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Progress Notes
February 2019

In This Issue

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Debt Ceiling Deadline and More Medicaid Cuts Loom

Debt Ceiling - The latest debt limit suspension is set to expire on March 1. The Treasury Department said earlier this month it can use extraordinary measures to assure the United States does not pierce the debt ceiling. Some forecasters project the extraordinary measures will last through the summer, though it’s too early to know exactly how long borrowing can be extended. Legislation to deal with the debt limit is often a vehicle for other pieces of legislation, including healthcare legislation supported by the hospital industry. However, healthcare is always vulnerable as a “pay-for” for other legislative priorities.

Medicaid Cuts - More massive Medicaid cuts are on the horizon for hospitals come October 1, 2019. That is when Disproportionate Share Hospital (DSH) payment reductions take effect. Known as DSH cuts, these are funds that help cover costs incurred by hospitals that serve a disproportionate number of Medicaid and uninsured patients. In 2010, the hospital field agreed to these cuts in return for an influx of insured patients due to the Affordable Care Act’s insurance expansion provisions. Since its enactment, the law’s strength has been diluted both by congressional action and executive order. Only about half of the then 46 million uninsured are insured today. The DSH cuts would cost New York State’s hospitals more than $7 billion over the next decade. Many hospitals in the state operate on very thin or negative margins – a situation set to become worse when these federal Medicaid cut kicks in on October 1, 2019. Implementation of the federal DSH cuts have been delayed six times; the hospital industry is fighting for another delay. 

Mandated Staffing Ratios and Single Payer Remain in Play

As we fight the proposed cuts to Medicaid, concerns about single payer legislation and nurse staffing ratio legislation remain.

Nurse Staffing Ratios - The governor asked the Department of Health to study nurse staffing. The Suburban Alliance and other associations oppose this effort, which could be the first step on the way to mandated nurse staffing ratios. Mandated nurse staffing ratios set unrealistic expectations, in terms of financial and human capital commitment, on hospitals. All evidence concludes that staffing is best handled on an individual hospital-by-hospital basis, which accounts for patient complexity, surge capacity, and other local situations. 

Single Payer Plan - Senator Gustavo Rivera and Assemblyman Richard Gottfried introduced an expanded version of their New York Health Act earlier this month. The plan now includes provisions for long term care and home care, adding about $20 billion to the plan’s current projected price tag of $139 billion. The plan’s sponsors say waste from the system would be removed; this will be one way to help pay for universal health insurance. Higher taxes on employers and employees would also be needed. The plan calls for all New Yorkers, including those on Medicare, to switch to the New York Health Plan. No commercial insurance would remain. The governor is instead asking for a universal access commission to advise the Departments of Health and Financial Services on how to achieve universal access to healthcare. Hospitals welcome the governor’s approach but continue to vehemently oppose the single-payer legislation under consideration. The Suburban Hospital Alliance has joined the Realities of Single Payer, a coalition of business organizations, hospitals, and other providers offering information about the ramifications of single payer in New York. 

Governor’s Budget Amendments Call for $225 Million in Medicaid Cuts to Suburban Regions

On February 14, 2019, Governor Cuomo released the 30-day amendments to his 2019 – 2020 proposed state budget, calling for approximately $1.1 billion in Medicaid cuts statewide - $225 million regionally. 

One of the proposed cuts specifically targets hospitals in the suburban regions. The revised budget nearly eliminates funding from the Indigent Care Pool (ICP) for hospitals in Nassau, Suffolk and Westchester Counties, as well as in New York City, which meet certain financial criteria. Eighteen Suburban Hospital Alliance members would see their ICP distributions capped at $10,000 per year, a reduction of $57 million. These are hospitals that meet the existing criteria for ICP funding, which partially reimburses providers for the uncompensated care they provide. Targeting such a specific group of providers for cuts sets an extremely dangerous precedent. 

The ICP cut would be in addition to a rollback of the two percent increase in the Medicaid rate, originally promised to hospitals by the governor in November 2018, and an additional 0.8 percent across-the-board cut to Medicaid rates that are also included in the governor’s revised budget. These cuts will reduce Medicaid reimbursements to all hospitals in the suburban regions by a total of $168 million over two years. 

A rally in Albany to protest these cuts is set for March 5, as part of the Healthcare Association of New York State’s (HANYS) Advocacy Day activities. Hundreds of hospital workers from all ranks are needed to gather at this rally so that a forceful message is sent to the legislature and the governor. Hospital members should register ASAP for the March 5 events. Direct questions about the event to learning@hanys.org or call 518-431-7867. If your facility is arranging buses, please contact Allison Manny amanny@hanys.org to coordinate.

