New York City’s performance is even worse than the statewide average
Statistically, New York has the fifth-highest per capita income of any US state. It also enjoys the advantage of the fourth-highest population and the third-highest aggregate GDP. You might conclude that with such a large tax base, the state of New York would offer some of the nation’s best health care services. Unfortunately, however, reports indicate that the truth may be closer to the opposite – at least with respect to the quality of the state’s hospitals.
Although New York spends more on health care than almost any other state does, throwing money at a problem doesn’t always solve it. The unfortunate reality is that, as of 2019, New York’s hospitals were collectively rated the worst among all major urbanized states (states with a population of at least six million population with an urban/rural ratio of 70 percent or higher) by the US federal government.
New York: A New “Lone Star” State?
Slightly over one-third of New York hospitals, a total of 48 hospitals, received the lowest possible “one-star” rating by the federal Centers for Medicare and Medicaid Services. Most New York City hospitals received this rating. In other major industrialized states, anywhere between 4 to 20 percent of all hospitals received one-star ratings. Florida, at 20 percent, is the only state that comes even close to matching New York’s dubious distinction.
These ratings are not arbitrary; they are compiled using data that hospitals are required to report to the federal government such as treatment complications, readmissions, patient satisfaction, and mortality. Obviously, some of these factors are vulnerable to outside influences. People in low-income neighborhoods, for example, being unable to afford doctors’ visits, might allow a minor malady to develop into a condition requiring readmission.
It is widely accepted that hundreds of thousands of preventable deaths occur every year in US hospitals. In response to this sobering reality, in 2019, the New York Public Interest Research Group (NYPIRG ), a private sector, Ralph Nader-style consumer watchdog group, issued its Code Blue Report that details the failures and inadequacies of private and public hospitals in New York state. New York’s performance average across all hospitals, it noted, is only 2.18 stars.
The five-star rating system is based on several factors, among which New York’s performance was variable but utterly unimpressive:
- Safety: Most New York hospitals ranked below average, although this was not true for upstate hospitals.
- Readmissions: Almost all New York City hospitals were ranked below average, and half of all upstate hospitals were.
- Patient satisfaction: Most New York hospitals ranked below average, along with almost all New York City hospitals
- Timeliness of care: Most New York hospitals were rated below average, including a stunning 100 percent of New York City hospitals.
- Mortality: New York’s performance was average among the large industrialized states.
- Overall: Among the nation’s worst hospitals, as rated by the foregoing standards, more than half are located in the New York City area alone. Disturbingly, Jacobi Medical Center in the Bronx was rated the worst hospital in the United States.
Two generalized conclusions that might be drawn from this data are that highly-ranked hospitals are nearly impossible to find in New York City, and that the quality of state hospitals drops off rapidly outside the upper echelon. The Hospital for Special Surgery, located in New York City, is currently the only five-star hospital in the entire state of New York. The state of Ohio, by contrast, hosts 20 five-star hospitals.
Medicare and NYPIRG Aren’t Alone in Their Assessments
It is not only Medicare and NYPIRG that share this damning assessment of New York hospital care. Hospital Compare, for example, gave the state of New York the lowest quality ranking in the entire nation, while Leapfrog Hospital Safety Grades found New York’s performance to be much worse than the national average.
The following is a list of only a few reasons that have been proposed for New York’s poor performance:
- Financial mismanagement and underfunding. New York is in the midst of a budget crisis that is driven largely by Medicare costs. It is becoming increasingly difficult to shuffle funding among various priorities when there isn’t enough to go around in the first place.
- An insufficiently institutionalized safety ethic among New York healthcare professions might be contributing to the problem. This subjective factor is difficult to quantify, however.
- The disadvantage faced by teaching hospitals (since student doctors often make mistakes).
