Tag Archives: closures

New York Needs Safety Net Hospitals

Here is our op-ed on the Medicaid Redesign Team that ran in today’s Albany Times Union. Comments most welcome!

By Nisha Agarwal and Shena Elrington

Gov. Andrew Cuomo‘s Medicaid Redesign Team was handpicked by him and elected by no one. Though touted as a collection of health care “experts,” the majority of the team’s members have strong ties to special interests in the health care industry.

Not surprisingly, its proposals for cuts reflect the vested interests of its members.

Proposal 67 calls for the closing or downsizing of safety net hospitals that provide health care services in medically under-served areas. We need more health services in these communities, not less, particularly since these communities have been ravaged by hospital closures in recent years.

Central Brooklyn, with its extremely low-income and 90 percent black and Latino population, has lost two hospitals, OB-GYN and prenatal services at two other local hospitals, 13 outpatient clinics, a federally funded health center and at least two women, infants and children program centers that provide nutrition education and assistance in recent years, despite having some of the worst health outcomes in the city.

The infant mortality rate in the Brownsville section of central Brooklyn is nearly five times that of Manhattan’s Upper East Side.

Do we really need more hospitals in areas like central Brooklyn to close?

When safety net hospitals close, people are forced to travel farther to see care at the few institutions that remain open — usually elite private academic teaching centers. These are the very same institutions to which many of the Medicaid team’s members have strong connections, raising questions about the appropriateness of using the regulatory process to funnel business to special-interest groups.

What is more, proposals that would actually support safety net institutions and use public dollars in an accountable and transparent way never made it into the final Medicaid reform package.

Proposal 66, for example, would have recalibrated charity care and Medicaid dollars so that the distribution of that funding would be based on the actual Medicaid and uninsured losses. Hospitals in New York now receive “indigent care” funding regardless of the volume of care they actually provide to Medicaid and uninsured patients. So, hospitals that provide very little care to low-income New Yorkers often get more money from the indigent care pool than they deserve, while safety net institutions, which provide a lot of care to Medicaid and uninsured patients, do not get their fair share.

Recalibrating the way this funding is distributed would not only make sense and bolster the financial stability of critical safety net institutions. It also is required under federal health reform and was very favorably ranked through the Medicaid Redesign Team’s own scoring process. Yet, the proposal never made it into the team’s final recommendations.

New York is in the midst of an epic budget crisis. Medicaid is seen as the linchpin to solving that crisis. But its redesign should not be done in such a way as to threaten the very institutions that serve as a safety net for our state’s most vulnerable residents. The erosion of our health care safety net threatens the stability of the system for all of us.

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Decisionmaking From on High

Tomorrow, Friday, February 18, is the deadline for members of Governor Cuomo’s Medicaid Redesign Team to submit their “scores” for 49 proposals given to them by the New York State Department of Health that are supposed to generate $2.85 billion–yes, billion–in cuts to the Medicaid program. These 49 were culled from the several thousands received via a severely flawed public hearing and online/written submission process that took place over the last several weeks in cities across the state. Not only were many proposals put forward by consumers and members of the public entirely excluded from the 49 that the Team will ultimately be deciding on, the few that did make it in were inaccurately captured in the bizarre spreadsheet format being used to capture major policy proposals to restructure the state and the country’s largest health insurance program for the poor. Oh, and did we mention that the proposals are going to be scored using Survey Monkey? That’s right, Survey Monkey.

In response, the Save Our Safety Net Campaign, of which we are a part, issued this open letter to the members of the Medicaid Redesign Team, instructing them how to vote on certain key proposals. This is not to say that we accept or buy into the ridiculous “process” that has been put in place by the MRT, but we also can’t remain silent on issues that will significantly impact the communities we care about. You can click here to download a copy of the letter.

