CPHS in the news

November 2011 

Cuomo Panel Seeks Broader Power Over Hospitals
Tuesday, November 29, 2011 - 02:18 PM
By Fred Mogul

Hospitals and healthcare advocates around the state will be watching Governor Andrew Cuomo's office to see what he does with new recommendations that could have far-reaching effects on the state's healthcare system.
The Brooklyn Health System Redesign Work Group, which Cuomo appointed as part of a year-long Medicaid reform effort, has released an 88-page report with specific suggestions for struggling hospitals and broad ideas for changing how the state regulates hospitals.
The five person panel wants to give the state health commissioner authority "to appoint a temporary operator for health care facilities that present a danger to the health or safety of their patients," including financially troubled ones "that have failed in their obligations." That authority would also allow the state to replace healthcare facility board members.
Such a shift in power would need legislation from the New York State Legislature. The governor's office made a similar proposal earlier this year, as part of the budget process, but it was removed.
Ken Raske, head of the Greater New York Hospital Association, said it's one thing to assert such control over places that are in dire straits and receiving government help, but it's another to let the state play such a role in all healthcare facilities.
"Clearly, I understand that if you're going to accept a state bailout, the state must have a say, and I would agree with that," Raske said. "But proposing to give the commissioner the power to hire and fire boards of trustees of institutions, as well as management, is problematic."
Raske said the GNYHA will try to shape any bill that comes up in the legislature.
The panel is chaired by Stephen Berger, a private equity manager who led a commission five years ago that closed dozens of under-used hospitals and nursing homes across the state.
This time, there were no proposed closures. But "Berger II," as some call it, does recommend "integration" — if not outright mergers — among different groups of ailing Brooklyn hospitals. As part of the consolidation, the panel suggests shrinking hospitals, basically getting them to shutter wards or reduce the number of beds, to make them more financially viable.
But Judy Wessler, from the Commission on the Public's Healthcare System, said redirecting resources from hospitals to primary care providers, such as clinics and doctors offices, could theoretically be effective — but rarely is.
"If you have enough adequate primary care, then you might not need all the hospital beds that you have, because people are treated in the community, and it works," Wessler said. "This report talks about that, and that's wonderful, but they don't have any plan for increasing the amount of primary care available in central Brooklyn."


October 2011

October 13, 2011, 12:30 pm

Uncertain Fate for Brooklyn Hospital Center

As a state-appointed committee charged with solving the financial crisis of Brooklyn's health care system inches closer to issuing recommendations, local community leaders are voicing concern about the future of Fort Greene's Brooklyn Hospital Center and the borough's other medical centers.

The Brooklyn Hospital Center filed for bankruptcy in 2005 and has struggled with low profit margins since then. It was repeatedly mentioned alongside other struggling hospitals during the most recent meeting of the state's Medicaid Redesign Team, Brooklyn Working Group. The group is one of nine subcommittees in Gov. Andrew M. Cuomo's program to overhaul and financially stabilize the state's debt-ridden health care delivery system.

"I don't think people in the neighborhood are aware how precarious Brooklyn Hospital's situation is," said Dr. Georgianna Glose, director of community advocacy group Fort Greene SNAP.

Peter Moskowitz Judy Wessler, director of the Commission on the Public's Health System, and her intern at the nonprofit's Lower East Side office.

The Brooklyn group was originally scheduled to deliver recommendations directly to the New York State Department of Health on Nov. 1., but at the Redesign Team's last general meeting in Albany, Stephen Berger, Brooklyn Working Group chair, hinted that the group would not be able to meet that deadline.

In late September community leaders protested outside of a Brooklyn Working Group meeting over the committee's unexplained last-minute decision to change the event from a public hearing to a meeting open to the public but without time allotted for comment. Now some of those same community leaders are worried that being denied a voice in the meeting was a sign the Brooklyn Working Group may shun local input altogether, and ultimately decide to merge or close hospitals in Brooklyn.

According to one presentation at the Brooklyn Working Group's last meeting, Brooklyn Hospital has about $60 million in total assets. That's more than other local hospitals like Interfaith Medical Center in Bedford-Stuyvesant and Wyckoff Hospital in Bushwick, both of which are tens of millions of dollars in debt. Still, $60 million may not be enough to weather recent and looming changes to the state Medicaid reimbursement policy, as well as the usual financial ups and downs hospitals face yearly.

"I'm still concerned because just emerging from bankruptcy doesn't mean they're on good footing," said Dr. Glose of the Brooklyn Hospital Center. "One bad year and they can be in the same boat."

Medical professionals generally consider a 3 percent yearly profit as a safe operating margin for hospitals, but Brooklyn Hospital Center's operating margin was just 1.7 percent last year, according to a presentation at the Brooklyn Working Group meeting.

The next step for Brooklyn Hospital Center remains unclear, and local nonprofits are worried about that uncertainty. The organizations say the current Brooklyn Working Group is heavily pro-business and doesn't represent the economic and racial diversity of Brooklyn.

"It shouldn't be only health care professionals and financial professionals," said Dr. Glose.

Some community leaders said they think the Brooklyn Working Group is more of a hospital closing committee. Stephen Berger, chair of the group, who is also the chairman of Odyssey Investment Partners, an investment banking firm, led a similar state commission in 2006 that recommended closing or merging some hospitals in New York City.

"They're not financially sound, so by Berger's standards they are expendable," said Judy Wessler, director of the Commission on the Public's Health System, a Manhattan-based nonprofit, referring to Brooklyn hospitals.

Alhough Ms. Wessler wants the commission to keep every hospital open, she's not opposed to the idea of Brooklyn Hospital Center restructuring with others – which could mean anything from merging some health services to sharing administrative resources.

Peter Moskowitz Ngozi Moses, director of the Brooklyn Perinatal Network, at her office in Downtown Brooklyn.

"I think it would be a fantastic thing, " said Ngozi Moses, director of the Brooklyn Perinatal Network, which works with Ms. Wessler on a campaign to save hospitals. "There's no central coordinating anywhere. It's like a free-for-all over who can survive."

If one of the more debt-ridden hospitals was to shut down or reduce capacity, Brooklyn Hospital Center would end up with a lot of its uninsured patients, leaving the center with even more debt, Ms. Moses said.

"If they don't pair up it's just a matter of time before they're below the line," she said.

A Crain's New York report in June suggested Brooklyn Hospital Center was in talks to restructure its services with Wyckoff Hospital and Interfaith Medical Center. Katherine Derr, the vice president of marketing and communications at Brooklyn Hospital Center, declined to comment.

Rajiv Garg, the CEO of Wyckoff Hospital, said restructuring always remains a possibility for Wyckoff, but would not say whether Wyckoff was currently working on restructuring with Brooklyn Hospital Center.

While Brooklyn Hospital Center's future remains unclear, the hospital remains mum. Perhaps one good sign for the hospital is that Stephen Berger's 2006 commission report listed Brooklyn Hospital as "essential."

The Brooklyn Working Group recently announced it would hold a public comment session on Oct. 19. Community leaders like Ms. Moses and Ms. Wessler will be allowed four minutes each to present their views on what they call Brooklyn's health care crisis.

"The Berger commission must listen to the advocates who are saying it's not just about the money they are losing," said Ms. Moses. "We don't feel like we can lose any more hospitals."

Cuomo Sets $50 Million Union Bailout

October 5, 2011 By JACOB GERSHMAN

The Cuomo administration has quietly authorized a $50 million bailout of an insurance fund for the 1199SEIU health-care workers, a decision that a union official said helped secure its endorsement of the state's Medicaid budget.

Last month, under orders from the governor's office, the New York State Department of Health raised the Medicaid reimbursement rate for New York City home-care agencies by $60 million and converted the money into extra insurance subsidies for low-wage workers, according to a Cuomo official.

Since the vast majority of providers are unionized and represented by 1199SEIU United Healthcare Workers East, the increase amounts to roughly an extra $50 million in Medicaid funding over 27 months for the union's cash-strapped benefit fund for personal-care aides, who are paid hourly rates to help elderly and infirm Medicaid patients with chores, groceries and bathing. Another $10 million goes to other group health plans. About 30,000 personal care aides are enrolled in 1199SEIU's fund.

