Editorial: Brooklyn needs funds, and a plan, for hospitals

Gov. Andrew Cuomo has warned the feds that four Brooklyn hospitals will have to shut down unless the state gets immediate permission to use money from expected Medicaid savings to keep them open. In all, he wants more than $1 billion for hospitals in poor communities.

Let's start with the easy stuff first.

Federal Health and Human Services Secretary Kathleen Sebelius should say yes immediately.

Whatever their recent travails, Brookdale Hospital Medical Center, Interfaith Medical Center, SUNY Downstate Medical Center, and a subsidiary, Long Island College Hospital, are vital to Brooklyn's tertiary-care system.

Closure would hurt patients from East New York to Crown Heights to Bed-Stuy to Cobble Hill. In a traffic-clogged borough of 2.5 million people with high rates of chronic disease, fast access to full-service medical care still counts for plenty.

Beyond that, the state has work to do.

Old-fashioned, inefficient behemoths with redundant, often-inadequate, services can't survive in the long run. They have to modernize. They have to specialize. They have to emphasize prevention as well as damage control. And attention, legislators -- they have to have a business model that keeps them solvent.

Example: A 2011 report to the state Department of Health, led by financial executive Stephen Berger, urged Downstate to consider consolidating its inpatient services at Long Island College Hospital as a way to eliminate overcapacity and let Downstate concentrate inpatient services in one location.

A rigorous analysis is needed throughout Brooklyn. The 2011 report noted that too many hospital boards have a strategy that only aims to make their institution "the last man standing in their communities." It's a loser of a plan.

Sebelius should hand over the money this time -- and, yes, $1 billion is a lot of cash. So leaders in Albany need to insist simultaneously on a real-world plan for efficient, effective, affordable care. Without an accurate roadmap for the future, Sebelius might want to remind her Empire State petitioners, there may not be a next time.