Local health systems say their hospitals are at low risk for triggering the threshold that would shut down their elective procedures, even as Covid cases are currently surging.

Gov. Kathy Hochul on Nov. 26 issued an executive order that would shut down elective surgeries for hospitals in regions at risk of running over capacity. That was defined as regions where staffed acute-care bed occupancy were at 90% or higher, or regions that had rates of between 85% and 90% and had a seven-day Covid hospital admission rate greater than 4 per 100,000 people. Earlier this month, 32 hospitals in upstate regions met that requirement and faced that shutdown.

Although the city's seven-day Covid hospitalization was 11.46 per 100,000 people as of Saturday, its hospital occupancy rate fared much better, with only 76.7% of its roughly 15,000 acute-care beds occupied, according to state data.

Major health systems in the city expressed optimism in the unlikely need to face elective service shutdowns due to their ability to having bed occupancy under control and add additional beds if needed.

"We've maintained a level of readiness throughout the pandemic, and that includes keeping a close eye on capacity," said Dr. Fritz François, executive vice president, vice dean and chief of hospital operations at NYU Langone. Its system-wide occupancy average had been between 75% and 80% recently, he said.

At NYC Health + Hospitals, the city's public health system, staffed bed occupancy hung around 85%, said Dr. Mitchell Katz, president and CEO.

New York largest health system Northwell Health had an occupancy rate of 85% as of Monday, said Michael Dowling, president and CEO.

"With this new variant, there's been an increase in case numbers and testing positivity rate, but that's not translating into the hospitalization we saw in the big wave in January for the delta variant," François said.

Even for those who end up hospitalized for Covid, the median length of stay has decreased to less than four days from the five or six days seen during the delta peak, François said. Some factors contributing to that might have included hospitals now having more robust playbooks to handle Covid hospitalizations, vaccinations conferring some protection and perhaps the omicron variant being less likely to cause severe disease, he noted.

The majority of recent hospitalized Covid patients were unvaccinated, whereas those who were vaccinated but still required hospitalization typically had underlying comorbidities, Dowling said.

François agreed, and noted vaccinated patients that required hospitalization had typically been elderly with some kind of end-stage disease, or cancer malignancies that required medication that impeded the effectiveness of Covid vaccines. "However, even for these patients, their outcomes would have been different compared to if they were not vaccinated," he said.

All hospital executives agreed that downstate hospitals were in good shape and elective procedure shutdowns were not remotely needed.

"Everyone keeps focusing on current occupied beds, but what's more important is also a hospital's ability to flex its needed beds," Dowling said.

Northwell has about 3,300 staffed beds, but that number can be increased by another thousand within days if needed, Dowling said, adding it has surged up to 5,000 beds as seen during the spring peak last year.

Health + Hospitals, likewise, could triple its beds to over 3,700 if needed, Katz said. "Can we do it? Yes. But no one wants to relive that again."

"The issue upstate requiring the shutdown had to do with staffing for beds," Dowling said. "It's when you don't have enough people to man both beds and run services that you would have to consider shutting down services."

It's not like the surge capacity hospitals built went away, François said, adding even if Covid cases increase over the coming weeks and months—as is expected—NYU Langone would still have sufficient staffing to able to handle elective procedures and Covid hospitalizations.

Dowling said he is glad the recent executive order is nuanced by region, rather than a blanket shutdown on services statewide. During the previous statewide shutdown last year, downstate hospitals quickly found that they were able to provide both Covid care and elective procedures, and thus resumed them shortly as permitted by the state, François said.

A statewide shutdown at this point will greatly disrupt care for people who need it and not address what is needed downstate, Dowling said. "Localized problems call for localized solutions." —Shuan Sim

The primary care physician network of Columbia University Irving Medical Center has launched an integrated behavioral health offering within its practices, it announced last week.

In what is called an "embedded" program, patients receive mental health screening prior to the visit; a behavioral health specialist can continue a patient's visit after the primary care consultation is done, should there be a need for such services.

"Unlike models that refer patients externally for behavioral health follow-up—even if it's within the same building—this model allows behavioral health providers to be involved in a patient's care plan from the start," said Dr. David Buchholz, senior founding medical director of Columbia Primary Care. Behavioral health specialists have access to the same electronic medical records as primary-care doctors, and they are involved in care plan discussions with those doctors, he said.

The program initially will focus on patients with depression, with one licensed clinical social worker embedded at each of the network's six locations, Buchholz said, adding the program is expected to be fully staffed within the next six months. It officially launched last month.