 Josh Vlasto, a spokesman for Mr. Cuomo, a Democrat, said the state's aid to the 1199SEIU fund was not given in exchange for support of the governor's budget. He said prior administrations first pledged state support for the union's health plan.

"This commitment dates back years and the process has been reformed in order to reduce costs to taxpayers," Mr. Vlasto said. "The Wall Street Journal's conspiracy theory is bogus as this was wholly separate from the Medicaid Redesign Team and this year's budget process."

But others said the extra dollars were key to gaining union backing of a budget plan that shaved nearly $1 billion from the state's Medicaid program. The union—which had vociferously opposed past budget cuts—won other victories, including a new minimum wage for home aides and an expansion of managed care that could help the union gain members.

Union officials said the benefit fund's cash problems were part of budget negotiations with the governor's office. "It was always on the table that we had to solve this problem," said Kevin Finnegan, the union's political director. Another person familiar with the budget negotiations said the bailout was key to 1199SEIU's support.

The governor's office agreed to the bailout before passage of the state budget in March after the union warned its workers would lose coverage without extra assistance. It worked out the final details in recent weeks.

The $50-million subsidy didn't require legislative approval and wasn't reviewed by the special team Mr. Cuomo appointed to lower costs in the Medicaid program. City providers are expected to be notified of the rate increase this month.

The funding decision caught observers of the state health system by surprise.

"We certainly support home-care workers getting important benefits, but $60 million can be used in a lot of other important and different ways," said Judy Wessler, director of the Commission on the Public's Health System, a patient-advocacy group based in Manhattan. "But off-budget deals that spend public dollars and don't go through a public-review process are troubling, even if it's for a good cause."

Federal and state funding of insurance coverage for health-care workers dates back to 1999, when New York was granted a federal waiver and an extra heaping of Medicaid dollars to help stabilize a work force that suffered from high rates of turnover.

But the subsidies have never fully paid for the plans, which now offer medical, hospital, prescription drugs, dental and vision benefits without charging premiums and with minimal co-payments.

The union operated the plan for years, but in 2007 the Spitzer administration tried to manage costs by putting a private Medicaid managed care company in charge, Fidelis Care New York, which billed the union premiums for a package of benefits similar to Family Health Plus, a Medicaid program.

But the cost of buying insurance from Fidelis increased rapidly, leading to more shortfalls. The union has pared the eligibility for the plan, dropping coverage of spouses and children.

Mark Lane, president and chief executive of Fidelis Care New York, said the premium hikes were approved by the state. They were predominantly caused by the severity of illness and use of services by the members insured, Mr. Lane said.

The bailout was funded, Cuomo administration officials said, by extra money turning up in Medicaid "worker recruitment and retention" funds appropriated by the Legislature.

Administration officials described it as a one-time fix. Starting in the fall, the union is resuming control over the plan's operations and is no longer working with Fidelis. The union said it will have more control over the scope of benefits and employee contributions, allowing them to potentially lower costs.

Write to Jacob Gershman at jacob.gershman@wsj.com

September 2011

Fed Dollars for NY Hospitals Occasionally Go to Wrong Hospitals:
Study Sunday, September 25, 2011 - 12:00 AM By Fred Mogul

New York's hospitals gets hundreds of millions of dollars from the federal government to pay for health care for the uninsured and under-insured — but a new study that suggests much of that money doesn't go to the right hospitals, with the most non-paying customers. The $395 million in so-called "Charity Care" New York gets from Washington, D.C., helps off-set deep financial losses hospitals suffer when they provide medical services for which they otherwise wouldn't get paid. But professor Alan Sager, from Boston University's School of Public Health, said a complicated state formula directs a large share of that money to hospitals that don't provide all that much free service to the uninsured. "If one hospital provides four times as much charity care as another hospital, it may need more than four times as much money, because if a hospital provides just a little charity care, it may not need to hire additional nurses and doctors and other care-givers," said Sager, who did the study for the Commission for the Public's Health Service, or CPHS, a watchdog group. He said a more just and effective way to distribute money from the Hospital Charity Care Pool would be to make the formula more closely follow individual patients. The Greater New York Hospital Association, or GNYHA, said the current formula works better than what Sager proposes because it offers a greater allowance for under-insured patients — people who have insurance, but also have high out-of-pocket expenses they can't pay – in addition to the uninsured. "In light of the growing high-deductible plans and consumer-directed plans that tend to shift the cost of care to the consumers, many individuals cannot afford to pay their co-pays and deductibles," said Elisabeth Wynn, a GNYHA official. "So, we think from a policy perspective that the [Charity Care] Pool recognizes that — especially for low-income individuals." But Judy Wessler, from CPHS, said that approach doesn't take into account the changing reality in Washington: the Affordable Care Act focuses on the uninsured, not the under-insured. If New York doesn't alter its current formula, she said, it could risk losing a crucial stream of money for struggling hospitals.

August 2011

Heard Around Town, Aug. 26, 2011By City Hall

* The Cuomo administration's request yesterday for executive pay information from social-service nonprofits was surprising to some who watched Cuomo's Medicaid Redesign Task Force ignore the issue of executive pay at hospitals. Top pay at New York City hospitals runs into the millions, but Assemblywoman Deborah Glick's bill to cap it was ignored, and so was a similar suggestion from the Commission on the Public's Health System. "There were people on the task force, and people they were representing, who earn a lot more than that," said the commission's director, Judy Wessler. "I think they decided not to take that one on."

July 2011

PUBLIC HEALTH ADVOCATES OFFER ROADMAP FOR CUOMO'S MEDICAID REDESIGN TEAM AHEAD OF FIRST PUBLIC HEARING ON BROOKLYN HOSPITALS Thursday, July 28, 2011 New York-

Public health experts are recommending a series of principles intended to guide the Brooklyn Work Group of Governor Andrew Cuomo's Medicaid Redesign Team (MRT), which is holding its first public hearing today to assess the strengths and weaknesses of Brooklyn hospitals and their future viability, with the goal of making specific recommendations on the future of the borough's health system.   The coalition includes doctors and nurses and other public health officials from Wyckoff, Interfaith, Brooklyn, and New York Methodist Hospitals, the Committee of Interns and Residents, and the New York State Nurses Association, along with public health advocacy organizations including the Commission on the Public's Health System, and New York Lawyers for the Public Interest, operating together as the Save Our Safety Net Coalition—all of whom agree that any re-structuring must emphasize preserving and protecting community health and wellness solutions through smart-sizing and consolidating services, rather than across the board hospital closures.   "We have to examine a realignment of local healthcare services that won't harm the Central Brooklyn community. We know from past experience that closing safety-net hospitals doesn't make the surviving hospitals more viable, but it devastates poor black and Latino families," said Dr. Sepideh Sedgh, Secretary-Treasurer of the Committee of Interns and Residents (CIR) and a physician at Maimonides Medical Center.   Citing recent studies, including a 2006 report by Professor Alan Sager that reveals that hospital closures in urban areas have failed to reduce healthcare costs, and have instead created additional barriers to care which actually correlate to increased costs, the healthcare leaders urged the Brooklyn work group led by Stephen Berger to focus on serving the needs of under-served communities.   Today leaders from across the healthcare industry recommended a series of guiding principles for the MRT's Brooklyn Work Group to ensure community health and wellness solutions through smart-sizing are prioritized over costly hospital closures:  
1.       LOCAL – Brooklyn needs health care services and jobs that are local and can give health and stability to the neighborhood.
2.       APPROPRIATE – Brooklyn is a diverse and dynamic community and health care should be the same. That means care that is culturally competent and in languages people can understand.
3.       ACCESSIBLE – If people can't get to the doctor, they delay treatment, and get sicker. This is not only bad for patients, but bad for business. Cutting vital health care resources in Brooklyn means patients have to travel further for care and are more likely to not get it.
4.       FAIR – Cuts should not disproportionately affect Medicaid consumers, the uninsured and safety net health care providers. These are the communities and institutions that most need these resources and more cuts will be devastating. 5.       OPEN – Any public funds should be distributed in an open way, especially charity care dollars that are meant to care for the uninsured. 6.       REPRESENTATIVE – Most of these decisions are being made by people who have no connection, insight or accountability to Brooklyn communities. The people these decisions affect should have a voice at the table.    
BACKGROUND Governor Cuomo's Medicaid Redesign Team has convened a 5-person subcommittee, The Health Systems Redesign: Brooklyn Workgroup. The subcommittee is charged to "assess the strengths and weaknesses of Brooklyn hospitals and their future viability." The team is chaired by investment banker Stephen Berger whom The New York Observer called the "hospital hatchet man" after his 2005 Berger Commission closed several hospitals in medically underserved communities across New York. The subcommittee is comprised of 5-members, none of which represent Brooklyn communities, Medicaid beneficiaries or other stakeholders that will be most affected by their decisions. The Committee of Interns and Residents/SEIU Healthcare is the oldest and largest union of resident physicians in the U.S., with 13,000 members in more than 60 hospitals. In New York, 6,000 residents are represented by CIR.

