and quality, we do anticipate that further adjustments may be needed before July 12th. This plan will have no impact on the other sites under the Mount Sinai Beth Israel hospital license or nearby. Just as we have done for the past 6 years, any impacted unionized staff will be offered the same pay elsewhere within the Mount Sinai system. We will continue to update and engage with everyone as we move forward in this process. For up-to-date updates, please visit: www.mountsinai.org/locations/beth-israel 24
Questions? 25
