As Hospitals Consolidate, Health Consumers Must Have a Voice

Guest post by Lois Uttley and Emma Chessen.

Remember St. Vincent’s Hospital in Manhattan, now the site of luxury condos? How about Millard Fillmore Gates Hospital, now an assisted living facility? Or Cornwall Hospital, which was gradually dismantled as an inpatient facility and replaced with outpatient care? Perhaps you were a patient of Amsterdam Memorial Hospital, which was closed in 2014 and converted into an ambulatory surgery center. Wonder what’s happening to community hospitals all over New York?

If so, you are not alone. Over the last 20 years, 41 New York hospitals have closed all of their inpatient services, affecting consumers across the state. Many of the remaining hospitals, particularly smaller community hospitals, are joining large health systems. In fact, the 12 largest health care systems now control half of all acute care hospitals in the state and 70 percent of the inpatient acute care beds.

Why is all this hospital consolidation happening? One cause is the movement of medical care into outpatient settings, leaving unneeded hospital beds. Another factor is the rise of complicated reimbursement schemes that require the sophistication of a large hospital system. Some urban hospitals are suffering financially from treating a high percentage of patients who are uninsured or have Medicaid, as opposed to better paying commercial insurance, and receive inadequate government support for serving these patients.

What does consolidation mean for consumers? Hospitals joining systems often argue that quality of care and financial stability will be improved. But, hospital consolidation can have negative consequences for affected consumers. Local hospitals that join large systems are sometimes downsized, closed or transformed into outpatient facilities. Patients needing advanced care may be referred to academic medical centers located an hour or more away. Decision-making often shifts to out-of-town system executives who don’t know the community and the specific health needs of the local population. Consolidation can also cause the price of health care to go up.

With such significant consequences for patients, it’s important that consumers have a say when their local hospitals are proposing mergers or other types of consolidation. But all too often, that doesn’t happen, according to year-long study MergerWatch recently completed with the support of the New York State Health Foundation. Our report, “Empowering New York Consumers in an Era of Hospital Consolidation,” concluded that New York’s 54-year-old Certificate of Need (CON) system of state hospital oversight needs to be updated to ensure that consumers are notified and engaged when their local hospitals propose to join health systems or plan to downsize, close or transform the way they deliver health services.

MergerWatch’s recommendations include requiring public hearings in affected communities prior to hospital closings or elimination of key services, such as maternity care or the emergency department. MergerWatch urges that when health systems are taking over local hospitals, they should be required to disclose whether services might be downsized or transferred elsewhere in the system, and predict whether the transaction might cause the price of health care to go up. The report also recommends changes to the New York State Department of Health website to make it easier for consumers to find information about proposed hospital consolidations and submit comments.

The report urges a stronger voice for consumers in state decision-making through increased consumer representation on the state Public Health and Health Planning Council (PHHPC), which considers the most important hospital transactions. The PPHPC has only one consumer seat, and it has been vacant since 2016, while the majority of council members (including the chair) are employed by hospitals and other health providers. By contrast, in New Jersey and Maryland the majority of hospital review board members are consumers and in Delaware, the chair of the review board must be drawn from the “public at large.”

As hospital consolidation continues around the state, MergerWatch hopes to see an improved and more transparent state review process that informs, engages and carefully considers comments from the consumers whose health care will be dramatically affected. Want to learn more about our findings and recommendations, and get involved in helping improve the system? Join our webinar on July 19 at 2 pm.

Lois Uttley, MPP, lead author of the new report, is founder of MergerWatch and Director of Women’s Health for Community Catalyst. She serves on the steering committee of Health Care for All NY. Emma Chessen, co-author of the report, received her Master’s in Public Health in May from Columbia University’s Mailman School of Public Health.

On Friday, June 22, more than 70 HCFANY members from across the state gathered in Albany for our annual spring to learn about the Coalition’s ongoing and upcoming work to strengthen and expand health coverage all for New Yorkers and promote health equity. As you all know, it has been a very challenging year for health care, and we are very grateful to all who attended and engaged with us!

