How Dr. Pardes Learned, the Hard Way, To Run a Hospital

Dr. Herbert Pardes now oversees a hospital system that includes 11,673 beds and employs about 82,000 doctors, nurses, and other employees. But one of his most formative encounters with the health care system came as a patient, when he was diagnosed with a rare illness, Perthes disease, which left him bedridden for 10 months as a child.“I’ll tell you one thing I think is absolutely critical of people in health care: It is interpersonal skills,” the president and chief executive of NewYork-Presbyterian Hospital said, simultaneously drawing on the childhood experience and outlining one of many goals he has for his staff.“Nobody wants anybody to be ill,” Dr. Pardes added.Under his direction, New York-Presbyterian has become a pre-eminent hospital for treating patients who do fall ill. Dr. Pardes, 72, assumed leadership of NewYork-Presbyterian Hospital in 1999, shortly after the merger between New York and Presbyterian hospitals.Today the hospital and its affiliates, which make up the NewYork-Presbyterian health care system is New York’s largest private employer. NewYork-Presbyterian Hospital has 2,335 beds, and it treats patients at five major centers in Manhattan and Westchester, including NewYork-Presbyterian/Weill Cornell Medical Center on the Upper East Side. Other centers include NewYork-Presbyterian/Columbia University Medical Center, Morgan Stanley Children’s Hospital of NewYork-Presbyterian, and NewYork-Presbyterian/Allen Pavilion, all in Washington Heights, as well as NewYork-Presbyterian/Westchester Division in White Plains.During his tenure, Dr. Pardes, whose multimillion dollar annual salary has attracted press and congressional criticism, has raised nearly $1 billion in a campaign to enhance the hospital’s clinical care. Under his leadership, the hospital also has undertaken major renovation and construction projects.In 2003, the 10-story Morgan Stanley Children’s Hospital opened its doors. Last year, the hospital broke ground on the Vivian and Seymour Milstein Family Heart Center at a ceremony attended by President Clinton.Today, NewYork-Presbyterian is among the city’s and the country’s best hospitals, currently ranking sixth in the U.S. News & World Report’s “America’s Best Hospitals” survey, and ranking first in New York magazine’s “Best Hospitals” survey in 2006.A psychiatrist by training, Dr. Pardes has served as director of the National Institute of Mental Health, and as U.S. assistant surgeon general during the Carter and Reagan administrations. He serves on the board of the Markle Foundation, and is the recipient of the Sarnat International Prize in Mental Health. He recently sat for an interview with The New York Sun.Q: Do you think we’re moving toward universal health insurance, and what impact would that have on patients? A. I think we are. I think there’s a growing consensus that there should be universal coverage. The question will be how to find the resources for it, but I think it would be good for patients because a lot of patients who don’t have coverage now delay coming to a physician. And when they come in, they are often more ill and it’s more serious or it requires more attention. Let’s say you had somebody who had a polyp in the colon, and if you found it early, you could just take it out. But let’s say they wait and the cancer spreads. Now they may have a disease that is more difficult to cure and they may need a more extensive treatment. The other thing I like about coverage is it gives a person dignity. It’s nice to feel, “I have the right to have health care.”Which of your own departments would you like to see grow? First of all, what we’re doing is we’re trying to maximize our innovative ability. We don’t only give care, we try to develop better care tomorrow. The second thing that we want, is we want our facilities to be as maximally attractive to patients as possible, because when you come into a hospital and you are scared to death that you have a bad illness, and then you walk into a dim, grim, gloomy place, it’s terrible. The problem, of course, is that capital is extremely scarce in New York, and in the United States generally for health care. We also want to be excellent comprehensively and the reason for that is because many people who come into the hospital these days have multiple disorders. The Hospital for Special Surgery is a hospital that is focused on orthopedics. Memorial Sloan Kettering does cancer. But they do a niche, if you will, which is fine. But often, people come in, they have symptoms, they don’t know what they’ve got. What I also would like is that we increase our capacity in areas where we really feel we could help people. I want you to be able, if you want quality care, to come here with almost everything. Why should a New Yorker have to go to some other city to get good care?How do you pay for it all? It’s tough. This is the toughest health care financing environment in the country, I think, because there are a lot of costs. There are a tremendous number of patients who are uncovered. We experience losses on a lot of our Medicaid work. We also experience losses on a lot of our Medicare work. We experience some profit, or some margin, on our commercial care. The commercial care profits nullify, they help to deal with the negatives. The one thing that gives us the wherewithal to do capital is, we get philanthropy. Roughly two-thirds of our business is government, and the remaining is commercial for the most part. But capital is a big problem in New York, and if you go to other states, there are many states where the cost is much less. But just the way the financial industry is the best, the theater industry is the best, the music industry is the best, why do I want somebody to say I’m going out of the state to get my care? Often those are the people who will help you philanthropically.How do you factor in reportedly high salaries for hospital