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PRESCRIPTION FOR CHANGE

Fixing the problems of Western New York's hospitals is a long-term project that will require all players to take a fresh look at what they do and how they do it. During the past five days, The News has recommended ways to do that. Here are some of those recommendations:

Hospitals must close. With 13 acute-care hospitals in Erie County alone, the quality of care is compromised as hospitals spend too much to maintain underused buildings and often attract too few patients to achieve acceptable standards.

Doctors must reform a medical culture that relies too heavily on hospital care. Excess capacity breeds overuse, according to credible research, and while that is a factor in this region's exorbitant rate of hospital admission and surgery, it is the doctors who make those decisions.

Doctors and hospitals must work together to create quality-enhancing programs such as clinical pathways, which are guidelines that standardize procedures without tying physicians' hands.

Hospitals that cooperate in various assessments of their performance should continue to do so, and those that do not should join. It may hurt to have unflattering statistics made public, but hospitals that are part of these programs are demonstrating a commitment to improvement.

Insurers should agree to raise reimbursement rates here to a level equal to other areas, but only as part of a step-by-step process that rewards increased efficiency and improved quality.

Albany and Washington should commit to enacting programs that give the public easy, useful access to financial and medical information about the performance of hospitals. Washington should take the lead, so that hospitals and patients can make helpful comparisons to hospitals in other states.

The public must stop blocking efforts to close hospitals, and instead, encourage a careful assessment that acknowledges that we can have better care with fewer buildings.

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