Home Health Policy Shift Roils Albany July 26, 2011 Wall Street Journal
By JACOB GERSHMAN

http://online.wsj.com/article/SB10001424053111903999904576468570546731358.html

Gov. Andrew Cuomo's effort to overhaul New York state's $6 billion home health-care industry is coming under scrutiny from patient advocates and other industry players who say the administration is bowing to the interests of large, politically connected providers. Mr. Cuomo is pushing forward with his goal of enrolling tens of thousands of home-bound elderly, disabled and frail Medicaid patients into managed-care plans. It's a policy shift that has emerged as one of the most contentious issues in Albany. Starting next year, Medicaid recipients who require more than 120 days of home health care will be automatically enrolled in a managed-care plan that will charge the state monthly premiums for each beneficiary and assume the costs of a variety of care outside of acute hospital treatment. The plan is to enroll tens of thousands of New Yorkers that rely on nursing aides to help them dress, bathe, walk or take medication. Few states have attempted to extend Medicaid managed care so deeply into this sector of public health insurance. "This is the sleeper issue that will dictate who gets control over billions of dollars in the home-care arena," an individual close to the policy process said. The two executives whom the administration has put in charge of the 18-member committee that is developing the complex guidelines for the mandated managed care, Eli Feldman and Carol Raphael, operate two of the largest nonprofit, long-term care companies in the state and are closely linked with the state's largest health-care union. The patient advocates say the administration has given too much control to executives at providers that stand to gain financially from the shake-out of the new system. They want more assurances from the Cuomo administration that patients automatically enrolled in the plans won't be deprived of crucial nursing services. They're also looking to get additional safeguards to prevent the plans from moving patients to nursing homes or other institutional settings without proper medical reasons. "The people running this committee are the stakeholders with all the financial leverage," said Valerie Bogart, director of legal services at Selfhelp Community Services, a nonprofit group that provides health care, housing and legal services to seniors, including Holocaust survivors. "It's not right. Your gut tells you it's not right." "I think it's a huge conflict of interest," said Judy Wessler, director of the Commission on the Public's Health System, a community health advocacy group based in Manhattan. Complaints from patient groups prompted the Cuomo administration to include more advocates on its policy team, but the changes have done little to assuage the critics. "None of the consumers represent the interests in New York City-based recipients of Medicaid long term care services," Ms. Bogart said. The Cuomo administration has been blunt about its goals. For-profit operators, they say, have been tapping into an unaffordable amount of Medicaid dollars. They say the companies are billing for an overabundance of long-term at-home services for patient populations that would be better off with more coordinated care. Among the largest for-profit operators are AmeriCare, Revival, Family Care and Extended. "This is a balanced team that represents key stakeholders and includes nationally recognized experts who will focus on implementing a system that will save taxpayers money and protect patients," said Josh Vlasto, a spokesman for the governor. One of the two leaders of Mr. Cuomo's managed-care policy team is Mr. Feldman, the president and CEO of Metropolitan Jewish Health System, which has employed Jeffrey Sachs, one of the principal architects of the administration's Medicaid agenda and a close friend of the governor's, as a consultant on state regulatory issues. The other co-chairman of the policy group, Ms. Raphael, is the outgoing chief executive of the Visiting Nurse Service of New York, a $1 billion home-care company that employs the same lobbying firm that represents 1199 SEIU and the Greater New York Hospital Association, both of which played leading roles in helping to shape the governor's Medicaid policies. The two companies use thousands of home-health aides who are represented by 1199 SEIU. The two companies control about a third of the state's home-care Medicaid dollars, and each has already established voluntary managed-care plans. Officials with the for-profit operators, which have been reluctant to air their concerns publicly, say they fear that the licensing and operating rules for the managed-care plans could be narrowly defined so as to ensure the dominance of Visiting Nurse Service and Metropolitan Jewish at the expense of rivals. The for-profit companies say they are already reeling from spending caps and labor wage floors imposed in the Medicaid budget. Few expect that they'll be able to set up managed-care plans that will be able to compete with the existing ones that will have a head start in enrolling patients and clearing regulatory hurdles. Cuomo officials say the two executives they picked to run the policy team are steeped in experience in dealing with managed long-term care. "The presumption was that knew they something about managed long-term care, and that's helpful," said a Cuomo official.  

June 2011

Fears That 'Managed' Medicaid Means Less Care June 30, 2011 By Jeanmarie Evelly

http://www.indypressny.org/nycma/voices/484/briefs/briefs_2/
http://www.norwoodnews.org/id=3733&story=fears-that-%E2%80%98managed%E2%80%99-medicaid-means-less-care/

The letter came one day this winter, while 57-year-old Norwood resident Nilta Vazquez was still in the midst of recovering from an extensive spinal fusion surgery she'd had that fall. At the time, she was unable to walk on her own, and had a health aide helping her at home. The letter said that Medicaid—the health insurance program for low-income and disabled New Yorkers that's funded jointly through the state and federal governments—was requiring her to switch over to a managed care plan. Managed care plans differ from traditional or "fee-for-service" health plans in that in the latter, a patient is allowed to visit any doctor that accepts Medicaid. In managed care, a patient instead has one primary care doctor charged with overseeing their care, and can only visit physicians within a certain, approved network of caregivers. Managed care is generally considered more cost effective, since Medicaid pays a managed care company a flat rate per person, per year, instead of many payments for each service or doctor's visit. For several years, the state has been rolling out so-called mandatory Medicaid managed care by counties—including the Bronx—but certain groups of Medicaid patients with special health needs were traditionally exempt from making the switch. But now, changes being made to Medicaid, commissioned by Gov. Andrew Cuomo in an attempt to rein in the state budget, will require nearly every Medicaid patient to transition into managed care—a move that some health advocates say could have adverse consequences. "Managed care companies don't have a good track record when it comes to treating specialized populations," said Robert Lederer, a research and policy analyst for the Bronx Health Link, a local advocacy group. "It puts in the hands of an insurance company, that's trying to maximize profits, this really critical decision of who gets what type of care." In Vazquez's case, the change to her plan meant the loss of a home health aide that had been treating her for five years, a woman she said was the only person she felt comfortable enough with to allow herself to be bathed and intimately taken care of. "I was being railroaded. I was so stressed out. For almost three months I was just crying," Vazquez said. She was able to maintain her needed home care visits, she said, but was unhappy with the health aides that were sent by the agencies accepted under her new plan. "The care that I have in place now is not reliable," she said. "I don't feel safe." The expansion of managed care is not the only change coming to Medicaid over the next several years. In an attempt to reduce state spending, Cuomo proposed cutting the Medicaid budget by $2.8 billion, and commissioned a "Medicaid Redesign Team" to come up with proposals for where that money could come from. "This approach was not about making cuts but redesigning a program whose costs are unsustainable," Cuomo said in a statement. But public health advocates say certain recommendations that were adopted in the budget cut corners at the cost of services. For example, there will be limits of 20 visits per year for physical, occupational, and speech therapy for most Medicaid patients; there will be a limit on the number of mental health and substance abuse visits a patient can have; obtaining certain medications will require approval; people who receive "homemaker services" will be eligible for fewer hours of help each week. "These changes can have a tremendous impact on the care [people] can get," said Judy Wessler, of the Commission on the Public's Health System. Other changes, like a 2-percent cut to Medicaid reimbursement rates for hospitals, nursing homes and other health providers, will hit hospitals in low-income neighborhoods the hardest, Lederer says—so-called "safety net" hospitals that treat a majority of the city's Medicaid patients and the uninsured. "Medicaid reimbursement rates are abysmally low as it is," he said. Vazquez says she hopes other people are better informed of the coming changes than she was when her plan was changed. "It's overwhelming when you're in a bed, and can't walk, and you can't get something because they're not going to cover you," she said. "I wish that my body would heal miraculously, so that I could go out there and work," she continued. "I was part of that working population at some point. I've worked hard in my life and I deserve better than this. People deserve better than this."