Please let us know if you have any comments or concerns. There will still be other opportunities to weigh in on this process. On February 24th, the Medicaid Redesign Team will be meeting to discuss the scored proposals. The meeting will take place in Albany, and it’s important to have consumer voices out in full force. March 1 is when the final recommendations of the Team will be announced. We are planning activities in New York City around the announcement and will keep you posted about details. And, of course, state elected officials will have to weigh in on the recommendations too, and we are hoping that if you are  a New York resident that you will tell your representatives how you feel about the Medicaid program and why it is important to you and your community.

Critical decisions about the health care system in New York should not be made from on high, but from the ground up.

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Community Input When a Hospital Closes

As we have written about before, the community of Southeast Queens has long experienced some of the worst health outcomes in New York City across a variety of measures.  No doubt, the shuttering last year of both Mary Immaculate Hospital in Jamaica and St. John’s Queens Hospital in Elmhurst has only placed additional strains on the already insufficient healthcare infrastructure in Queens, and on Southeast Queens in particular. These and other hospital closures occurred without any input from community members – the very people who utilized the services that these hospitals provided were left unable to make their voices heard on how the closure would affect them, and on what healthcare services they thought were critical for the community.

In order to ensure that communities affected by future hospital closures would have at least some voice in the process, Assembly Member Rory Lancman and State Senator Shirley Huntley introduced the Hospital Closure Planning Act. This original bill would have required the Commissioner of Health to hold a “public hearing” within 30 days of a proposed hospital closure in order to assess the impact a hospital closure would have on the area it serves.

Despite the overwhelming support in the legislature, as well as advocacy in support of the bill from Southeast Queens United in Support of Healthcare (SQUISH) among others, Governor Patterson vetoed that initial bill.  Now, after negotiating with DOH and the Governor–and, importantly, after the closure of St. Vincent’s in Manhattan, which, in contrast to the hospital closures in Queens garnered significant and vocal opposition from a notably wide range of politicians and stakeholders –the Governor signed a revised version of the bill.

As Assembly Member Lancman said last week, “The government has to, at least, make an effort to let communities affected by a hospital closure know how their healthcare needs will be addressed. We may not be able to stop a hospital from closing, but we ought to be able to measure the impact of that closing and come up with a plan for serving the residents who relied on that hospital for healthcare services.”

The revised bill requires the Commissioner to hold a “community forum” within 30 days after a hospital closure to hear from affected community members.  After the forum, the Commissioner must also release a written report on the anticipated impact of the closure to the community, as well as the Department of Health’s plans to mitigate the negative effects of the closure and to ensure continued access to healthcare.

To be sure, the Act is only a small first step in making sure that low-income communities of color most in need receive equal access to quality health care. Nevertheless, it is an important one in that it begins to recognize the community’s role in health planning.

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Proton Beams or Primary Care

Crain’s Health Pulse, the New York health industry rag, has been abuzz for the last couple of weeks with news about health services in Queens.  Specifically, there’s been a lot of talk about a proposed “proton beam cancer center” to be located on the former site of Mary Immaculate Hospital (“MIH”), and to be funded by “500 rich foreigners” (for real).  Readers of this blog will recall that we have been collaborating with a community-based coalition, Southeast Queens United in Support of Healthcare (SQUISH), for several years, first working with coalition members to keep MIH from shutting down and now partnering with them to advocate for health services to fill the void created by the hospital’s closure.  The question is: does a proton beam cancer center fill that void, even in part?

And the truth is we’re not really sure.  On the one hand, cancer is one of the leading causes of death in Jamaica, Queens, resulting in 3,636 potential years of life lost in the area according to the NYC Department of Health.  Proton beam therapy is basically a way to offer cancer radiation treatment that is more targeted and less likely to impact healthy tissue surrounding the cancerous cells.  Considering these facts, a proton beam cancer center would seem to be a good thing because it offers cutting-edge treatment for a disease that kills a lot of people in Southeast Queens.

