Why aren't Brooklyn hospitals like Manhattan ones? Payer mix makes all the difference.
A recent joint legislative hearing on Brooklyn's hospital crisis triggered an analysis of the revenue streams of hospitals in the borough. Some politicians—Assemblyman Vito Lopez the most vocal among them—questioned the existence of a Brooklyn rate or a Manhattan rate.
As pointed out by Stephen Berger, the former chairman of the Medicaid Redesign Team's Brooklyn Task Force, the key issue is not whether Manhattan hospitals command higher rates—it is the dismal payer mix of Brooklyn's community hospitals. Most have very little commercial business to offset cuts in Medicaid or Medicare. Insurers who cater to large employer groups can't do without New York-Presbyterian, or Mount Sinai, in their networks, said Mr. Berger. That gives the Manhattan hospitals more leverage than Brooklyn hospitals in negotiating rates.