executives? Well what happens is, we run as a large enterprise and the competition for people we recruit are all the other enterprises. So if we recruit a chief information officer, that same person may also be recruited by a consulting firm, an insurance company, and a pharmaceutical company. If you want strong talent, then you’re in the marketplace, then you have to meet those needs. On the other hand, I would say we have a team at all levels here who love the mission. So at any given enterprise there are ranges of reimbursement and they have something to do with the way this country works, which is, it works on a market. The pediatrician may not make as much as the heart surgeon. Like it or not, that’s the box you’re in.Last year, the Commission on Health Care Facilities in the 21st Century, otherwise known as the Berger Commission, issued a report recommending that several hospitals in the city and state merge or close. In light of that recommendation, can you reflect on some techniques you’ve used at NewYork-Presbyterian after its own merger in 1998? Well, I don’t pretend any expertise on merging before I dealt with the merger here. In actually making things work, one of the things I’ve found is, you don’t do forced integrations. It is not wise, and all you do is get a lot of angry people. Second, a lot of things shouldn’t be integrated. But there are places where you have smaller departments where if you bring them together, you have a better overall operation. So what we do is tailor our strategy to the circumstances that prevail for the specific field. We have one burn center, which is superb here. We don’t want any more burn centers.Do you foresee a merger between NewYork-Presbyterian and Memorial Sloan Kettering? You never can tell. There’s nothing current on that. There have been previous times when people explored it. Ten years before New York Hospital and Presbyterian Hospital merged nobody would have predicted it. I think it was a creative move on the part of the then-trustees of New York Hospital and Presbyterian Hospital. And they were smart in doing it.Overall, what is your position on the recommendations of the Berger Commission? I think that one of the things that we felt was advisable in the Berger Commission was the fact that there are some hospitals in New York which either don’t have enough activity or enough volume and activity to really be sustained. The thing that the Berger Commission was trying to do was do appropriate pruning, and the intention would be that the remaining hospitals would be strengthened by the fact that resources were spread a little less thinly. So the hospital supported the idea of the Berger Commission. That doesn’t mean we agree with everything they said. I don’t agree with the conclusion on Westchester Square, for example. But by and large, we were supportive, we thought it was a good idea, and we think that Stephen Berger is an excellent leader.How will the recommendations, though, affect NewYork-Presbyterian and other hospitals in New York City?We do have an interest in the New York Westchester Square Hospital. It is part of our system. We think that’s the impact that concerns us. I think that that is a superb hospital and you know, you don’t always agree with other people’s conclusions. But I do think there was a need, to try to prune some of the hospitals, to create, to encourage, to produce collaborations where appropriate. And they also contracted somewhat the bed count within the state. So those are important results, and I hope it will contribute to an overall healthier system.What do you think of proposed funding cuts in federal and state Medicaid and Medicare reimbursement, and what’s your strategy for moving forward? On the federal level, I think the cuts that the administration recommended are simply excessive and very disturbing. My hope is that with a changed Congress, they will not go anywhere. But I think there may be some impact as a result of the fact that there are some needs that the Congress needs to deal with. For example, I’m concerned about the reduction in fees for physicians in Medicare. And I’m concerned that there be adequate support for children’s coverage financially. And so my hope is that the new leaders – and we are very fortunate, we have some superb new leadership. I mean, the fact that Charlie Rangel is now head of the House Ways and Means Committee is just sensational. On the state side, I think the governor understandably is trying to rationalize the health care systems here, he is trying to strengthen the state budget, so we have to realize what he’s doing. I think he’s extremely intelligent and thoughtful.Do you have an opinion on the sparring television advertisements between Governor Spitzer and the health care workers union? I’m not sure I have any. I think that’s part of the natural process in an open country. People have views. They express them. One of the things that concerns me is that there are obviously problems in health care that we ought to work to fix, but there are so many great things that happen. We have been one of the lead hospitals in developing a way to fix a heart valve without making a cut. Usually if you’re going to fix a heart valve you would make a major cut in the body. What that means is that you put small instruments, some people sometimes calls these robots, within a blood vessel, in the leg, arm, and you thread these small mechanical instruments into the heart. They tie things together, they cut, they separate things, they do it magnificently. Well, imagine health care going forward. It could go something like this. Wednesday I’ll have my heart valve repaired, and Thursday I’ll go to the theatre. You see major illnesses reduced down in terms of the impact and that’s sensational.

How Dr. Pardes Learned, the Hard Way, To Run a Hospital

How Dr. Pardes Learned, the Hard Way, To Run a Hospital

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