The agenda included an Advocates’ Panel during which we heard updates on HCFANY work on New York’s indigent care pool and safety net hospitals and the Coverage 4 All Campaign for immigrant coverage. We also discussed strategies for improving market stabilization and affordability in the individual market. Slides from the presentation are available here.

We were also honored to present our annual “Consumer Health Champion” Award to the grassroots groups, the “New York Grassroots Defenders of Health Care” who have been so instrumental in the fight to defend the ACA and Medicaid here in New York. Awardees included: ACR Health, “Faso Friday,” Long Island Save Our Health Care Alliance, NY-11 for Health Care, Rochester ADAPT, and Saratoga Progressive Action.

The meeting concluded with discussion and planning groups on federal advocacy, protecting New York State’s individual market, and preserving and expanding immigrant coverage.

orange-light-alarm-mdAlbany, NY – Health Care for All New York (HCFANY), a statewide coalition of over 170 consumer advocacy organizations, encourages consumers and consumer advocates to weigh in on health insurance rate proposals for 2019. On June 1, the Department of Financial Services (DFS) posted a summary of the carriers’ rate proposals. The insurance carriers claim that about half of the average requested increase of 24 percent is attributable to the recent repeal of the individual mandate.

Consumers should remember that many people receive premium assistance through Advanced Premium Tax Credits (APTCs), which limits the impact premium increases will have on some beneficiaries. Consumers should also remember that these rate increases apply only to individual and small market plans purchased through the New York State of Health – people with the Essential Plan or Medicaid are not affected. Finally, consumers should remember that the rate requests are in fact requests, and the amounts could change if DFS does not approve them.

In this area of failure of federal action, HCFANY is calling on New York State to investigate policy options to stabilize the individual insurance market for New York’s consumers, for example, establishing a state individual mandate or increasing premium assistance.

HCFANY also urges consumers to regularly check the DFS website. There is a 30-day comment period from the date of posting for each carrier rate. HCFANY has released a rate review guide for consumers and posted templates, but encourages consumers to tell DFS how premiums affect themselves, their families, or their businesses in their own words.  DFS will then review the carriers’ requests and the public’s comments to make their final rate decisions, typically late in the summer or early fall.

WowEarlier this month, the NY State of Health (NYSOH), New York’s official health plan Marketplace, released its 2018 Open Enrollment Report. As of January 31, 2018 more than 4.3 million New Yorkers enrolled in coverage through NYSOH. This represents an increase of nearly 700,000 people compared to last year’s open enrollment.

According to the report, more than 259,000 people enrolled in Qualified Health Plans (QHPs), and nearly 60 percent qualified for federal subsidies to make monthly premiums more affordable. In 2018, monthly premiums for individuals remained 50 percent lower on average than before the establishment of the Marketplace, and most New Yorkers purchasing QHPs had at least four insurers to choose from.

The report also highlights the continued success of the Essential Plan (EP), New York’s Basic Health Program, which now has more than 738,000 people enrolled – an 11 percent increase since the end of January 2017. Ninety-two percent of individuals determined eligible for EP ultimately enrolled in coverage, and enrolling in EP saved consumers an average of $1100 per year compared to a higher cost QHP.

There are also more than 2.9 million New Yorkers enrolled in Medicaid through the Marketplace and nearly 375,000 enrolled in Child Health Plus.

Finally, the report emphasizes the important role in-person assistors continue to play in enrolling New Yorkers in health insurance coverage. In 2018, 77 percent of New Yorkers who enrolled in coverage through NYSOH did so with the help of an in-person assistor, including Navigators, certified application counselors, and insurance brokers. New Yorkers who enrolled in Medicaid, Child Health Plus, and Essential Plan coverage were more likely to do so with in-person assistance.

New York’s commitment to strong health insurance programs and consumer assistance have helped the State reach a historic low of 4.9 percent uninsured.

Open enrollment for 2018 has ended, but New Yorkers eligible for Medicaid, Child Health Plus, or Essential Plan coverage can enroll at any time through the NYSOH website. New Yorkers who experience a qualifying life event may also be eligible for a special enrollment period to enroll in a QHP. If you need help enrolling, Navigators are available to provide in-person assistance. Please visit online or call (888) 614-5400 to find a Navigator in your area.