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.
Guest post by Ben Anderson, Director of Health Policy at Children’s Defense Fund-New York. The New York State Department of Health (SDOH) is embarking on a “First 1000 Days on Medicaid” initiative that aims to bring together a diverse group of stakeholders from across sectors that touch the lives of young children. The stakeholders include representatives from a range of fields from the health care to post-secondary education to child welfare. The charge of the initiative is to produce recommendations for a ten-point plan that focuses on improving outcomes and access to services during the first three years of life.
The initiative arises from advances in neuroscience which tell us that most of the basic architecture in the brain is built by the time a child reaches the age of three. This basic architecture serves as the scaffolding upon which all future learning is built. Healthy physical and emotional experiences during these early years help form connections in the brain to facilitate future growth in cognitive, emotional, and social skills. Conversely, negative experiences impede the development of these connections, which make developing cognitive, emotional, and social skills more difficult.
Research from the Institute for Social and Economic Development (ISED) show that exposure to six or more risk factors prior to the age of three results in a greater than 90 percent chance of developmental delays (Barth et al. 2008). Risk factors include poverty, poor parental mental health, parental substance use disorders, domestic violence, and certain medical conditions. Additional research links adverse childhood experiences to increased risk for diabetes, heart disease, and cancer (Dong et al. 2004). Accordingly, what happens in the earliest years of life impacts lifelong well-being.
Medicaid is uniquely positioned to address these issues because the program serves many of the children who face the greatest risks for poor health outcomes (Halfon et al 2014). In New York, 59% of children in their first 1000 days of life depend on Medicaid. Developmental screenings and many early intervention services for children with developmental delays are currently covered by Medicaid. Primary care physicians who identify risk factors or developmental delays during regular check-ups are often the first point of contact and serve an important function by referring children and families to resources in the community to address the concerns.
The First 1000 Days on Medicaid initiative will convene stakeholders several times between now and November 1 to develop their recommendations. Subsequently, DOH will release its ten-point plan. HCFANY looks forward to working with the Department on this critical venture that has the promise to change the trajectories of our youngest New Yorkers.
Last week, children’s health advocates from across the country came together in Washington, DC for the Georgetown University Health Policy Institute Center for Children and Families Annual Conference. The conference provides an excellent opportunity for national and state advocates to share their experiences and learn from one another, which is especially important in the face of the current federal threats to children’s health care.
This year’s conference theme was “Covering Kids and Families: Playing to Win.” Topics included the current political landscape, the future of the Medicaid and CHIP, value-based purchasing, and using effective messaging and social media to win the fight for children’s health coverage. We heard from experts in the field about the state of play in Washington, the impact of perception, race, and bias on Medicaid, expanding health coverage for immigrant children, and avenues for working together with early childhood and education advocates to protect children’s health.
HCFANY’s Children, Youth, and Families Task Force represented New York consumer advocates at the conference. HCFANY’s Kate Breslin, President and CEO of the Schuyler Center for Analysis and Advocacy, spoke on a panel that highlighted New York’s child-focused value-based purchasing (VBP) initiatives and opportunities for advocates in other states to engage in VBP for children.
Health Care is Under Attack in Congress! It’s “all hands on deck” BIG time!
Join HCFANY at our upcoming annual meeting next Monday, January 23 from 11 a.m. to 3:30 p.m. at 1199 SEIU, 155 Washington Street, in Albany. Please register here.
Highlights will include:
- Special keynote speaker: Dr. David Sandman, President and CEO, NYS Health Foundation
- Presentation of HCFANY’s Annual “Consumer Health Care Champion” Award to Assmblymember Crystal Peoples-Stokes. AM Peoples-Stokes has been a key leader for health care justice, serving on both the Health and Insurance Committees, and within the leadership of the legislature’s Black, Puerto Rican, Hispanic, and Asian Caucus.
Important topics to be discussed:
- The immediate fights over the future of the ACA and reproductive health care
- The coming fights over Medicare, Medicaid, and Child Health Plus
- Governor Cuomo’s proposed 2017-18 budget
- HCFANY’s 2017 policy agenda for New York
- New York’s continued push toward health system transformation: DSRIP, SHIP, PHIP, and value-based payment
Any questions? Contact Taylor Frazier at firstname.lastname@example.org ot 212.614.5541
More info at www.hcfany.org