On the other hand, no one knows if the proposed cancer center would actually be affordable or accessible to most of the residents of Southeast Queens.  Will it accept public health insurance plans like Medicare and Medicaid?  Will it have sliding fee scales for the uninsured and under-insured?  If not, then the proton beam cancer center will hardly fill the enormous gaps in health access that plague the neighborhoods of Southeast Queens, and will serve instead as a lily pad for rich foreigners who can hop in and out of Queens for their high-end treatment from nearby JFK airport.  Viewed from this perspective, the proton beam cancer center isn’t worth celebrating; what is needed is more primary care and hospital beds.  Indeed, just recently, Crain’s also reported that the intensive care units of hospitals in Queens are themselves in a state of acute stress — over-capacity by over 200% in some cases.

There is no doubt that the Southeast Queens community needs more health services.  As we’ve written before, in New York City and in other major metropolitan areas across the country there is a close relationship race, place and access to healthcare services, and Southeast Queens is a prime example of the mis-match between healthcare need and resources.  In the wake of MIH’s closure, it is unclear whether wave-of-the-future technology like proton beam cancer therapy is really what the doctor ordered, or if it would simply be better to have some old school primary and preventative care services that would help people avoid getting gravely ill in the first place.  In an effort to better understand the implications of the center on their community, members of SQUISH are considering reaching out to the State Department of Health to find out more about the proposal and make their concerns known.  We will keep you apprised of any developments, but, in the meantime, don’t be shy!  Let us know through your comments here if you live in Southeast Queens and have any opinions on the matter.  We look forward to hearing from you.

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Policy Is About Priority: Where Do Moms Fit In?

This post is by Rylee Sommers-Flanagan, a summer intern with the Health Justice Program and a student at Emory University in Atlanta, GA.

Recently, news sources and blog sites released a flurry of commentary and news articles on the results of a study by the New York State Health Department that indicate unusually high mortality rates for pregnant women in New York, particularly New York City. While the report declined to make a causal link, the article published in the New York Times mentioned not only that “death rates were highest in the Bronx and Brooklyn,” but that black women were “seven times as likely to die in pregnancy as white women.”

Unfortunately, these numbers don’t surprise us. Due to entrenched racial inequalities, health disparities between whites and people of color are visible in both treatment and outcomes. Care is often segregated and sometimes it is simply nonexistent.

Take, for example, Central Brooklyn, where 92% of the population is of color. Since 2003, three major medical providers – Caledonia Hospital, St. Mary’s Hospital and the Lyndon B. Johnson Health Center – have all closed. Also in the last seven years, Central Brooklyn has lost OB/GYN and NICU services at the Interfaith Medical Center, prenatal services at the Kingsbrook Jewish Medical Center, as well as two WIC centers and four primary clinics, all now closed.

Losing these services won’t improve the disparate health fates of residents in Central Brooklyn. Predictably, the most dramatically medically underserved are also victims of the highest rates of maternal mortality and similarly elevated infant mortality rates – in Central Brooklyn, 8.75 infants die per 1000 live births compared to 2.1 deaths per 1000 in the Upper East Side.

Maternal and infant mortality are enough cause for concern, but decreased medical services have many more consequences. Another telling example is the remarkable gap in both rates and results of diabetes in Central Brooklyn as compared with the same in New York City as a whole. In 2008, 68% more people died from diabetes in Central Brooklyn than did in the rest of New York City. The story repeats itself to the tune of a variety of medical conditions. Hope seems foolhardy in this climate of hospital bankruptcies, pared budgets, and continuously diminished access to care.

But improvement is not impossible. One approach, embodied in the Infant Mortality Reduction Initiative (IMRI) has been successful in reducing infant mortality and increasing the number of women who receive pre- and post-natal care. By networking with existing programs and creating community partnerships, IMRI is generating progress. Yet, even as the report on maternal mortality illuminated the distance stretching ahead, the city has moved to severely reduce funding for IMRI and consequently participating organization like the Brooklyn Perinatal Network. There are few groups currently filling the gaping fissure left by multiple hospital closures and decreased services in the medically underserved regions of New York City. We need them all to be secure.