 

News Briefs

Nurse Staffing Survey - Earlier this month, chief nursing officers at Suburban Hospital Alliance member hospitals received a HANYS Nurse Staffing Ratio Survey. It seeks to collect information about current nurse staffing ratios and vacancy rates at member hospitals. This information is critical to our advocacy efforts against the mandatory staffing ratio legislation under consideration in Albany. No institution-specific data will ever be released publicly; the goal is to aggregate statewide data so that we can estimate both the financial and workforce impacts of the legislation if enacted. This is not the same survey that the Department of Health distributed electronically through the Health Commerce System earlier this month. Please complete the HANYS survey by March 1, 2019. For more information and to return responses contact Wendy Darwell at wdarwell@nshc.org or Bob McLeod at bmcleod@hanys.org

Healthcare Coverage - The New York State of Health marketplace announced that more than 4.7 million New Yorkers enrolled in comprehensive health coverage through the marketplace. This is an increase of more than 435,000 people from 2018. The state says marketplace enrollment is at its highest point ever, including more than one million people enrolled in Qualified Health Plans and the Essential Plan. Eighty-six percent of enrollees were returning from last year, and 14 percent were new in 2019. 

On Long Island, the Suburban Hospital Alliance regional affiliate the Nassau-Suffolk Hospital Council is one of three state-appointed navigator agencies for the region. The Hospital Council maintains a user-friendly, bilingual website – www.coverage4healthcare.org - that lists enrollment sites and dates and other helpful information. Assistance is offered on a first come, first serve basis.

In the Westchester and Hudson Valley area, state-certified navigator agencies are Community Service Society of New York, Maternal Infant Services Network of Orange, Sullivan and Ulster Counties and the Westchester County and the Rockland County Departments of Health. 

Enrollment in Child Health Plus, Medicaid, and the Essential Plan are available year long. 

Blood Shortage - Cold weather and widespread flu conditions are making it harder for New York communities to maintain their blood supplies. Hospitals interested in hosting a blood drive should visit www.nybloodcenter.org. Individuals can also check out this site for donation sites and mobile units.

Dahill Dose Blog – Check out the latest posts at www.dahilldose.com. Authored by SHANYS President/CEO Kevin Dahill, the blog offers informed and insightful commentary about healthcare policy, legislation, and regulation.

HANYS' Community Benefit Spotlight – A new series showcasing the work of HANYS' member hospitals and health systems do to improve population health, address regional health disparities and deliver care to local communities outside of facility walls. Get your success stories shared on HANYS website, in email, and on social media with policymakers, leading healthcare professionals and the public! Submit your story today.


News from
Long Island

Patient Empowerment –  The Long Island Community Foundation has awarded Catholic Health Services of Long Island $50,000 to develop a program that will encourage patients to take a more active role in their health care. CHS’s H.O.P.E. program —Health Optimization through Patient Engagement —will deploy health coaches across the system to engage and educate patients on how to improve overall health outcomes, especially for those with chronic diseases such as diabetes.

Leapfrog Grades – Three Long Island hospitals were awarded an "A" from The Leapfrog Group’s Fall 2018 Hospital Safety Grade. St. Charles Hospital and St. Francis Hospital, both members of Catholic Health Services, and Mather Hospital, all were recognized for their efforts in preventing medical harm and errors.


Sepsis SafetyMercy Medical Center is the first hospital in New York State to receive The Joint Commission’s Gold Seal of Approval® for Sepsis Care. The Gold Seal reflects Mercy’s commitment and dedication to providing the highest standard in sepsis care.

Specialty Healthgrades - Good Samaritan Hospital Medical Center has been recognized as one of America’s 100 Best Hospitals for Coronary Intervention according to a national study by Healthgrades, the leading online resource for comprehensive information about physicians and hospitals. 


Top Healthgrades - Also appearing in the top 100 of Healthgrades' America's Best Hospitals for 2019 is Stony Brook University Hospital, putting them in the top 2% of hospitals in the nation for exhibiting clinical excellence year over year.


News from the
Hudson Valley

Accreditation – The Vassar Brothers Medical Center Laboratory received accreditation by the College of American Pathologists for meeting high standards in its laboratory. The hospital’s lab is one of more than 8,000 CAP-accredited facilities worldwide. The federal government recognizes the accreditation as being equal to or more-stringent-than the government’s own inspection program. 

Top Healthgrades - Vassar Brothers Medical Center also appeared in the top 100 of Healthgrades' America's Best Hospitals for 2019, where they are in the top 1% of hospitals in the nation for consistently providing overall clinical excellence across a broad spectrum of conditions and procedures year over year. 

Global Ethics Recognition – The Greater Hudson Valley Health System, comprised of Orange Regional Medical Center, Catskill Regional Medical Center, Orange Regional Medical Group, Catskill Regional Medical Group and Orange Regional Medical Center Foundation, has been recognized by the Ethisphere Institute, a global leader in defining and advancing the standards of ethical business practices, as one of the 2019 World’s Most Ethical Companies. GHVHS is one of only six honorees worldwide in the non-profit healthcare providers industry, underscoring their commitment to leading with integrity and prioritizing ethical business practices.

