Hospital Challenges, Observation Status, Ambulatory Care

Migrated from APHA Connect! 2016
In 2016, APHA Connect! was located at its own, separate website. In early 2017, we integrated APHA Connect! with this myAPHA membership site, but we were unable to import the actual discussions from the old site. So, in order to retain those interesting and informative discussions, we have copied and pasted them here to the myAPHA site, minus their old Connect! links.

Find below one of those 2016 discussions. Don’t forget to check out the APHA Connect! Discussion Forums to see if the conversation was continued!

Previous Title (Connect! 2016):  Resources on the Business that is REALLY driving hospital closings

  • Berlin


    Sorry for delay. Posting form Anna Smith on Facebook group about the arguments Mt. Sinai CEO made on a Radio News show about closing a major hospital unit and point by point what he did NOT say.

    Hope its useful to advocates who may realize what is at play “behind the scenes”


    Last week I posted about the impact of the closing of Beth Israel Hospital on ERs in lower Manhattan. True to his word, the excellent WNYC (public radio) interviewer just interviewed the CEO of the Mt. Sinai hospital group, of which Beth Israel is a part. The CEO was very smooth, and everything sounds like it is in the public interest. Unless you know lots about health care policy.
    Below is the email I sent to the show.
    Just to be clear, I have no problem closing surplus beds in an old, and not very good, hospital. It is the one sided description of the benefits of ambulatory care that I find outrageous,
    The Beth Israel CEO said several things that are much less innocent than they sound.
    1) they will keep people who have had ambulatory procedures for 23 hours.
    I believe that stays of under 24 hours do not count as admissions. Therefore, if an ambulatory patient develops an infection, goes into cardiac arrest, etc., and then needs to be admitted in hour 24 or later, Federal Medicare/Medicaid “Present on Admission” mandates do not apply. This has SIGNIFICANT financial benefits for hospitals.…/150809981
    2) Ambulatory is the future – sure. If a patient who had an ambulatory procedure needs to be admitted within 30 days because of complications, the hospital is not subject to financial penalties (a different Federal mandate)…/is-observation-status-substitut…/…/workingWithGroupHe…/forms/POA.pdf
    3) Observation status: again, the patient is not admitted so some of the mandates above do not come into play AND a Medicare patient is not eligible for Medicare funded rehab! Lots of hospitals are playing the Observation Status game – NYU built a new facility just for this.
    4) Being an outpatient costs the patient much more (at least under Medicare)…/observation-status/
    5) The more hospitals consolidate, the higher the costs to the healthcare system.…/hospital-mergers-within-state-……/151219906…/
    I am not a health care policy professional but a very interested and well informed individual. Please do not take what was said during the interview on face value!

  • #4947

    Bonnie Sheeren


    Thank you so much! This is great stuff! I am saving for later to delve into all this! It’s always wise for all of us to have the bigger picture!

    Thank you again!

  • #4984

    Jess Joseph


    Ben, thank you for bring my attention to to the radio interview with Mount Sinai CEO Dr. Ken Davis.I think it’s an extraordinarily good 25-minutes summary of the challenges facing hospitals today. Anyone who is interested can hear it here:

    As for Anna Smith’s comments, whoever she is, her point is that because of the way Medicare pays, the changes Mount Sinai is making will result in patients paying more. That’s probably true, but it’s an issue that Davis does not address because he was not asked about it. In any case, it’s Medicare who is making the rules, not Davis. There’s not much Davis or Mount Sinai can do about it.

    But she doesn’t stop there. She then goes on to say that Davis is “smooth” and that though “everything sounds like it is in the public interest,” he said “several things that are much less innocent than they sound.” Having heard the interview, I find no basis for these insinuations and I find them objectionable in a professional context. As you say, Ben, her arguments cover “point by point what he did NOT say.”

    She posted these comments on the WNYC site as “Anna from NY” which is normal for popular media. But on a professional site like ours, I think we’re better served if only pass on comments from identifiable sources including their professional credentials. After all, that’s how we identify ourselves to each other. Why lower our standards for people we don’t even know?

    Finally, just to put the closing of Beth Israel in perspective for those of you who are unfamiliar with New York City, there are still two renowned hospitals——NYU Medical Center and Bellevue——less than a mile away from Beth Israel!

    And thanks again for bringing this to my attention.

  • #4985




    Thank you for your comment. Indeed as we are in close proximity and have not met in person, perhaps it is time to arrange that.

    I shared the information because I thought that others in our group would find it of value. You and Anna may have different views and reasonable minds can differ. She used her full name on Facebook and is accessible there and is not some anonymous ghost, but clearly a knowledgeable person who backs up her arguments with citations to external verifiable and generally reliable sources. I do not see anything amiss in my posting her words and citations with full transparency as to where they came from.

    As far as her insinuations, and whether to find them offensive, I take no position. I certainly have heard enough smooth sounding interviews from all sorts of people with particular agendas who do not tell “the whole truth” in media interviews. For heaven’s sake we are in the middle of an election cycle, and we have Brexit. Any of the Sunday Press show interviews fit that bill?

    As you acknowledge her main point, and the point that our colleagues need to recognize, it that these changes in Hospital structures, practices and closings are likely to result in patients paying MORE. Steve Brill in his famous Time Magazine piece talked about a crucial issue in containing costs being to PREVENT hospital consolidation. Mt. Sinai has been a major consolidator: purchasing both Beth Israel and St. Luke’s Roosevelt. Yes it is Medicare rules that are in part driving this but it is also a profit and compensation motive. As professionals it behooves us to recognize that factor.

    So while this interview may have been to your liking, the citations supporting points not made, for whatever reason, are independent, verifiable and transparent. It is precisely this kind of information that should be found on these forums.

    I thank you for your time which you obviously spent listening to the interview and looking up the WNYC website. I thank you for the time you put into your response. I thank you for your cordial tone and I hope you find my response to be equally as cordial. I hope that we can meet in person soon.

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