This has been proven in the health-care field on any number of occasions. Indeed, just as the Iris Cantor Center opened, Mount Sinai Hospital closed a similar facility in New York that was suffering millions of dollars in losses each year. The Mount Sinai center was located near Harlem, and it bled cash in part because of its high percentage of Medicare and Medicaid patients, whose insurance often barely covered the cost of services.

TOP VIEW The experience of a prominent New York philanthropist reflects the dilemma many of us face when we go about funding a nonprofit institution, particularly in the health-care sector: Exclusively serving those who cannot afford to pay for medical care will quickly drain a facility of the financial resources it needs to survive.

Business Realities
As much as a philanthropist might want to underwrite a medical facility’s costs so that it can serve all of those in financial distress, Mount Sinai’s fate shows how difficult it is to keep one afloat in a poor community, as medical costs soar and the government cuts spending on health care. Philanthropists such as Cantor have learned from examples like this that it is better to put a facility on a strong economic footing, and serve a smaller number of the poor, than it is to go bust and serve none at all.

Cantor wrestled with the problem of philanthropy versus pragmatism when planning the new facility. The location, at New York-Presbyterian’s Weill Cornell facility on East 61st Street, is in the heart of one of the city’s most affluent neighborhoods, but a tough commute for poor women who live in Harlem or the less well-heeled sections of the outlying boroughs.

Its clientele reflects its address. Dr. Orli Etingin, director of the center, says at least 80 percent of the facility’s patients are insured. (The ratio varies depending on the medical service provided.) Many have private insurance plans that pay generous reimbursement rates. For these patients, the center offers a one-stop oasis for every procedure a woman might need. The center’s active cardiac care and neurology practices, two fields that are becoming increasingly important as the population ages, contribute to its overall financial health. But its success is due in no small measure to its ability to attract patients who can pay out-of-pocket for some of the best dermatologists and plastic surgeons in the country.

The remaining 10 percent to 20 percent of its clients are poor patients who either have insufficient insurance to cover their procedures, or none at all. Often, these patients are referred from other parts of the extensive hospital system of New York-Presbyterian. In most cases, the hospital absorbs the cost of their care. Cantor says the center eventually plans to do more community outreach. If poorer patients were not being served, she says, “I don’t think I would be satisfied.”

All of the center’s services are already operating in the black, which is notable: The Center for Women’s Health at Weill Cornell’s sister campus, Columbia-Presbyterian/Eastside, did not break even until about six years after it opened. Even Etingin expected the center to take longer to start turning a profit. While the reimbursements and out-of-pocket patient fees have not covered the cost of establishing the facility, none of the center’s services—even those with the largest proportion of uninsured patients—are losing money, Etingin says. But the wholehearted pursuit of medical care for the less fortunate will still have to wait: Bauer projects that it will take 10 to 15 years for the center to generate enough cash to reinvest in outreach and services for poorer patients.

Since she and her late husband established the Iris and B. Gerald Cantor Foundation in 1978, Cantor’s style of hands-on giving has evolved. At first, she backed projects with a strong visceral appeal, like a mammography center in Los Angeles; her sister had died of breast cancer at 29. As the projects grew bigger and more ambitious, however, the Cantors’ business acumen increasingly came into play.

“I go where my emotions lead me, and my head follows,” Cantor says. She has been a hands-on micromanager of the decor and details at the center. “It has to be a place where women will want to go,” she says. The walls had to be the perfect shade of warm, sunny yellow. The terry cloth robes patients wear between procedures had to be fluffy, just like the ones at the Ritz-Carlton.

“Donors like Mrs. Cantor have to be nimble to serve people in a meaningful way and still keep the lights on.”  —Douglas Bauer

In order to attract more philanthropic dollars, and serve its patients, Cantor wants the center to become an important venue for medical research.  The facility is negotiating with a major pharmaceutical company to conduct clinical research to determine if women benefit more from cardiac care at a women’s health center than they do in a more traditional specialist setting. The center is also boosting its expertise; it recently added a cardiologist to its staff, along with an echocardiogram facility, and plans to further expand its diagnostic cardiac services.

Cantor is relying largely on her fund-raising ability to galvanize other high-profile donors. The Hearst Corp., Credit Suisse First Boston, JP Morgan Private Bank and the Starr Foundation are several of the benefactors that have contributed millions in funds to the Women’s Health Center. Since opening, the facility has attracted an additional $5 million to $6 million in donations. Its most recent fund-raising dinner, at which Tony Bennett performed, added another $1 million to the center’s coffers. But despite these fund-raising efforts, it is the success or failure of the center’s business strategy that will determine whether Cantor’s goals are achieved.