Global Care and Safety Recognition - HealthAlliance Hospital: Broadway Campus, HealthAlliance Hospital: Mary’s Avenue Campus and Margaretville Hospital, all members of the Westchester Medical Center Health Network, have each earned a certification indicating they meet or exceed globally established standards for safe, reliable, high-quality healthcare that satisfies patient needs and lowers healthcare costs. These certifications to the ISO 9001:2015 quality management system mean that these hospitals maintain or surpass globally established and recognized standards for exceptional patient care and safety, plus have effective systems in place for continual improvement. They join Westchester Medical Center, Maria Fareri Children’s Hospital and the Behavioral Health Center in Valhalla and MidHudson Regional Hospital in Poughkeepsie, all members of WMCHealth, as the only hospitals in the Hudson Valley earning this certification.

Phelps Hospital, Northwell Health CEO Elected Chair of the Northern Metropolitan Hospital Association

Chappaqua resident and president/CEO of Phelps Hospital/Northwell Health, Daniel Blum, was named chair of the board of directors of the Northern Metropolitan Hospital Association (NorMet), the association that represents not-for-profit and public hospitals throughout the Hudson Valley. The appointment was announced at NorMet’s November 27, 2018 board meeting. The two-year term expires on January 1, 2021. The CEOs from each of the member hospitals comprise the board of directors.
Blum is an accomplished healthcare executive and leader in the Hudson Valley region. Prior to his appointment as CEO in 2014, Blum served Phelps’ as its senior vice president. Before joining Phelps, Blum held various leadership roles at White Plains Hospital, New York Hospital – Cornell Medical Center, Stellaris Health Network, and St. Vincent’s Hospital (Manhattan). Both Stellaris and St. Vincent’s are now defunct. 

He began his healthcare career as a paramedic and paramedic instructor. He is a board member of the Healthcare Association of New York State, Westchester EMS, Robin’s Nest Child Care, Kendal on Hudson, and the Mid-Atlantic Executive Board of Vizient. He is past chairman of the New York State Department of Health Emergency Medical Advisory Council. He continues to serve on this Council, as well as the Westchester Regional Emergency Medical Council. 

Blum holds a bachelor’s degree in philosophy and a master’s degree in healthcare administration from New York University. He is a member of the American College of Healthcare Executives and Medical Group Management Association.

NorMet, along with its sister organization the Nassau-Suffolk Hospital Council on Long Island, forms the core of the Suburban Hospital Alliance of New York State, which is the advocacy coalition for all hospitals located in these two suburban regions.

Committee Updates

Fiscal Policy Committee - The Fiscal Policy Committee re-convened for the first time in 2019 on February 6. Hospital Council staff discussed legislative priorities for the coming year and provided updates on the Site-Neutral Payment (HOPD) and 340 B lawsuits. Hospitals chosen for the first round of S-10 audits provided the group with feedback on their experience. Members were provided with an overview and analysis of the state budget proposal and its anticipated impact on their institutions. 

Quality Committee - At the February 13 Quality Committee meeting, Mason Forando, Director of Data Informatics at HANYS, provided members with an overview of recent changes to the CMS Star Ratings methodology and the expected impact on hospital scores. Hospital Council staff provided state regulatory updates on the proposed human trafficking regulations, changes to the Patients’ Bill of Rights, proposed changes to stroke center designation criteria and new requirements for CMV testing in newborns.

Corporate Compliance Committee - At the February 26 meeting of the Corporate Compliance Committee, members were provided updates on federal regulatory issues including price transparency, surprise billing and revisions to the Yates Memo. Hospital Council staff also discussed changes to state regulations that impact the Patients’ Bill of Rights and the treatment and referral of victims of human trafficking. Recent trends in DEA diversion audits were also reviewed.

Long Island Health Collaborative - Members of the LIHC met on February 14, to hear updates on various Collaborative projects, on the PHIP funding, which remains in jeopardy, and the steps the PHIP staff and Population Health Improvement Programs across the state are taking to restore funding. In addition, Dr. Lisa Benz Scott, Director of Stony Brook University's Program in Public Health and MPH Program, gave a presentation entitled, “The Opioid Crisis on Long Island – a Data-Driven Population Health Approach.”

Upcoming Events

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Advanced Executive Leadership for Physicians is an intense, effective, and efficient way to support the career development of physician leaders interested in evaluating and elevating their executive leadership skills. Combining essential policy and program review, advanced learning, peer interaction, and, new in 2019, individual executive coaching connected to a Leadership Action Plan.

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