May 2011

NY1 05/11/2010 08:25 PM HHC Head Announces Plan To Layoff 500 Workers By: Grace Rauh

http://www.ny1.com/content/news_beats/politics/118475/hhc-head-announces-plan-to-layoff-500-workers/

The head of the city's public hospital system announced a series of cutbacks Tuesday in an effort to close a $1.2 billion budget gap.Health and Hospitals Corporation President Alan Aviles says there will be at least 500 layoffs next year and another 500 jobs cut through attrition.Over five years, there would be 3,700 job reductions. However, those cuts only affect employees of the Health and Hospitals Corporation.The corporation also has contracts with outside providers who supply most of the doctors who work in the system. Those contract costs will be reduced by about six percent, which would mean fewer doctors working in the public healthcare system.Advocates say the cuts will have a serious impact on patients, but Aviles disagrees."We will close no hospitals, no patient will be turned away, and our commitment to serve the uninsured, undocumented immigrants, and others who need us most will remain intact," Aviles said."They have to travel further. They have to wait a longer time for an appointment. They might end up in the emergency room for care. We keep hearing people are blamed for going to the emergency room, but if you don't have other options, you go to the emergency room," said Judy Wessler of the Commission on the Public's Health System.These cuts could have been worse if the city had not come up with more than a billion dollars over the next few years to help support the public hospital system.

April 2011

醫療權益機構頒獎表揚鄭石2011-04-22 [ 打印 ] [ 大 中 小 ]   　　擁有20年曆史的非牟利公共醫療權益機構CPHS，昨（21日）晚在下東城舉行慶祝晚宴，並向三名 為推動公共醫療的傑出人士頒發獎項，越棉寮社區中心主任鄭石是唯一一名獲得殊榮的華人。鄭石對獲得如此表彰感到榮幸，他介紹根據2010年的人口普查顯 示，過去十年裏，亞裔紐約客增長的速度達到了32%，佔到了紐約市人口的13%。但是市府分配到了社會服務款項不到0.24%。他指出，尤其是越南移民收 入在貧困線以下的達到了三分之一，更有17%沒有任何形式的醫療保險。同時，越南女性移民患有癌症的比例，是平均水準的三倍，而越南移民患有乙肝的比例高 出平均水準14倍。這都說明瞭在尤其亞裔社區裏，公共醫療維權，福利的爭取，道路仍然任重道遠。

Urban Health celebrates Ribbon-Cutting and New "Home" Model

Date: 04/13/2011Story by Debralee Santos and Ryan Maye Handy The Bronx Free Press

http://www.urbanhealthplan.org/documents/4-13-11BronxFreePress.pdf

On Wed., April 6th, a crowd of over 50 health care workers gathered in the lobby of Urban Health Plan to greet Dr. Thomas Farley, New York City Health Commissioner, and Dr. Nirav Shah, the New York State Commissioner of the Department of Health. Dr. Shah, the youngest New York State Health Commissioner to date, and the many distinguished guests had come to celebrate National Health Week, and the official opening of a new floor in the clinic's facilities on Southern Boulevard.Together with Urban CEO Paloma Hernández and founder Dr. Richard Izquierdo, he cut the ribbon in front of the new wing's door. In a short speech before the ribbon-cutting ceremony, Shah said that Urban Health's success makes it an ideal mentor for other community health centers. He also took note of the new model, a patient centered medical home, pioneered by Urban Health."A medical home to me is a health care provider who's thinking of your health even when you are not," Shah said. He praised Urban Health for being a part of the initiative to focus more on preventative care for patients. The work done by Urban Health helps to cut down the number of unnecessary hospitalizations, on which the state government spends $1.4 billion, according to Shah. "Whereas the traditional center was built around the doctor and a budget, this new model is centered around what's good for the patients," said Shah.CEO Hernández, resplendent in a red suit and beaming, expounded on the merits of the model. "This means 24-7 care, at any time of the day. We are here Sundays, and open early and late. We have walk-in services," she noted. After the speech, Hernández led Shah up four flights of stairs to the new ward, which will be reserved for gynecology, podiatry, and adult medicine. As Shah, Hernández, and Izquierdo cut the bright-blue ribbon, guests admired the spotlessly clean new ward. Annie Lopez, Urban Health's OBGYN coordinator, paraded with the guests through the empty examination rooms, inspecting the new equipment."It's beautiful," she said of the wing, with its 13 examination rooms, and the sea-foam-painted waiting room. Lopez estimated that the new wing would help Urban Health to accommodate 4,000 new patients. Judy Wessler, director of the Commission on the Public's Health System, was also among those listening to Shah's speech and touring the new examination rooms. Wessler's organization plans to honor Hernández for her work at Urban Health, although expressed disappointment with the work done by Shah and the Medicaid Redesign Panel. Shah had spoken proudly of the over 1000 suggestions the panelreceived from the public—Wessler maintains that the panel ignored most of them.Still, Wessler was impressed by the new clinic wing. And so were the many patients who happened upon the ceremony as they tended to their own appointments at the clinic. Janet, who wheeled her toddler son Jayden past, stopped to watch for a moment as photographs were taken, smiled."I like it here. They are all really nice," she said, gazing up at the podium.

March 2011

Hospitals' hefty pay rewards, rankles Just 10 area docs got 25% of top personnel's $120 million comp haul

Read more: http://www.crainsnewyork.com/article/20110320/SUB/303209979#ixzz1ZNAh0Q4x

Although Gov. Andrew Cuomo is seeking to slash $2.3 billion from the state's Medicaid budget for the upcoming fiscal year, the top layer of the local hospital industry isn't likely to suffer much under the knife.The 50 highest-paid hospital executives and employees in the New York area pulled in nearly $120 million in 2009, according to Crain's annual tracking of the latest publicly available tax filings. The grand total for the highest-paid group in 2008—the peak before the recession hit—was more than $156 million.Nearly $30 million of the 2009 total was earned by 10 doctors from Beth Israel Medical Center and St. Luke's-Roosevelt Hospital Center. Dr. Mark Sultan, the head of plastic surgery at Beth Israel, topped the doctors' list, with $4.7 million in cash compensation. The two hospitals shelled out millions more to a handful of surgeons and specialty-care physicians."We believe the salaries we pay our physicians are extremely competitive," said a spokesman for Continuum Health Partners, the system that includes Beth Israel and St. Luke's.Nationally, the median compensation for specialty physicians in 2009 was around $235,000, according to statistics compiled by the Medical Group Management Association in Englewood, Colo. Some health care advocates have criticized hospital salaries in the New York area as excessive."These are not-for-profit hospitals," said Judy Wessler, director of the Commission on the Public's Health System, a local watchdog group. "There need to be some shared sacrifices." The Greater New York Hospital Association, which represents almost 300 hospitals and health care facilities, disagrees with that assessment. "One could argue that the professional responsibilities of higher-paid executives in plenty of other industries pale in comparison," said a GNYHA spokesman. "To attract the best national talent in a field as important as hospital management, hospitals must pay their executives strong, competitive salaries."John P. Ferguson, president of Hackensack University Medical Center in New Jersey, headed Crain's list of local hospital executives receiving the most compensation in 2009. Mr. Ferguson raked in $7.3 million, or 235% more than the roughly $2.2 million he got the year before. About $5 million of the most recent payout was part of a severance package that Mr. Ferguson received when he was ousted from HUMC.Next in line that year was a city-based exec: Dr. Harold Varmus, chief of Memorial Sloan-Kettering Cancer Center.The lowest-paid among the top execs in 2009 was Stacey Malakoff of the Hospital for Special Surgery, who earned just under $1.3 million.Meanwhile, Alan Aviles, president and CEO of the Health and Hospitals Corp.—a $6.7 billion system that includes 11 hospitals and dozens of community-based clinics citywide—earns $351,000 a year. That's nowhere near enough to crack the list of the area's best-paid executives. As hospitals and clinics brace for deep cuts this year, Ms. Wessler wishes that more institutions, and their leadership, would help ease the pain."There should be some commitment to putting as many dollars into services as possible," she said. "Instead, hospitals are paying a few people these very high salaries."

