Tag hospitals

NY Post: Cuomo’s budget would scrap audits protecting doctors from being overworked

By Carl Campanile, 3/19

Gov. Cuomo’s budget plan scraps rigorous state audits of hospitals that help make sure resident doctor-interns aren’t severely overworked and exhausted on the job — and critics worry that could imperil patient safety.

The audits — conducted by an independent contractor hired by the state — enforce the Libby Zion Law, named after the 18-year-old daughter of the late New York Times writer Sydney Zion, who died from botched care at a Manhattan hospital in 1984.

The law requires that doctor-interns at 100 teaching hospitals work no more than 80 hours per week, or 24 consecutive hours — and facilities hit with violations get slapped with financial penalties.

But Cuomo’s $68 billion spending plan would eliminate the audits — considered the nation’s most stringent because the law allows for surprise inspections and reviews of payroll data.

City & State NY: Health Care Officials Offer Diagnoses for New York’s Funding Challenges – Richard Gottfried, Mitchell Katz and Carlina Rivera Weigh In

(mayamaya/Shutterstock)

By City & State | February 27, 2018

Thanks to a flu season that’s one of the worst in recent memory, it has been a tough winter to stay healthy. Influenza hospitalizations are up and thousands have died. The flu vaccine has proven to be less effective than in years past, and public health experts say the disease may have yet to reach its peak. The spread of the virus is likely to continue for weeks.

It has also been a tough winter for New York policymakers and government officials who rely on Washington for funding. While congressional Republicans failed to repeal the Affordable Care Act, they’ve taken incremental steps to undermine the law, such as eliminating the individual mandate. The federal government has also reduced funding for safety net hospitals and for the ACA’s Basic Health Program, both of which play a major role in New York. Some Republicans in Washington still hope to scale back Medicaid and Medicare as well.

So we checked in with a few of New York’s top health care officials to hear their diagnosis of the situation – and how to remedy it.

Assemblyman Richard Gottfried (Jeff Coltin)

RICHARD GOTTFRIED, Chairman, Assembly Health Committee

C&S: What are your health legislative priorities this year?

RG: Our first order of business is, of course, dealing with health care cuts in the budget. This is not the worst year, not the worst budget we’ve seen, nor the best. But there are still serious cuts in health programs and restrictions in Medicaid that I and the Assembly will be trying to reverse. Beyond that, not necessarily in any particular order, passing the Reproductive Health Act in the Assembly again, and hopefully helping to advance it in the state Senate. A particular budget agenda item which we hope to deal with in the budget, and if not we will continue to try to deal with after the budget, is protecting safety net hospitals. The state’s various aid programs for hospitals are not very well targeted to get money to the hospitals that have the most serious financial need. Next, again in no particular order, is strengthening the medical marijuana program. I will be focusing on three issues there. One is to repeal the list of specific conditions for which medical marijuana can be used. There is no other drug that I know of that the law lists the conditions it can be used for. Secondly, today, only physicians, nurse practitioners and physician assistants can certify a patient for medical marijuana use. I think it makes sense that any practitioner who, under law today, can prescribe controlled substances ought to be able to certify a patient for medical use of marijuana as long as the treatment for the condition is within that practitioners scope of practice. The third piece deals with the current business model of producing, distributing and retailing, or dispensing, of medical marijuana. Today, all the licenses that have been issued require the registered organization to grow, process, distribute and dispense the product. There is almost no industry where we allow that degree of vertical integration, and certainly no industry where we require it. The next item is the New York Health Act, my single-payer bill. We will, I hope, pass that again in the Assembly as we have in the three years before. And our goal will be to continue to build support for that around that state. The last item is the Medical Aid in Dying bill that would allow an adult patient with decision-making capacity who is dying from a terminal illness to get a prescription for medication that would end their life. I think that legislation is very morally compelling for New York and I hope we can at least get it to the Assembly floor and pass it.

C&S: How would you assess the state of health care in New York based on what you’ve seen?

