Ur­ban hos­pi­tals, an en­dan­gered species, still fill a unique role in their com­mu­ni­ties

Modern Healthcare - - COMMENT - In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? mod­ern­health­care.com/op-ed. View guide­lines at Send drafts to As­sis­tant Man­ag­ing Edi­tor David May dmay@mod­ern­health­care.com. at By Barry R. Freed­man

As the CEO of a hos­pi­tal named af­ter Al­bert Ein­stein, I’m of­ten asked which of his quotes is my fa­vorite. My an­swer is al­ways the same: “Life is like rid­ing a bi­cy­cle. To keep your bal­ance, you must keep mov­ing.”

Our abil­ity to keep mov­ing has en­abled Ein­stein Health­care Net­work to sur­vive 150 years and grow from a 22-bed hos­pi­tal in an old farm­house to a com­pre­hen­sive health­care provider and ed­u­ca­tion leader with hos­pi­tals and out­pa­tient-care cen­ters across the Philadel­phia re­gion.

We’ve adapted, ad­justed and ad­vanced—to the chang­ing fi­nan­cial en­vi­ron­ment, to new trends in health­care, to the dizzy­ing on­slaught of new tech­nolo­gies. Other ur­ban hos­pi­tals have not sur­vived this tor­rent of change. The star­tling truth is that nearly half of ur­ban hos­pi­tals in 52 ma­jor cities closed be­tween 1970 and 2010, ac­cord­ing to one study. But sur­vival is pos­si­ble, as our story proves.

Some hos­pi­tals fol­lowed their af­flu­ent pa­tients to the sub­urbs. Oth­ers were doomed by com­pe­ti­tion, which led to over-ex­pan­sion, du­pli­ca­tion of ser­vices and, ul­ti­mately, merg­ers, ac­qui­si­tions and clo­sures. Even now, beds re­main empty at too many hos­pi­tals as health­care rapidly piv­ots to­ward am­bu­la­tory care, and new tech­nolo­gies en­able pa­tients to be treated with­out hos­pi­tal­iza­tion.

Ein­stein has been buf­feted by these same cir­cum­stances. But we’ve never al­tered the one thing I be­lieve has kept us from fal­ter­ing in this new world: our mis­sion. Ein­stein be­gan in 1866 as the Jewish Hos­pi­tal with a motto that ap­peared over the build­ing’s en­trance: “Ded­i­cated to the re­lief of the sick and wounded with­out re­gard to creed, color or na­tion­al­ity.” This pow­er­ful phrase as­sured Jewish Civil War vet­er­ans, freed slaves, im­mi­grants and the im­pov­er­ished that they could rely on us for out­stand­ing med­i­cal care de­liv­ered with­out dis­crim­i­na­tion. The Jewish ethic of Tikkun Olam— mean­ing “re­pair the world”—is still our guid­ing prin­ci­ple.

Our com­mit­ment to serv­ing a vul­ner­a­ble pop­u­la­tion in­formed our de­ci­sion not to aban­don the ur­ban neigh­bor­hood we serve to­day, even as we opened a new sub­ur­ban hos­pi­tal four years ago. The ex­pan­sion was a strat­egy to di­ver­sify our payer mix and sup­port our ef­forts in Philadel­phia as our neigh­bor­hood be­gan show­ing the wear of flee­ing mid­dle­class res­i­dents. Our com­mit­ment was re­in­forced when 17 other city hos­pi­tals made a fi­nan­cial de­ci­sion to close their la­bor and de­liv­ery units. Ein­stein not only re­mained com­mit­ted to pro­vid­ing this essen­tial ser­vice, we ex­panded to pro­vide greater ac­cess.

As we grow in other lo­ca­tions to en­large our pa­tient base and safe­guard our fi­nan­cial se­cu­rity, we’re stay­ing put in the city. Our Philadel­phia cam­pus re­mains the largest in­de­pen­dent aca­demic med­i­cal cen­ter in the re­gion, train­ing over 3,500 health pro­fes­sional stu­dents a year. We know that ur­ban hos­pi­tals play a piv­otal role in main­tain­ing the vi­brancy and health of a city.

We not only care for some of the city’s most vul­ner­a­ble pop­u­la­tions, but we an­chor chal­lenged neigh­bor­hoods, main­tain­ing sta­bil­ity by pro­vid­ing thou­sands of jobs and act­ing as an oa­sis for folks with a ten­u­ous foothold in so­ci­ety. One out of four res­i­dents in our ur­ban ZIP code makes less than $10,000; 1 in 10 is older than 65 and liv­ing in poverty; the me­dian in­come is half the na­tional av­er­age. Many of our pa­tients re­main unin­sured, de­spite the ex­pan­sion of Med­i­caid, and are be­set with chronic con­di­tions such as heart fail­ure and di­a­betes, which re­quire con­sis­tent treat­ment.

Sur­viv­ing 150 years in an ur­ban set­ting that has un­der­gone tu­mul­tuous change isn’t re­ally a mir­a­cle. It re­quired hav­ing a strat­egy and vi­sion that pro­pelled growth while re­in­forc­ing our mis­sion. We set out to change the world but adapted to a world that changed us—while we re­mained de­voted to our founding prin­ci­ples. Per­haps this loy­alty to mis­sion and de­vo­tion to neigh­bor­hood can com­pel other ur­ban hos­pi­tals grap­pling with the same up­heavals to find a way to sur­vive while stay­ing put.

Barry R. Freed­man is pres­i­dent and CEO of Ein­stein Health­care Net­work in Philadel­phia.

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