March 19, 2011 Here's a Job for a Crusader of Yesteryear

Let us call from dark caves of memory a man with a terrible swift sword. Two years ago this month, the country learned that failed financial companies, saved with public funds, had paid millions of dollars in bonuses to their executives. Apocrypha have it that when the press confronted the 19th-century political chieftain William Marcy Tweed with evidence that he had grossly, and grotesquely, lined his pockets with public money, the Boss replied, "Well, what are you going to do about it?" With the discovery of vast fortunes made with public bailout money, you could almost hear Tweed rising from his grave in Green-Wood Cemetery to taunt the nation. What were we going to do about it? The most imaginative response came from Andrew M. Cuomo, then the state attorney general. He went after records of bonus payments made by the American International Group, a company that had a central role in the financial crisis. What Mr. Cuomo lacked in legal pretext or standing to seize money, he made up for with guile and gall. He announced that his office would subpoena the names of all the people who had gotten bonuses, and he suggested that those names could be made public. Or perhaps they'd like to return the money. Many decided they'd just as soon send the money back: about $50 million in bonuses were returned. Mr. Cuomo has moved on to other work. As governor of New York, he says he is determined to reform Medicaid, the insurance system for the poor and the disabled — and a gusher of revenue for hospitals where executives regularly receive million-dollar packages of salaries and bonuses. Last week, a federal criminal complaint charged David Rosen, an executive who ran hospitals in Brooklyn and Queens, with bribing politicians. By far the most bewildering aspects of the hospital administration were not the subject of criminal charges. The records show that the hospitals were financial basket cases, existing solely because of public subsidy and insurance. Mr. Rosen was paid $1.5 million to $2 million a year. His deputies were each paid $1.3 million. The state's Department of Health asked questions two years ago about the pay and was told by the chairman of the hospital corporation that expert consultants had come up with the figures. The state retreated. As a matter of fact, not only is paying high salaries at destitute hospitals within the law, it also appears to be routine. North General Hospital in Harlem went into bankruptcy in June; the last available tax records show that its chief executive was paid $494,291. Other distressed hospitals in and around the city include New York Downtown, where the most recent records show the chief executive was paid $673,150 and two deputies over $300,000 each; Wyckoff Heights Medical Center, where the chief made $483,577 and had two deputies paid over $300,000; and Southside Hospital in Bay Shore, on Long Island, which paid its boss $507,063. COMPARED with other impoverished hospitals — Bronx-Lebanon, for instance, which in some years has paid its chief executive over $4 million — these hospitals offer modest salaries. But they are unhinged from any semblance of market economics. "These are not for-profits," said Judy Wessler, director of the Commission on the Public's Health System, an advocacy group. "They are not profit-making entities — not that I believe profit-making entities should be paying these kinds of salaries either. They're always crying about how poor they are and all the money they are losing." You might think this would be just the kind of issue that, say, a crusading attorney-general-turned-governor might dig into. Health executives' salaries in New York State are not as stupendously high, of course, as pay in the financial industry, but they are outlandish in comparison with pay in New York City's public hospital system. That system pays executives a fraction of what is handed out at private hospitals that are subsidized by the state. There is no evidence that the city hospitals suffer because their executives make only about $200,000 a year. Governor Cuomo set up a task force to cut Medicaid costs that included significant representation of executives from the health care industry, so perhaps it is not surprising that whatever the merits of their recommendations, they did not include limits on the salaries of people like themselves. So far, Mr. Cuomo has not drawn any line on health care executives' salaries. He has, however, promised to let income taxes drop for people making over a million dollars.
E-mail: dwyer@nytimes.com

http://www.nytimes.com/2011/03/19/nyregion/19about.html?emc=eta1

New York slashes hospital spending, but can't touch multimillion-dollar CEO paychecks 

18 March 2011

http://followthebottle.com/news/new-york-slashes-hospital-spending-but-cant-touch-multimillion-dollar-ceo-paychecks/

As New York's health care system slashes spending by charging more to be unwell and providing fewer services to disabled people, one area of costs is off-limits: multimillion-dollar compensation for hospital executives. The best-paid hospital CEOs are paid nearly 10 million dollar a year (and compensation packages for CEOs are on the rise). When an advocacy group mooted the possibility of caps on executive pay, they were outmaneuvered by lobbyists who ensured that the salaries for top administrators would not be considered in efforts to balance the budgets.

A Health Department spokesperson says that the state can't set compensation levels (or even advise on them) for private businesses, even when those businesses are financed at public expense, which means that no matter how much of a hospital's budget comes from Medicaid and Medicare, CEOs' salaries can't be touched by regulators. The NYT cites the example of Greenwich Village's St. Vincent's Hospital Manhattan, which received large public contributions but went bankrupt anyway, due to mismanagement from administrators — the top ten of whom took home $6 million in pay in the hospital's last year.

At Bronx-Lebanon, a hospital that exists only by the grace and taxed fortunes of the people of New York State, the chief executive was paid $4.8 million in 2007 and $3.6 million in 2008, records show. At NewYork-Presbyterian, a hospital system that receives nearly half a billion dollars annually in public money, the chief executive was paid $9.8 million in 2007 and $2.8 million in 2008…

A proposal to allow public financing for only the first $1 million in wages for an executive died before it even reached the task force. "It was classic how it was killed," said Judy Wessler, director of the Commission on the Public's Health System, an advocacy group that had suggested the limits.

"We submitted the proposal in writing, met with the state staff members about it, then testified for our two minutes at a hearing," Ms. Wessler said. "Then in the written summary of all the 4,000 proposals, they twisted the wording of ours so that it would be impossible to implement. Then they said it was not viable, so it wasn't even put up for a vote."

Via BoingBoing

'Nonprofit' hosp bigs' megabucks
By CARL CAMPANILE Last Updated: 3:50 AM, March 16, 2011 Posted: 3:06 AM,

Read more: http://www.nypost.com/p/news/local/nonprofit_hosp_bigs_megabucks_SBqUYW2yNvQUMFvbbDuu7O#ixzz1WjVGk700

They're called "not-for-profit" hospitals -- but their top executives and doctors are living large with rich salaries and benefits, according to new data obtained by The Post. In all, 119 administrators and physicians statewide pulled in at least $500,000 a year, with 34 of them getting more than $1 million in compensation, according to 2009 state Health Department figures, the latest available. No. 1 on the list was Enrico Ascher, director of vascular surgery at Maimonides Hospital in Brooklyn. He received $3.56 million. Stan Brezenoff, CEO of Continuum Health Partners, overseeing such hospitals as Beth Israel, St. Luke's and Roosevelt, pulled in about $3.5 million. David Rosen, the ex-CEO of MediSys hospitals, which include Jamaica, Flushing and Brookdale, was just indicted in a bribery scandal. He made more than $2 million. Bronx Lebanon CEO Miguel Fuentes Jr., who runs an institution that receives among the highest taxpayer subsidies to serve poor and uninsured patients, collected $1.8 million. Three executives at Montefiore Hospital in The Bronx cleared $1.5 million, including CEO Steven Safyer. Five executives at New York-Presbyterian received more than $1 million. Former CEO Herbert Pardes took in $1.78 million. Watchdogs slammed the high salaries while the state slashes services to the needy. "It's really an outrage. Where's the shared sacrifice?" said Judy Wessler, of the New York Commission on Public Health Systems, who proposed restricting Medicaid reimbursements for hospitals paying any executive a salary exceeding $1 million. carl.campanile@nypost.com

Crain's Health Pulse Today's News Thursday, March 03, 2011
Consumers Protest MRT Process

Medicaid consumer advocates, who had one seat on the Medicaid Redesign Team, have been mounting an attack on the reform process. The Save Our Safety Net Coalition and the Commission on the Public's Health System yesterday distributed the e-mail addresses of MRT members and urged advocates to contact the panel with a standard message: the MRT rushed to "approve a package of recommendations that you had in your hands for less than 24 hours." The advocates say that the early vote "meant the public had no opportunity to review, digest and comment on this package." Jason Helgerson said during the MRT meetings that he met with many more groups than were represented on the panel, which also tapped public input. Advocates disagree. "There's universal concern among consumers that the process was sorely lacking," says Mark Scherzer, legislative counsel for New Yorkers for Accessible Health Coverage.  

