NYU Langone, Now Reopened, Seeks to Regain Market Share

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Nurse Practitioner Donna Quinn, back at NYU Langone, after spending two months at Lenox Hill Hospital.

From the time C.J. Wise found out she was pregnant with her son Finn, she’d been seeing an obstetrician who practiced at NYU Langone Medical Center. She was excited to deliver at the hospital, considered one of the best places for mothers and babies in the city. Then, when Sandy hit in October, and NYU was evacuated and then closed, Wise recalls, she was “very, very upset.”

“There’s enough uncertainty about when in that five-week period you’re going to go into labor," she explained  "'Am I going to get to the hospital? Is the labor going to be long? How painful it will be?' You don’t want to think about where it’s going to happen.”

With NYU closed, Wise’s doctor was given temporary privileges to deliver at Beth Israel Medical Center. Wise was nervous, but to her great surprise, she loved it. The nurses and staff went out of their way to accommodate her, and she considers the delivery “perfect.”  In an interview in her Carroll Gardens, Brooklyn, home in January, her 5-week-old baby on her lap, she said that next time around, she would probably go back to Beth Israel, if her doctor chose to become permanently affiliated with it.

Most of NYU Langone is now back up and running, including the labor and delivery unit.  But the question looms whether NYU will lose some of the patients, and even doctors, who sought refuge at NYU’s biggest competitors after the storm. If that happens, Sandy could end up having a long-term impact on NYU Langone’s share of the fiercely competitive health care market in New York City.

Most of the 500 NYU doctors who left for other hospitals have since returned, according to Dr. Andrew Brotman, a senior vice president at Langone. But more than a dozen have applied for permanent privileges at Mount Sinai Hospital and Beth Israel, according to those hospitals, and there are probably more at other institutions. It’s not clear, however, how many of those doctors would also keep their privileges at NYU.

Brotman said he’s not concerned about the shift, and he isn’t surprised by claims that other hospitals tried to recruit some of the NYU doctors working there after the storm.

“It is a very competitive environment," he said. "People try to recruit from each other having nothing to do with a storm. It happens all the time."

Brotman added that while NYU Langone was “extremely appreciative” of the warm welcome its staff received at other hospitals, NYU’s loss was in some ways its competitors’ gain. Hospitals like Lenox Hill, Mount Sinai and Beth Israel all saw spikes in their monthly birth rates during November and December, when NYU was closed. 

NYU doctors were still able to bill insurers directly for their services, and some competitors—including Beth Israel—helped offset the salaries of doctors employed by NYU. But doctor bills make up about 10 to 12 percent of the fees that hospitals charge for a test or procedure, Brotman said. “The rest of it went to those other hospitals.”

Dr. Harris Nagler, the president of Beth Israel, said that while his hospital did not make any efforts to poach NYU doctors, Beth Israel did benefit from its exposure to new doctors and patients. He predicts that Beth Israel will have a higher occupancy rate in the future.

"I think some patients and physicians will see the opportunity here and have enjoyed their experience and may seek new relationships,” he said.

The city's other hospitals faced serious challenges in accommodating the influx of patients—especially in the emergency departments—considering that a total of five New York institutions closed for at least some time after the storm. But according to some health experts, these other facilities managed well enough that larger lessons may be gleaned from the experience. 

David Sandman, the senior vice president of the New York State Health Foundation, said the important question is not whether hospitals return to pre-Sandy conditions, but whether they should. 

“It was more than a wake-up call to remind us that New York City does have a lot of excess inpatient hospital capacity,” Sandman said. “When two very large hospitals—Bellevue with 900 beds, and NYU which also has close to 900 beds—were suddenly taken out of service, we did have some backlogs and wait times at other places. But the system was able to absorb most of that capacity.”

Sandman, who was part of the so-called Berger Commission, a panel charged with rightsizing the state's health care system six years ago, said he hoped Sandy will lead to a renewed discussion about opportunities to downsize.

But NYU’s Brotman disagrees, and argues that other hospitals struggled to meet the increased patient demand, particularly in labor and delivery.

“It was really difficult to find places to deliver a baby in the city,” he said. “We have a renewed feeling that we’re needed and needed badly, and that makes everybody feel optimistic.”

Between damages and lost revenue, Brotman estimated that Sandy cost NYU $1.2 billion. Funding from FEMA, the National Institutes of Health and NYU’s insurance policies should help them recover that in the next two to five years, Brotman said. 

In the meantime, most of NYU’s units are back up and running, and the hospital’s census of patients is rebounding. It is now about two-thirds of what it was before Sandy. Just a few days after the labor and delivery unit reopened in mid-January, it was already bustling with doctors and nurses buzzing around the hallways. 

Nurse Practitioner Donna Quinn said she enjoyed the month and a half she spent at Lenox Hill but always felt like a guest. “It makes you appreciate where you were, where your home is,” Quinn said.

Several of the doctors and nurses in the unit wore identical pins in the shape of the ruby slippers from The Wizard of Oz.  NYU executives are hoping that the rest of the staff and patients will agree: There’s no place like home.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.