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Hospitals should face realities ECMC, Kaleida, Catholics work at cross-purposes, consumer loses

Here is the bottom line on hospital care in Buffalo: Quality of care has declined and hospital systems face serious financial challenges. What should have evolved into collaborative approaches has devolved into damaging competition. Major problems face this city's health care systems, including:

Too many hospitals: A federal study in 2002 found 34 percent too many hospital beds, and it's worse now. After bruisings taken by the Catholic Health System over closing Our Lady of Victory Hospital and Kaleida Health over its attempt to close Children's, nobody's leading.

Competition: Sniping between Erie County Medical Center and Kaleida is symptomatic of deeper competition between systems for doctors and business in an area of tight medical insurance reimbursement rates and, in ECMC's case, losses of government money. Instead of cooperation on services that require expensive equipment, or specialties that produce profits, there is duplication -- for example, in separate Kaleida and Catholic neonatal care units.

Dilution of quality: Competition means instead of having one high-volume and high-quality heart surgery center, for example, there are separate lesser-volume and therefore potentially lesser-quality centers. More than 100 coronary artery bypass operations per year are recommended for improved patient outcomes. A 2003 report shows Buffalo General performing 742 such operations, Millard Fillmore 441, ECMC 289, Mercy 118 and Millard Fillmore Suburban 59.

Attracting and keeping doctors: A weak system loses physicians, especially the nationally recognized doctors who draw others here. That kind of recruitment demands not only the ability to pay top dollar, but to provide a high-quality workplace for specialists.

In addition to OLV, three other hospitals closed in the last few decades -- Columbus, Lafayette and Deaconess. Kaleida officials say they trimmed 637 hospital beds from its five hospitals in the equivalent of another major closing without cutting any costly bricks and mortar. But the efforts have not solved the problem. There are suggestions that ECMC and one hospital from each of the major systems would have to close to right-size local hospital care.

Gov. George E. Pataki created a hospital closing commission to study the problem statewide. But its recommendations to the out-going governor aren't even due until December 2006. It's clear Buffalo health care must get its own house in order. There is no movement toward that. There must be. The University at Buffalo Medical School could play a stronger leadership role in shaping the system, but hospital leaders also must stop the squabbling, sit down and control the needed system contraction before it becomes a collapse.

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