How to fix Queens' healthcare woes?

Posted: Thursday, March 3, 2011 12:00 am
How to fix Queens' healthcare woes? by Mark Lord
Queens Chronicle 

In an effort to strengthen healthcare and prevent further hospital closures in the borough, community leaders, activists and residents gathered a public meeting at the Renaissance Charter School in Jackson Heights to talk health.

"Queens healthcare has fallen behind the rest of the state," said Matthew Bishop, a member of the board of directors of Citizen Action of New York, one of the event's sponsors.

"We have had three hospital closures in four years," he added. "We are medically under served. We have a unique challenge in Queens. The numbers speak for themselves."

Dario Centorcelli, director of external affairs at Elmhurst Hospital Center, said there was concern at his hospital over recent fiscal developments, including a cut of $6.5 million in state funding over the past four years. The loss, along with increased workloads resulting from the closure of other area hospitals, led Centorcelli to say: "I don't know if we can take much more."

"Since St. John's closed," he said, "there has been a 7 percent increase in emergency room cases, as well as a 2 to 3 percent increase in hospital admissions.It's very, very busy."

He expressed concern that staff reductions might become a necessity, leading to increased waiting time for patients.

"When you start playing with healthcare, people die," he said.

The Commission on the Public's Health System, a city-based healthcare advocacy group, has proposed that hospitals with 50 percent uninsured and Medicaid patients be labeled as safety-net hospitals and treated more favorably in Medicaid reimbursement.

A member of the committee, Judy Wessler, spoke at the meeting. She said she was outraged by Gov. Cuomo's Medicaid Redesign Team and many of its recently released recommendations.

Wessler, also involved with the Save Our Safety Net Campaign, said the redesign team, assembled by Cuomo, merely "tried to make it look like they wanted to hear from everyone on the process."

The unelected team which, according to Wessler, primarily represents hospitals and providers and one union, "is making decisions that will be plopped into the budget and state legislators will vote on it," she said.

Because uninsured patients in New York must often seek treatment at hospitals, Wesseler said the state's hospital system is ranked last nationally in efficiency when measuring the number of people treated at hospitals who could have been treated as outpatients.

"We are the world's joke," said Larry Litt, a political satirist who attended the meeting. "We have no education system in healthcare that is valid. We have an information problem on what healthcare is. We will be destroyed by for-profit healthcare."

Mark Hannay, director of Metro New York Health Care for All Campaign, a multi-constituency health care justice coalition and another of the event's sponsors, referred to the country's new healthcare reform law, named "The Patient Protection and Affordable Care Act," as "a major step forward, especially given that maintaining the current status quo was not an option over the long term.

"Up to 2 million of New York's 2.8 million uninsured could get health coverage under the new law. However, we still have more work to do to get to true universal healthcare across America and here in New York. The fight and process continues," he said.

Queens resident Abby Drucker, a registered nurse for over 40 years and a member of New Visions Democratic Club, said she is "appalled over the demise of healthcare. I'm spitting bullets over politics as usual. We pay people's salaries and nobody listens.

"Very few young people are getting involved in politics and getting involved in issues. I don't know what the future's going to be," she said.

John Krall, another concerned citizen, was on hand to "drum up support" for his efforts to reopen Parkway Hospital in Forest Hills, another recent casualty. Krall said that a group of private investors could provide funds of up to $75 million to reopen the shuttered facility.

"We could employ 1,000 people and reopen in four months. All we need is our license back."

Krall blamed local politicians, whom he referred to as "wishy-washy" and "non-committal," for placing roadblocks along the path that could lead to the reopening of Parkway.

The meeting is the first step in dealing with the issues at hand, said Bishop. "We may not agree on everything, but I hope we can move forward to improve healthcare and protect it in light of our current fiscal problems.

"We will face healthcare challenges for years to come. We will continue to communicate and reach out to elected officials."

Other sponsors of the event were Assemblyman Francisco Moya (D-Corona) and Councilman Danny Dromm (D-Jackson Heights). Both sent representatives to the meeting.

February 2011

February 22, 2011
Cuomo Adviser Takes Pay From Health Industry By NICHOLAS CONFESSORE