New York City is not the only player to blame in this game. According to The Lancet, 23 countries are on course for reducing maternal mortality as outlined in Millennium Development Goal 5, that’s 75% by 2015. The United States is not among them. A surprising set of countries – China, Egypt, Ecuador and Bolivia – are ahead of schedule.

Ultimately, policy is about priority; why aren’t mothers, infants and health a priority? Well, that’s our question for the City of New York, as well as the rest of these United States.

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Community Health Planning: Now As Important As Ever

This post features guest author and ally, Judy Wessler of the Commission on the Public’s Health System (CPHS), which has fought for years to preserve and expand New York’s health care safety net.  CPHS just released a new Report on Charity Care Payments to New York City Hospitals that readers of this blog are encouraged to look at.  In addition to the lack of community health planning, the method by which charity care dollars are distributed in New York State critically impacts which hospitals remain financially healthy and which ones — usually the ones providing care to the must vulnerable — do not.  If you are interested in getting a copy of the report, please contact Judy by clicking here.

Some people still laugh when some of us talk about the need for community-based health planning.  But the way things are going in this city, particularly with the threat of St. Vincent’s Hospital in Manhattan closing, we should be doing something.  St. Vincent’s is the only hospital on the West Side of Manhattan until 59th Street and it has a very active Emergency Room which is very much needed, along with other special programs.  One wishes that many voices now heard for St. V’s would have been heard when the St. Vincent Catholic Medical Center was off-shedding their other hospitals, most located in medically underserved communities of color.  Many communities that need services were stripped of those services – in Central Brooklyn, Southeast Queens, the North Shore of Staten Island.  Intervention is important – and oversight is even more important.  It was well-known that there were serious questions about the competence of the people and the companies that ran the St. Vincent Catholic Medical Center.  One wonders if there was ever a tally of what was spent by these hospitals in the bankruptcy court – millions upon millions of dollars.

This brings us back to the need for health planning.  If services are going to be increased or reduced, it is critical for communities and health care workers to know about this and have a say in what happens.  But this is not what is happening.  The state had an opportunity to fund some community-based planning with HEAL/FSHRP state/federal dollars.   An RFP was released to set up pilot projects to demonstrate what could be done with planning efforts.  Unfortunately, at least in New York City, the State Health Department chose the winners, and almost all of them are health care providers.  Does anyone know what is happening in these demonstrations?  Is any information available to the public?  Has anyone been invited to join in these efforts?  Surely it is time to go back to the drawing boards and come up with better solutions.  We need involvement of communities to ensure that there is not another St. Vincent’s problem.  We also need the State Health Department to be more involved in the monitoring of hospitals and their continuing viability.  The department needs to step in and act.  There are other hospitals that are financially SHAKY right now.  Some of them may be needed where they are located.  We should not have to wait for an announcement that XXXX hospital is going to close or go into bankruptcy.

More soon on what else could, and should be done.  We would welcome your ideas as well – and circulate those ideas that could work.

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Squeaky Wheels: Community Advocacy and Healthcare in Southeast Queens

This post is by Equal Justice Works Fellow Seth Cohen, an attorney at New York Lawyers for the Public Interest (NYLPI). Seth’s EJW Fellowship is sponsored by Johnson & Johnson and Patterson Belknap Webb & Tyler LLP.

As we have written about in previous posts, Southeast Queens is a low-income community of color that has long experienced some of the worst health outcomes in New York City across a variety of measures. Despite this, and despite the fact that this community—long designated a Medically Underserved Area—has experienced a continuing trend of healthcare disinvestment. Consider this: over the past year, three hospitals that served Southeast Queens have closed; there are only 48 full-time primary care doctors per 100,000 people in Southeast Queens, almost 2/3 less than in whiter neighborhoods in Queens. All the while, Southeast Queens has the unenviable distinction of having abysmal health outcomes, including some of highest rates of infant mortality, low birth weight, and diabetes in the City.