Patients facing depression can receive a short course of psychotherapy through the program.

"Evidence has shown many people with depression don't need long courses of psychotherapy," Buchholz said. For patients who need more extensive care, linkage with Columbia's psychiatry department is available, he said, with one psychologist and two psychiatrists tapped for the program.

The embedded model has been observed to improve patient outcomes and lower falloff rates compared with ones that refer externally, Buchholz said.

The primary care network also is exploring integrating services from Columbia's School of Dentistry at practice locations.

"Our mission is to provide holistic health, not just primary care," Buchholz said.

The network has ensured its embedded behavioral health specialists are on the same insurance carrier panels as its primary care doctors, so the coverage should be seamless, he said. In the rare instance of a narrow coverage for behavioral health, the practice can offer free services to persuade the carrier to cover subsequent visits, he said.

Columbia Primary Care comprises 21 doctors in Manhattan, the Bronx and Westchester County. Its parent medical institution is a partner of New York–Presbyterian. —S.S.

The Hazelden Betty Ford Foundation is transforming its Tribeca facility to expand its substance-use disorder and mental health offerings, it announced Monday.

The organization, headquartered in Minnesota, had owned the building since 2011 and operated it as sober housing, or group residences for addiction recovery. With the sober housing program closing just before Covid and its Chelsea facility lease expiring, it made sense to combine services into the expanded Tribeca location, said Janelle Wesloh, vice president of recovery management and clinical excellence, east region.

The Tribeca site is located at 283 West Broadway, and it features 14,000 square feet across six floors and a basement. The renovation is estimated to cost about $4.5 million, Wesloh said.

The new location will offer outpatient treatment for addiction and mental health, family services and long-term support for addiction recovery. It will also offer programming for the LGBTQ community and training for health care professionals.

There are 10 clinical professionals currently offering services virtually while construction is underway, and it is expected there will be more full-time onsite staff than that at opening, Wesloh said. The center would be hiring mental health providers, "peer coaches" who have lived experience with substance use and counselors, Wesloh said.

The site is pegged to open as early as February, although current Covid conditions might waylay that, she said, adding a 30th anniversary celebration is planned in the spring.

The organization was founded as the Hazelden Foundation in Minnesota in 1949, and the Betty Ford Center in 1982, with both merging in 2014. It runs 17 sites across nine states. —S.S.

New York Advocates for Home Care and seven other parties are accusing the state Department of Health of withholding information about why it denied more than 80% of businesses that applied to provide services under a large home-health care program.

The plaintiffs are fiscal intermediaries, entities that help Medicaid recipients contract home health services under the federal Consumer Directed Personal Assistance Program. They claim the state wrongly withheld contracts from more than 300 companies. They submitted requests under the state Freedom of Information Law seeking answers, but they got mostly redacted documents in return, according to a lawsuit filed Sunday in state Supreme Court in Albany.

"Our immediate goal is to stop the imminent dismantling of this critical home care program, especially as the state faces a major home care crisis and an ongoing pandemic," said Linda Clark, a partner at Barclay Damon who represents New York Advocates for Home Care. "The opaqueness of this request for offer process has not served anyone, especially the 139,000 New Yorkers who depend on CDPAP."

The suit seeks not only the release of the petitioned, unredacted information but also a stay of the state decisions that led to the rejection of the fiscal intermediaries' applications.

A Health Department spokeswoman said the department does not comment on potential litigation in connection with an open procurement.

New York Advocates for Home Care, founded in July, represents more than 30 provider organizations. —Aaron Elstein and S.S.

WHO'S NEWS: Dr. Richard Smith on Monday was announced as professor and university chair of the department of otorhinolaryngology-head and neck surgery at Montefiore Health System and Albert Einstein College of Medicine. Smith assumed his new position on October 1 and had been the interim chair of the department since February 2020.

HEALTH ANALYTICS: RWJBarnabas Health's Center for Discovery, Innovation and Development has partnered with Pinnacle Solutions to create Predictive Health Solutions, a company for health care analytics to improve patient outcomes. The company will initially help providers tackle the problem of patient no-shows, and eventually work on overbooking strategies and other problems faced by providers.

DENTAL OPENING: ProHealth Dental on Monday hosted a ribbon cutting ceremony for the grand opening of its Mount Kisco location. The 4,000 square feet site is part of a clinical affiliation with CareMount Medical.

CONTACT US: Have a tip about news happening in the local health care industry? Want to provide feedback about our coverage? Contact the Health Pulse team at [email protected]

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