- The disadvantage faced by hospitals located in low-income neighborhoods. In the eyes of some skeptics, this could mean that the gloomy statistics represent unique factors affecting the state, rather than poor performance by health care professionals. But using statistical methods to account for factors such as income, as NYPIRG did, doesn’t make New York look much better.
- Some highly publicized hospital rankings systems, such as the US News and World Report’s, focus almost exclusively on performance in difficult or specialty tasks, rather than routine care for the chronically ill patients who make up the bulk of the hospital population. This practice could provide hospitals with a distorted set of incentives.
- Relatively small fines against hospitals whose policies put patients at risk. Although state law allows the Department of Health to issue fines against non-compliant hospitals, this power has not been used aggressively. Only $14,000 in penalties were assessed against New York hospitals in all of 2018, for example – an amount that a hospital could generate from the hospitalization of a single patient for a few days, at most.
California, by contrast, routinely fines individual hospitals several times as much as New York’s statewide annual total.
- Some New York hospitals have failed to implement “best practices” (industry standards arising from general consensus such as 24-hour nursing rounds, color-coded armbands, etc.)
Ultimately, a state-funded investigation is probably going to be required to get to the bottom of the problem – or to conclude that the “problem” is actually nothing more than a statistical mirage.
The Bright Spots
There are a few bright spots in this dismal picture. The 2019-20 US News and World Report list of Best Hospitals, for example, named three New York hospitals among its top 20 US hospitals – Presbyterian Hospital, NYU Langone, and Mount Sinai Hospital.
Criticisms of the Ranking System Itself
Numerous criticisms have been leveled at the ranking systems of various organizations. Most of these criticisms take aim at their objectivity in terms of legitimate patient expectations, and the Association of American Medical Colleges has been a particularly vocal critic.
A few of the most common criticisms of the hospital ranking system appear below:
- In some cases, the rankings reflect issues that are relatively trivial or at least not very serious, such as noise levels and the average wait time to receive pain medication for a fractured bone. This could provide a distorted impression of the hospital’s overall level of care.
- Rankings fail to take into account differing conditions faced by different hospitals in different communities. Jacobi Medical Center in the Bronx, for example, rated the worst hospital in the US, defends itself in part by noting that over 150 languages are spoken in the surrounding community, greatly hindering the smoother communication upon which effective treatment relies. The heart of this criticism is the claim that the rankings take very different hospitals, and then improperly place them in a single category, and then judge them against each other.
- The ratings are biased against New York City hospitals that serve economically disadvantaged populations, because the health of these populations tends to be worse to begin with. The argument is that, if you place a five-star hospital in an economically disadvantaged area of the Bronx, they would lose four of their stars immediately.
What Turns a Bad Experience into a Medical Malpractice Claim
Not every bad medical outcome justifies a medical malpractice claim. Under New York law, you have a medical malpractice claim if:
- A doctor-patient relationship was formed between you and the defendant (nurses and other healthcare professionals can also commit medical malpractice, however). Normally, this is a matter of course. However, it might become an issue if, say, the passerby who rendered first aid to you after a car accident just happened to be a doctor.
- During the course of treatment, your healthcare provider failed to meet a professional standard of care. This standard, although much higher than the standard of care required for a non-professional, is generally determined by expert medical testimony.
- Your healthcare provider’s failure to meet the standard of care directly caused you some sort of physical harm – an undiagnosed disease went untreated, for example; a doctor operated on the wrong body part; or your healthcare provider gave you an infectious disease by failing to properly sterilize the medical instruments used to treat you, etc.
Ultimately, you are more likely to receive an insurance company settlement rather than to have to go to trial.
You Need to Move Quickly
You may not always know when you have a medical malpractice claim because, sometimes, establishing a claim requires an investigation combined with significant scientific and legal expertise. If you suspect that you might have a medical malpractice claim, contact E. Stewart Jones Hacker Murphy immediately, either online or by calling us directly, to set up a free initial consultation. Our offices are located in Albany, Colonie, Schenectady, Saratoga, and Troy.