RG: It’s mixed. We have some of the finest health care providers, some of the finest physicians and hospitals in the country, but millions of New Yorkers still every year go without health care because they can’t afford or they suffer financially to get that care. Many of our nursing homes provide care that is well below national averages and well below standard. Our systems for inspecting nursing homes are really lacking. We need to invest a lot more of our resources into primary and preventive care, which is very difficult to do in a world where health care is controlled by insurance companies.

C&S: You mentioned your single-payer bill you would like to pass through the Assembly again. Why is that the best way forward for New York to go in in terms of health care?

RG: I believe that no New Yorker should go without health care or have to suffer financially to get it. To use the president’s term, that only gets complicated when the system is focused on the care and financing of insurance companies. And as long as our system is rooted in insurance companies, we will be spending tens of billions of dollars on, necessarily, on insurance company and health care provider administrative costs. You will have insurance companies taking thousands of dollars out of families’ pockets for premiums and deductibles and co-pays without any relation to ability to pay. And insurance companies telling us which doctors and hospitals we can go to, and which services they will pay for. To me, that’s no way to run a health care system. And I don’t know any alternative to a single-payer system that can work.

C&S: And you have seen support for that grow since you first introduced it?

RG: Oh, enormous growth and support, particularly in the last several years, because people have seen that while the Affordable Care Act made a lot of improvements, it still leaves us in the hands of the insurance companies with enormous problems. So people who thought maybe reforming the insurance system would do the job, now see that that really still leaves us falling way short. And it’s also clear that whatever health policy comes out of Washington is going to make things worse in New York, whether it’s for insurance or Medicaid or Medicare. So more than ever, people realize that, whether you call it improved Medicare for All, or single-payer, is really the only answer, and that we have really no alternative but to pursue that at the state level because it’s clearly not coming from Washington any time soon. And so we are constantly picking up more community organizations. There are activists all around the state having meetings with their state senators, there are more unions supporting the bill than ever before, so the issue really is moving forward more than I’ve ever seen.

C&S: Do you have any concerns for what is happening on the federal level, such as cuts in spending or other kinds of legislation that might affect health care in New York?

RG: Their efforts to dismantle the Affordable Care Act will undermine insurance in New York. They are already implementing cuts that are hurting the program called the Essential Plan, which is a subsidized health care program for people whose incomes are a little above Medicaid. And there will be more devastation coming to Medicaid any day now. And their next target will be Medicare. Republicans have had their eye on trashing Medicare since it was enacted in 1965. And that will be coming next. And all of that will be ripping money out of our health care system and putting more burden on out-of-pocket spending by New Yorkers who can’t afford it.

Dr. Mitchell Katz (NYC Health + Hospitals)

MITCHELL KATZ, President and CEO, New York City Health + Hospitals

C&S: What are the problems you’re facing at Health + Hospitals and what are your plans to address them?

MK: I believe, like the nuns, that there’s no mission without a margin. And so while my career has been dedicated to taking care of people who don’t have insurance, I’ve always done that by billing insurance for people who do have insurance, and attracting insured patients to my systems. Currently in Health + Hospitals, in most of our centers, we are still sending away insured patients, not providing the services that are better remunerated. This doesn’t come from a bad place, it’s sort of the history of public hospitals, that public hospitals like ours generally started before Lyndon Johnson’s Medicaid and Medicare in the ’60s when nobody had insurance. And so nobody billed and that was fine. But gradually, public hospital systems have learned how to bill and how to attract and keep paying patients, so there’s a margin to provide the care to the people who don’t have insurance. Health + Hospitals has a long way to go in that area, but this is work I’ve done in two other municipalities, and it’s well-known how to do it. And it’s a lot easier than saving people’s lives in trauma, which I’m proud my system does every day. So if we can revive a pulseless person who’s lost most of the blood volume in their body, surely we can learn how to bill insurance the way other systems do, and we are.

C&S: Could the affordable health care program that you spearheaded in California, Healthy San Francisco, work in New York City?