When Andrew M. Cuomo married Kerry Kennedy in 1990, Jeffrey A. Sachs served as an usher. When Mr. Cuomo's daughter Michaela was born, he asked Mr. Sachs to be her godfather. When his marriage fell apart years later, Mr. Cuomo stayed in Mr. Sachs's triplex near the United Nations. Since Mr. Cuomo's election as governor last fall, Mr. Sachs, 58, has taken on a powerful role among his health care advisers as the administration confronts crucial decisions, including how to overhaul New York's $53 billion Medicaid program. But at the same time, Mr. Sachs, known to many in Albany as "Andrew's best friend," is working as a paid consultant to some of the biggest players in the New York health care industry, including Mount Sinai Medical Center, NYU Langone Medical Center and the state's largest association of nursing homes, all of which have financial interests at stake in the coming Medicaid changes. Mr. Sachs, whose firm is named Sachs Consulting, has never registered as a lobbyist, which would require him to divulge his clients and fees to the state ethics commission. Through a spokesman, Mr. Sachs said that none of his contacts with state officials constituted lobbying under state law, which broadly excludes anyone who advises clients on how to influence public policy, among other exceptions. After inquiries from The New York Times, a spokesman for Mr. Sachs released a statement late Tuesday saying that Mr. Sachs had "frozen all contact on behalf of clients with state officials for the duration of the Cuomo administration." Mr. Sachs will remain a health care adviser to the governor, and the spokesman, Jesse Derris, did not rule out Mr. Sachs's participating, if asked, in general discussions of health care policy. Mr. Cuomo's spokesman, Josh Vlasto, issued a statement soon after Mr. Derris, saying, "Nobody in the administration knows his clients, nor could it possibly matter, since Mr. Sachs has said he won't represent anyone before the state, so the innuendo of the story is totally irrelevant." The influence Mr. Sachs has been wielding since Mr. Cuomo's election on Nov. 2 has startled some in the state's tight-knit health care world. In December, according to correspondence obtained by The Times, the director of a state-run psychiatry institute said that he was fired after Mr. Sachs, unhappy that the director had clashed with one of his clients, pressured a top state official to dismiss him. And, as Mr. Sachs advised Mr. Cuomo on his transition and health care policies, state officials have made decisions that surprised many in the health care industry but were favorable to Mr. Sachs's clients. After inquiries from The Times, the administration abruptly rescinded one of the decisions. In addition to helping Mr. Cuomo recruit senior staff, Mr. Sachs has quickly emerged as a leader on the governor's 27-person Medicaid redesign team, the group that is drawing up the governor's plan to pare billions in spending from the program. "His membership on the Medicaid team is worrisome to us because he has clients that are not disclosed," said Judy Wessler, director of the Commission on the Public's Health System, a nonprofit group that opposes Mr. Cuomo's proposed cuts. The Cuomo administration appears sensitive about the governor's relationship with Mr. Sachs. When Mr. Cuomo announced the members of the Medicaid redesign team, Mr. Sachs was identified only as "chairman of the John F. Kennedy Jr. Institute for Work Education," a nonprofit development organization, omitting his work at Sachs Consulting. Mr. Sachs, a nonpracticing dentist who earned his degrees at the State University at Stony Brook, is known as much for his cultivation of the powerful and famous — he was a friend of the late John F. Kennedy Jr. and a board member of the Leonardo DiCaprio Environmental Foundation — as for his shrewd understanding of health care systems. His influence began to build late last year, as the Albany establishment, especially officials in the Paterson administration who wished to remain in state government, prepared for Mr. Cuomo's arrival. Though he was never formally named to Mr. Cuomo's transition team, Mr. Sachs played a major role, participating in interviews of candidates for top health care jobs and running some of the interviews, according to people involved in the process. Mr. Sachs was also an early advocate of the "Wisconsin model" of Medicaid, under which the governor would set a target for spending reductions and then appoint a task force of industry stakeholders to apportion the cuts. The approach has political appeal for the governor, in that it entices would-be opponents of spending reductions to participate in the plan rather than protest it. But it also endows the unelected team members with immense power. Mr. Sachs made recommendations to Mr. Cuomo and his aides about whom to appoint to the Medicaid team, which Mr. Cuomo formed through an executive order in January. During the transition, Mr. Sachs also helped assemble a four-person policy team to begin meeting with state agencies about the best approach to reducing Medicaid spending. The team included James Introne, an executive at ArchCare, the Roman Catholic hospital network, and Bruce E. Feig, an executive deputy commissioner at the state's Office of Mental Health. Mr. Sachs knew them both well: Mr. Introne was his former boss and mentor and Mr. Feig his assistant in the Carey administration. Mr. Feig later worked for Sachs Consulting before taking his current job in 2007. On the recommendation of Mr. Sachs and others, Mr. Cuomo later appointed Mr. Introne, a veteran of state government and large health care organizations, as deputy secretary for health, the top health care policy job in the administration. Mr. Cuomo has also kept Mr. Feig in his job as the No. 2 official at the Office of Mental Health. While he was helping Mr. Cuomo assemble his health care staff, Mr. Sachs's name arose in an unusual personnel matter, one that held great interest for one of his clients, NYU Langone Medical Center. For at least a year, NYU Langone had had strained relations with Dr. Harold S. Koplewicz, a well-known psychiatrist who founded the hospital's child psychiatry center but left in 2009 to start a competing research and clinical center. Relations worsened because Dr. Koplewicz, who also served as director of the Nathan S. Kline Institute for Psychiatric Research, a state-run psychiatric center in Rockland County that also has a research affiliation with NYU, refused to allow NYU to screen those he hired at the institute, among other issues. During an October meeting between Mr. Sachs and Dr. Koplewicz, Mr. Sachs suggested the doctor resign from the Kline Institute, people briefed on the meeting said. Should he lobby too aggressively to keep his job, Mr. Sachs warned, Mr. Cuomo, then widely expected to win election, might choose to close down the institute. In a later meeting in December, Michael F. Hogan, state commissioner of mental health, told Dr. Koplewicz that he had been warned by Mr. Sachs that his reappointment by Mr. Cuomo would be jeopardized if Dr. Koplewicz did not resign, according to the people briefed. Afterward, Dr. Koplewicz wrote Dr. Hogan a letter detailing his accomplishments as director of the institute and complaining of the pressure being exerted by Mr. Sachs. "As you explained — and I appreciate your candor — you have been pressured by NYU through Jeff Sachs to have me resign as a condition for your reappointment as commissioner of mental health," Dr. Koplewicz wrote in the letter. In a response sent the following day, Dr. Hogan did not dispute Dr. Koplewicz's account but suggested that he had been insufficiently cooperative with NYU and the Office of Mental Health. "Accordingly, your service as director, Psychiatric Research Institute, will end effective Jan. 13, 2011," Dr. Hogan wrote. Dr. Koplewicz and Dr. Hogan both declined to comment, though neither disputed the authenticity of the letters. One day after Dr. Koplewicz was fired, Mr. Cuomo announced Dr. Hogan's reappointment as commissioner of mental health. Mr. Vlasto, the Cuomo spokesman, said Dr. Koplewicz's firing was unrelated to Dr. Hogan's bid for reappointment. "Dr. Koplewicz was dismissed after a yearlong saga," Mr. Vlasto said. "His dismissal had absolutely nothing to do with the reappointment of Commissioner Hogan." Mr. Derris, in a separate statement on Tuesday night, said: "Dr. Koplewicz had issues for over a year with his job performance, and lost his position because of it. The implication that Jeff Sachs had anything to do with his dismissal is pure fiction." Dr. Koplewicz's departure shocked some local officials in Rockland County, who had admired his work and pressed administration officials fruitlessly for an explanation. "I made several phone calls advocating for his continuing in that position, and did not get any kind of response," Assemblywoman Ellen Jaffee, a Democrat of Rockland, said. Even as Mr. Sachs was helping shape the incoming administration's health care team, he was promoting his clients' private interests. In December, the Department of Health issued a so-called emergency rule change granting Mount Sinai Hospital of Queens, a Sachs Consulting client for the last eight years, additional Medicaid reimbursements worth millions of dollars. The hospital had been seeking the rate change for at least five years, officials there said, and it was not clear why it was finally issued during the waning days of the Paterson administration. But two people with knowledge of the decision said that Mr. Sachs personally phoned state officials, including Lawrence S. Schwartz, the top aide to then-Gov. David A. Paterson, to discuss the hospital money. At that time, Mr. Schwartz was under consideration by Mr. Cuomo for a job in the new administration. Mr. Schwartz now works for Mr. Cuomo as a senior adviser. Separately, two weeks ago, Mr. Introne ordered the freeze of undisbursed grants under a program intended to encourage efficiencies in New York's health care system. They included a $62 million disbursement, approved after a two-year review, that would underwrite the planned merger of SUNY Downstate Medical Center and Long Island College Hospital, a struggling institution in Brooklyn. The delay startled officials at both hospitals, in part because Mr. Cuomo's budget, released earlier in the month, had already authorized other financing related to the merger. The decision threatened to imperil the merger, without which LICH would be forced to close. But the delay had one potential beneficiary: Brooklyn Hospital Center, a Sachs client, which stood to absorb most of LICH's patients should that hospital close down. The following day, a spokesman for Mr. Cuomo said that the administration had decided to hold up all the grants as part of a review likely to take two to three weeks. After local officials protested the decision and after inquiries from The Times, the administration announced three days later that the LICH grant would proceed. Both Mr. Introne and Mr. Sachs declined through spokesmen to say whether they had ever discussed the grants. But Mr. Sachs's position on the grant was well known: He had been telling others in the industry for months that the grant to LICH was a mistake and that the state needed a more comprehensive approach to address hospital financing in Brooklyn and Queens. "What Jeff said is, 'This is crazy,' " said Stephen Berger, who sits with Mr. Sachs on the Medicaid redesign team. " 'You're dealing with one hospital. We have four or five there. Why are you dealing with one hospital when the others are falling like dominos?' "  

Governor's Panel Has 2 Weeks To Submit Medicaid Spending Plan By Cara Matthews  Gannett News Service  February 17, 2011 ALBANY --

