Important note: Information in this article was accurate in 1985. The state of the art may have changed since the publication date.
The New York Times - December 24, 1985
Ronald Sullivan
New regulations being proposed by state health officials would authorize the creation of 10 to 15 primary-care AIDS centers in hospitals, most of them in New York City, which has about 32 percent of all AIDS patients in the country. The designated hospitals would receive financial incentives.
State officials said the new approach was the result of an increasing awareness that hospitals, with all their technology and medical expertise, were largely unable to stem the fatal course of AIDS, acquired immune deficiency syndrome.
Death With Dignity
The new rules, they said, would give patients the choice of forgoing heroic measures in favor of more palliative care and of dying with as much dignity as possible.
The new regulations will be proposed to the State Hospital Review and Planning Council next month under an emergency resolution approved by Dr. David Axelrod, the State Commissioner of Health. State health officials said they expected the council, an independent advisory body within the Health Department, to adopt them.
"Our goal is to insure comprehensive, caring professional services to meet the full spectrum of needs experienced by AIDS patients," Dr. Axelrod said yesterday.
State health officials said the new regulations were intended in part to enable hospitals such as Bellevue Hospital Center, which has more AIDS patients than any other hospital in the country, to shift from intensive inpatient care to more appropriate levels of outpatient care.
The officials said they had not determined what the new program would cost. However, they said it was expected to reduce the cost of lengthy hospitalizations for AIDS patients and produce substantial savings.
According to Mel Rosen, director of the AIDS Institute within the Department of Health, the new program could reduce current hospital stays of 30 or more days by as much as half. He said such a reduction would allow hospitals to spend additional funds on outpatient treatment and home-care services.
The state would establish a special financial incentive for hospitals that agree to provide and manage a full range of services for AIDS patients -from the moment they enter a hospital until the day they die.
State health officials also said that every participating hospital would be required to provide hospice care for dying patients, either in the hospital or elsewhere. They said this would insure that terminally ill AIDS patients would receive the compassion and care that hospitals rarely can provide.
According to Brian Hendricks, deputy director of the State Office of Health Systems Management, participating hospitals would receive an increase of from 25 to 50 percent in the daily reimbursement for AIDS patients. For a municipal hospital such as Bellevue, this would mean going from the $460 a day it now receives to from $575 to $700 a day. Even that increase, however, would not cover Bellevue's costs, which it estimated at almost $900 a day.
Expedited State Payments
For AIDS patients who have no insurance and who do not qualify for Medicaid, the Federal health program for the poor, the state would expedite payments for their care from a special pool of funds created to pay hospitals for serving poor, uninsured patients.
According to Bellevue officials, AIDS is now the single most common medical diagnosis there. They said that AIDS patients now occupy a fourth of the 200 beds in the department of medicine, and the prospect of treating twice as many AIDS patients next year was having a devastating impact on a staff that could barely cope with current levels.
Federal health officials said that more than 15,000 cases of AIDS had been reported since 1981. They said 6,000 new cases were reported this year, and 12,000 more are expected in 1986.
Bellevue and other public and private hospitals in the city that treat large numbers of AIDS patients have called on the state to establish a system under which no hospital - private or public - would be swamped with AIDS cases.
Patterned After San Francisco
About 300 AIDS patients are hospitalized in New York City. Most are in about a dozen large teaching hospitals, evenly divided between municipal and private institutions.
Some hospital officials have called for a new payment system that would let them begin providing AIDS care in less costly and more appropriate outpatient and home-care settings.
In a response that was drafted weeks ago, state health officials proposed the new system, which would be patterned in part after the comprehensive outpatient system adopted in San Francisco. The average period of hospitalization for AIDS there is less than half as long as in New York City.
Mr. Hendricks said initial reaction to the new program appeared positive and he expected most of the large private and public teaching hospitals that have large AIDS caseloads to seek the new designation.
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