MK: I think that the model could work. Like a lot of other questions, it comes to participatory democracy. One of the features of Healthy San Francisco was that employers who did not provide insurance for their workers were required to pay into a fund or provide benefits or pay insurance bills. So that’s a political question as to whether or not the city would want to do that. It would have been a lot harder, maybe not impossible, but certainly a lot harder to have had the success we had in San Francisco without the employer spending requirement.

New York City Councilwoman Carlina Rivera (Ali Garber)

CARLINA RIVERA, Chairwoman, New York City Council Hospitals Committee

C&S: What has been your experience so far heading this new Committee on Hospitals?

CR: Well, it’s been educational. It’s definitely been informative as to how nuanced the issues can be. We have two other committees that are tackling issues in the health field, but we’re focused on hospitals. So what I’ve been doing is trying to meet with as many stakeholders, groups, individuals, people who are advocates, people who are retired advocates who worked in hospitals and with patients, and really try to get a broad perspective of what’s going on, how the budget, the deficit is affecting patient care, and how best we can use this committee for oversight, for investigations. But also to push forward legislation that’s going to take care of all New Yorkers. My focus is to really dive deep into Health + Hospitals, but also bring in our private partners. This is a very big network, I say it’s the most important public system in the city, and I want to make sure we’re talking about the underinsured, the insured, the undocumented and all of the people who are so dependent on the system. So again, it’s going to be a focus on the public system, but bring in our private partners as well. And it’s been eye-opening. There are a lot of people working on different campaigns, local, citywide and of course statewide, so I’m trying to, again, meet with as many different people as possible, other elected officials who are chairs of their own committees in their own legislative bodies, and then of course labor and community leaders that do the work.

C&S: Based on some of these meetings that you’ve been having, what is the most pressing issue when it comes to Health + Hospitals?

CR: I would say that would be DSH funds, Disproportionate Share Hospital programs, and that’s the funding to hospitals that treat the poorest New Yorkers. And also the risks from Washington, the threats of cuts to this very important care, these programs, the charity dollars and the way they’re distributed amongst the public and private systems. But when I talked to people, undoubtedly, one of the first things that comes up is DSH. I think it’s also about how are we going to address a billion-dollar deficit and keep 11 major hospitals open? We have the mayor’s commitment that he will keep these facilities open, but how are we going to look at underutilization in terms the spaces in these brick-and-mortar facilities? And how are we going to generate revenue? I had a really great conversation with (President and CEO of Health + Hospitals) Dr. (Mitchell) Katz, along with some of the committee staff here at the Council, just to get a little preview of some of the issues that we’re going to be going over next week. And he has some basic, I think, fundamental outlook on how to make sure we’re getting the reimbursements that we’re not getting, and to implement a more efficient system, and getting paid for the services we’re providing.

C&S: Dr. Katz is also new to Health + Hospitals, and you’re the new head of a new committee. What is that like, to have everyone who’s now trying to tackle this problem be fairly new? Is that detriment or is it good to have a lot of fresh ideas coming in?

CR: I think that’s it, you took the words right out of my mouth. I think it’s great to have fresh ideas. I think it’s good to have someone with a different perspective. He’s coming from tackling a similar issue in another major city. I come from more of the community-based care perspective. My work in Healthy Aging has been working with seniors, with very low-income families in accessing health care and navigating the Affordable Care Act. Though my experience is limited and his is incredibly comprehensive, I’m really excited because it just allows for a clear break from past issues and mismanagement, and I think that’s going to be something that’s going to be important to looking at the health care system in a different lens.

C&S: Was this a chairmanship that you had wanted? And how did you feel when you received it?

CR: Yes, of course. I think I’ve said this before, that I think that making this its own standalone, full committee, it shows the needed urgency for such an important issue. I did mention my interest to the speaker. We’re very aligned when it comes to our beliefs and values and the things we want to achieve in terms of our agenda for the City Council. So we talked a lot about health. We talked about some of the work that he had done, how I wanted to continue that work in terms of the legislation and the policy he put forward, and then bringing my own ideas based on my experience. So this was something I was interested in, and when I was assigned to it, I was very, very excited. I know that I have him for support, I have a great committee staff here and lots of advocates throughout the cities.