With two weeks left until their reporting deadline, members of the governor's Medicaid Redesign Team are reviewing and scoring 49 proposals with the biggest policy and financial implications. The panel received thousands of ideas from e-mails, letters and testimony at public hearings on how to save money and increase efficiency in the program, which costs nearly $54 billion a year. The suggestions were pared down to 274 proposals, and 49 of the key ones were broken out for closer review, said Claudia Hutton, a Health Department spokeswoman. All proposals for improving the Medicaid system, a health care program for the poor and disabled, are still under consideration, she said. The 27-member Medicaid Redesign Team, created by Gov. Andrew Cuomo, has until noon Friday to rank the list of 49 ideas. It meets in Albany Feb. 24 and will submit recommendations to the governor March 1 on how to cut $2.85 billion in Medicaid spending in the 2011-12 fiscal year, which begins April 1. Absent any cuts, the total federal, state and local share of Medicaid spending would total $58.3 billion in 2011-12. New York spends more than twice the national average per recipient and ranks 21st among states for the quality of its health care system. The team will continue its work after the budget process to develop proposals for long-term Medicaid savings. Cuomo has asked it to identify $4.6 billion in savings for 2012-13. Some of the 49 proposals would: * Eliminate the 2011 1.7 percent inflation-factor increase for hospitals, nursing homes, home care and personal-care services April 1. The state would save $102 million and total savings would be double that. Total savings also includes federal matching funds and county shares of the programs. * End Level 1 personal-care services, including housekeeping, shopping and meal preparation and set provider-specific annual per-patient spending limits at roughly the spending level five years ago. The state savings would be $310 million in 2011-12, as would the total savings. * Reduce the annual profit margin for Medicaid and Family Health Plus managed-care programs from 3 percent to 1 percent. The profit margin is to maintain reserves and cover costs in case of catastrophic health events. The 2011-12 state savings would be $94 million and total savings would be double that amount. * Discontinue funding included in Medicaid and Family Health Plus premiums for direct marketing by Medicaid managed-care plans and enrollment assistance. State savings would be $56.8 million in the coming year. The Save Our Safety Net campaign, a coalition of advocates, is concerned that the opinions of members of low-income and minority communities aren't being well represented in the Medicaid-reform process, said Nisha Agarwal, director of the Health Justice Program at New York Lawyers for the Public Interest. One money-saving idea that the campaign put forward but didn't make it to the list of 49 proposals would allow Medicaid to reimburse for language assistance. Non-English speakers who don't receive this service cost Medicaid more money because they may go for repeat doctor visits or end up in emergency rooms, Agarwal said. Save Our Safety Net supports some of the proposals, including one that would recalibrate how state funds for hospital charity care are distributed, Agarwal said. However, it opposes a proposal to provide financial assistance to safety-net hospitals that want to close, merge or restructure, she said. "It's basically funding to close hospitals in medically underserved areas," she said. Forty-one advocacy groups are asking the Redesign Team to support a proposal to have managed-care behavioral-health organizations, such as Magellan, coordinate treatment for recipients who need mental-health and substance-abuse care and have major physical health problems, said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services. Care for this high-cost population often is not well coordinated and they end up with repeat hospitalizations and emergency room visits, Rosenthal said. They currently receive services outside the Medicaid managed-care system. An alternate proposal, opposed by the 41 organizations, would fold the health care for these recipients into the managed-care system. "We have to reject overnight quick-fix solutions that would appear to deliver a lot of cash, but under examination don't, cost more and will likely erode the recovery safety net we've worked so hard to build," Rosenthal said.

http://www.theithacajournal.com/article/20110216/NEWS10/102160377/Governor-s-panel-has-2-weeks-submit-Medicaid-spending-plan?odyssey=mod|newswell|text|FRONTPAGE|s 

January 2011

NYU Med Center Critics Say Hospital Under-Serves City's Poor Thursday, January 20, 2011 By Fred Mogul

NYU Medical Center recently made public its plans for expansion but critics call it one of the city's worst when it comes to serving the city's poor. The hospital, which announced Wednesday that it will nearly triple the size of its Emergency Department, received far fewer uninsured and Medicaid patients than any other hospital in the city, according to public data for 2008 and 2009. "It actually has the worst record of any hospital of being available for Medicaid patients, low-income patients, certainly for the uninsured," said Judy Wessler, of the Commission for the Public's Health System. About 11 percent of NYU's patients were on Medicaid or uninsured -- a fraction of most other city hospitals, according to 2008 data. NYU said its staff sees low-income patients at nearby Bellevue, a public hospital. NYU also says its emergency room complies with federal law, does not turn anyone away and does not control where ambulances bring patients. The expansion will be financed primarily by $64 million in tax-exempt bonds -- the typical mechanism for underwriting large hospital projects -- with the help of some private donors. It also comes on the heels of the closure of Saint Vincent's Hospital.

http://www.wnyc.org/articles/wnyc-news/2011/jan/20/nyu-hospital-expanding-er/ http://www.thepoptort.com/2011/01/new-yorks-medicaid-trouble.html

Cuomo Criticized Over Medicaid Team By Jacob Gershman  Wall Street Journal   January 8, 2011

Gov. Andrew Cuomo's alliance with the state's health-care union and hospital lobby is drawing fire from some patient advocates, who question the governor's decision to give the powerful industry figures a front-and-center role in the process of overhauling Medicaid. Mr. Cuomo has put union leaders and hospital lobbyists in charge of a "Medicaid redesign team" and asked them to propose ways to cut spending by a target amount. He wants them to draw up a plan in weeks, to meet the April 1 budget deadline. Cuomo administration officials say they're more likely to get concessions and win over lawmakers by partnering with the industry's biggest players and giving them more responsibility for fixing a Medicaid program that's driving the state's debt crisis. But health-care consumer groups say Mr. Cuomo is playing favorites with the same industry heavyweights that lobbied for the old system. "The governor was very clear in talking about not allowing special interests to dominate. But then he appointed a task force for Medicaid with the top special interests controlling it." said Judy Wessler, director of the Commission on the Public's Health System, a patient-advocacy group based in Manhattan. "This is why we're in this crisis, and he's just repeating it." Mr. Cuomo unveiled the Medicaid panel in his State of the State speech Wednesday, saying it would be composed of health-care stakeholders. The only participants he mentioned were union leaders, hospital lobbyists and the chief executive of North Shore-Long Island Jewish Health System, Michael Dowling, a health-care adviser in the administration of Gov. Mario Cuomo. The governor's speech touched off complaints from other health-care advocates, who feared they were being left out. On Friday, Cuomo officials released an expanded list of about two-dozen members, including Medicaid Matters, a coalition of patient groups, and several city and local health officials. A spokesman for Mr. Cuomo said the team "represents a diverse group of key stakeholders who know the system, can fix it, and save taxpayers money." Elizabeth Swain, head of the Community Health Care Association of New York State, said she was taking a wait-and-see approach. In an interview Thursday, she said she understood the governor's logic of putting "key decision-makers in the same place as those who must change the way they see the world." But she added: "I certainly understand why consumer and advocate organizations are offended. There wasn't even a tip of the hat to the ultimate recipient of these services." Mr. Cuomo's dealings with 1199 SEIU, a local union with hundreds of thousands of workers, and hospital lobbyists is a stark turnaround from Gov. Eliot Spitzer's administration, which tangled with those groups over Medicaid rates and cost-cutting. In 2007, the union and the Greater New York Hospital Association, a lobbying and for-profit group-purchasing group, waged a public-relations war against Mr. Spitzer's first budget. "Their goal is to block any attempt to reform the system," Mr. Spitzer said at the time. He said the state was spending too much money on hospitals and nursing homes and not enough on preventive care. He aimed to steer Medicaid dollars toward clinics and primary physicians. Lawmakers blocked the bulk of Mr. Spitzer's cuts to Medicaid. He increased outpatient rates, but his effort to shake up funding formulas for nursing homes and other long-term care, whose costs have skyrocketed, stalled under the Paterson administration. The union and the hospital association praised Mr. Cuomo this week, saying they welcomed the chance to lower costs and offer ideas. They said the state can shrink the program without relying on the types of cuts sought by Mr. Spitzer and other governors, who sought to slash revenue streams to hospitals. "The money is not being used in the most effective way," said 1199 president George Gresham on Tuesday. "Looking for savings doesn't necessarily set me off."

http://online.wsj.com/article/SB10001424052748704739504576068170498603248.html#  

Crain's Health Pulse, 1/5/2011 

Gov. Andrew Cuomo plans to announce a task force on Medicaid spending co-chaired by Michael Dowling, president and CEO of the North Shore-LIJ Health System, and Dennis Rivera, president of SEIU Healthcare. Mr.Dowling served Mr. Cuomo's father for 12 years, including as state director of Health, Education and Human Services and deputy secretary. Mr. Rivera's proposed appointment alarmed advocates, including Judy Wessler, director of the Commission on the Public's Health System. Ms. Wessler said yesterday that his involvement in a task force on health care issues and cost containment, would be "a very unfortunate move by a new governor." She cited Mr. Rivera's role as president of 1199 SEIU in spending heavily to battle annual budget cuts affecting academic medical centers. That fight put funding at risk for community-based services, public health and public hospitals serving low-income populations. A Cuomo spokesman did not immediately respond to requests or comment.

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