One might think that the New York State Department of Health (DOH), the state government entity that handles all things health, would move quickly to shore up health services in a community with such a critical shortage of services and such a critical need for them. To its credit, DOH awarded $30 million in HEAL NY grants to spur healthcare services development borough-wide. Southeast Queens United in Support of Healthcare (SQUISH), a community-led coalition, advocated for allocating part of those funds toward fundamental healthcare services that Southeast Queens needs most: primary care; emergency care; and inpatient beds. The DOH grant disbursements signaled a first step—over $5 million was awarded to two community health centers that serve Southeast Queens.

Nevertheless, the grants did little to directly address the community’s most critical needs. For an area that has seen a disproportionate share of hospital and clinic closures in the borough, Southeast Queens simply did not receive funding proportionate to the critical need and unacceptable health outcomes the community faces. Indeed, it ultimately received the least amount of HEAL funding as compared to other areas in Queens.

Part of the difficulty for Southeast Queens—or any low-income community of color in New York, for that matter—is the fact that New York lacks any meaningful, structured way for people who live in the community and who use healthcare services there to provide ground-level input to DOH as to what they see as the most pressing health concerns, and how to best address those concerns. As it currently stands, DOH seems to turn a blind eye to the very individuals who actually utilize healthcare services. This perspective, though, is questionable at best, and will certainly not lead to a reduction of health inequities any time soon.

According to the National Partnership for Action to End Health Disparities, an initiative launched by the United States Department of Health and Human Services, such ground-level input is essential to eradicate health disparities. Three of the primary actions the Partnership calls for include:

  • Create opportunities to engage stakeholders from all sectors in discussions and actions to ensure community responsiveness and accountability toward ending existing health disparities;
  • Create mechanisms for individuals (e.g., residents, advocates) who have been affected by, or concerned with, health disparities to share their stories with the public and decision makers at all levels
  • Develop or support efforts to educate legislators and elected officials about health disparities and the determinants of health

Notwithstanding these recommendations, DOH has continued to take a hands-off stance, maintaining that it is merely a “neutral” government entity unable to actively engage in or commit to correcting the systemic health inequities that persist in the community. As dispassionate and impervious as this may sound, DOH has indicated, however, that it was up to community residents to work with elected officials and other stakeholders to locate and negotiate with healthcare providers who would be willing to serve the community. Only then might DOH get involved.

So, this is exactly what SQUISH has started to do.

SQUISH has initiated conversations with Addabbo Family Health Care to prepare for leveraging any future federal dollars from healthcare reform to bring additional Federally Qualified Health Clinics (that serve predominantly Medically Underserved Areas like Southeast Queens) to the neighborhood.

SQUISH also recently met with elected officials—including Assembly Members William Scarborough, Michelle Titus, Barbara Clark, and New York City Council Member Leroy Comrie—to begin to hammer out a plan to effectively address healthcare needs in the near-term and also to craft a long-term plan to ensure quality healthcare delivery in Southeast Queens.

There is also the matter of figuring out how to influence next steps at the site of Mary Immaculate Hospital, the now-defunct hospital in Jamaica that went bankrupt and shuttered its doors approximately one year ago. The current owners of the site have indicated they “envision[] several options for redeveloping the Mary Immaculate site, including an educational facility, nonprofit organization use, government operations or a religious facility.” No doubt you can see what redevelopment option is curiously absent from this list: reusing the site to provide health services to the community. While reopening a hospital may prove a challenging enterprise, it is not unheard of. The communities of Watts and Willowbrook, low-income communities of color in Los Angeles, California that are similarly medically underserved, were recently successful in forging a pact with various stakeholders to reopen their community hospital, the King/Drew Medical Center, using federal stimulus funds. As put by one community resident affected by the lack of local healthcare services put it,

“The fact that we are in the richest and most affluent society in the world yet don’t have health and medical infrastructures in key urban cities to take care of potentially life-threatening situations is the reason we should have hospitals in communities, particularly underserved communities with large populations of uninsured.”

Three thousand miles from Watts, this sentiment is equally applicable  in Southeast Queens as SQUISH continues to advocate for healthcare for its community.

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