Assembly Health Committee Year in Review

Assembly Health Committee Year-End Update

The Assembly Health Committee wrapped up 2017 with 34 bills signed into law and 19 vetoed, including four which were vetoed with specific agreement for further administrative actions. Some bills were signed or vetoed based on agreements to enact changes in 2018. (A governor often raises concerns and wants changes in a bill after it has been passed by the Legislature. This usually happens after the Legislature has adjourned for the year. It is not widely known to the public, but in New York it is common for a governor to insist that the leaders of the Legislature agree to changes in a bill as a condition of the governor signing it. If the legislative leaders and the bill’s sponsors agree, the governor then signs the bill and the Legislature enacts the changes early in the following year.)

The Assembly Health Committee also held public hearings including:

  • Home care workforce adequacy.
  • Adult home oversight and funding.
  • Health care services in state prisons and local jails.
  • Nursing home quality of care and enforcement.
  • Water quality budget implementation.
  • Immigrant access to healthcare.

Below are summaries of bills acted on by the Governor as well as the public hearings.

City and State: Federal uncertainty keeps New York’s health care agenda in limbo

November 20, 2017

Health care legislation in Albany during the 2018 session will be largely affected by decisions made in Washington. State Sen. Kemp Hannon, chairman of the Senate Health Committee, said the state Legislature would be “very careful” and will be “watching what happens” in Congress this year when deliberating health care issues.

Last week, U.S. Senate Republicans launched another effort to dismantle the Affordable Care Act by including a measure in their sweeping tax reform proposal to eliminate the requirement that Americans buy health insurance or face a fine.

Additionally, the Children’s Health Insurance Program, which gives federal aid to provide medical coverage for low-income children, expired on Oct. 1. Nearly 700,000 children in New York state were enrolled in CHIP as of last year, according to Medicaid data.

Gotham Gazette: Amid Health Care Funding Fights, Cuomo Explores Special Session

By Rachel Silberstein, October 12

Governor Andrew Cuomo has been floating the idea of a special legislative session to address federal cuts to the state’s health care programs, as well as other concerns that have developed, since the state budget was agreed to in April.

In that budget, Cuomo pushed to include and won a provision granting him nearly unilateral power to adjust the state’s financial plan mid-year in the event of at least $800 million in federal cuts to the state. In April, the governor said the provision would ensure that “we do not overcommit ourselves financially” and indicated it allowed him to sign off on a budget that did not otherwise account for likely federal cuts. But, it appears as if Cuomo may call lawmakers back to Albany — likely with agreement from the legislative majorities to an agenda — regardless of whether the threshold has been met.

Albany Times-Union: N.Y. hospital prices tied to market power, not quality

By Claire Hughes. 12/17/16

If a knee joint replacement costs $20,000 at Hospital A and $35,000 at Hospital B, what does that whopping 75 percent difference tell you about the likely results of surgery at each place?

Unfortunately, nothing.

Certainly not that Hospital B does a better job at knee replacements. Nor that hospital B has patients with more complex problems, provides more advanced care or is making up low government payments by upcharging your insurance company.

City Limits – Fewer hospitals, more worries: What medical mergers mean for health care in NYC

By Toni Kamins, 6/22

These days the Mount Sinai Health System (MSHS) name and logo are omnipresent in Manhattan with a few outposts in parts of Brooklyn and Queens. Appended to pre-existing hospital and health-care facility signs – New York Eye and Ear Infirmary, St. Luke’s-Roosevelt Hospital, Beth Israel Hospital, many dozens of group medical practices, urgent-care centers, testing labs, and diagnostic and imaging centers – they are the outward manifestation of New York’s (and the country’s) rapidly changing health-care delivery environment. But the changes go far beyond mere names and signage; they represent the corporatization of one of our most basic services.

One recent change, the announcement in late May that MSHS will close or significantly downsize its Mount Sinai Beth Israel Hospital over the next four years, has sent a shockwave through lower Manhattan. Neighborhoods such as Chelsea and the West Village, which are still reeling from the health-services void left by the closing of St. Vincent’s hospital in 2010, will now have additional challenges as geography coupled with Manhattan traffic result in longer—perhaps life-threateningly long—trips to emergency rooms attached to far-away full-service hospitals.

PRESS RELEASE: Safe Staffing for Quality Care Act Passes Assembly

PRESS RELEASE

“Safe Staffing for Quality Care Act” Passes Assembly

Bill Sets Standards for Adequate Hospital, Nursing Home Staffing

(6/14/16 – Albany)  The New York State Assembly today passed the “Safe Staffing for Quality Care Act” (A8580A/S782) with bi-partisan support.  The bill would set a maximum number of patients that nurses and other “direct care staff” can care for in hospitals and nursing homes (staffing ratios) and was based on peer-reviewed academic and evidence-based recommendations.

“Safe staffing is a critical step to ensuring the safety of patients and the safety of nurses,” said Assembly Member Aileen Gunther, the lead sponsor of the bill. “Study after study has shown that investments made in nurses are good investments – whether it’s ending mandatory overtime, requiring safe patient handling policies, or setting safe staffing ratios. As our system of care is evolving, patient outcomes are a key factor in determining provider payments. Safe staffing will improve outcomes, save money, and save lives.”

“Safe staffing saves lives, improves outcomes and reduces avoidable patient injuries,” said Assembly Health Committee Chair Richard N. Gottfried.  “Research published in the Journal of the American Medical Association (JAMA) determined the odds of patient death increased by 7% for each additional patient the nurse must care for at one time.  The ratios and hours specified in this bill are based on peer-reviewed and evidence-based recommendations, and will ensure that hospitals and nursing homes are safer and provide higher quality care.”

The Villager – Prognosis for Beth Israel: New E. 13th mini-hospital

By Lincoln Anderson, 5/26

BY LINCOLN ANDERSON | Answering mounting questions about the future of Mount Sinai Beth Israel Hospital, on Wednesday, Mount Sinai Health System announced a $500 million investment to create a new “Mount Sinai Downtown” health network — the centerpiece of which will be a new, much smaller hospital on E. 13th St.

The new Downtown network, a press release said, will “usher in a sweeping transformation of care delivery from river to river below 34th St.”

As has been rumored and reported over the past year, the current Mount Sinai Beth Israel Hospital — which occupies the full block of prime Gramercy real estate between E. 16th and E. 17th Sts. and First Ave. and Nathan D. Perlman Place — will eventually be sold, a P.R. spokesperson confirmed.

In turn, the key feature of the new plan is a vastly scaled-down Mount Sinai Downtown Beth Israel Hospital to be built on the site of the New York Eye and Ear Infirmary of Mount Sinai — specifically, on the site of its residents building, at 321 E. 13th St. The press release said the new hospital would be built at E. 14th St. and Second Ave. However, the spokesperson confirmed that the plan is for it to be built at the residents building site.

Press Release – Assembly Health Committee Update

Assembly Health Committee Update:
New Legislation Advanced to Improve Access to Medical Marijuana

The Assembly Committee on Health favorably reported 10 bills at its meeting on April 5. The Health Committee had not met since its March 1 meeting because of work on the state budget.

The Committee reported bills to expand public access to epinephrine auto-injectors (“epi-pens”); establish age-appropriate sex education grant programs; and require apartment building owners to develop and distribute smoking policies.

The Committee also reported three bills to improve the 2014 Compassionate Care Act medical marijuana law and expand patient access. Changes required by the Executive as conditions of signing the bill, and Health Department regulations, drastically limited the scope of the program. The three bills reported by the Committee would:

  • Allow physician assistants and nurse practitioners to prescribe medical marijuana (today they are already fully authorized to write prescriptions for even the strongest and most dangerous controlled substances).
  • Expand the list of eligible conditions. The conditions added in this bill were initially passed by the Assembly but deleted from the final law at the Executive’s insistence.
  • Create an advisory committee to assist the Commissioner in making regulations, advise the Commissioner on clinical matters, and review appeals of denials of patient or caregiver applications; require that medical marijuana regulations conform to the legislative intent and have a valid clinical or public safety basis.