We advocate for better health care policy

Suburban Hospital Alliance members recognize the damage done to the state’s finances by the COVID-19 pandemic and the resulting economic downturn, and we share the view that the federal government has an obligation to provide support to state and local governments for their recovery. We have not only expressed to our congressional delegation the urgent need for direct aid but have engaged local officials and the business community in this advocacy.

We are deeply concerned about the contingency plans included in the proposed FY 2021-22 Executive Budget, should Congress fail to provide sufficient support to the state. The FY 2021-22 proposal doubles down on cuts to healthcare included last year’s budget by calling for additional Medicaid rate cuts and additional cuts to important capital payments and to the Indigent Care Pool. It is unreasonable to ask hospitals and health systems —still in the throes of the COVID-19 crisis and facing their own fiscal uncertainties with respect to federal funding —to once again bear the burden of closing the state’s budget gap.

The State’s already struggling healthcare institutions bore much of the burden of closing last year’s FY 2020-21 budget gap and are still working though the implementation of those cuts. Those budget actions included: an across-the-board Medicaid rate cut; an across-the-board cut to the Medicaid capital payment, elimination of several critical funding pools, and a significant cut to and reformulation of the Indigent Care Pool that disproportionately impacted hospitals in the suburban regions. In addition, the state has withdrawn capital funding for hospitals that was committed in prior years for the purpose of modernizing institutions.

The FY 2021-22 Executive Budget proposes key investments in COVID-19 testing capacity and the vaccine effort, and calls for new funding for the Essential Plan that would make coverage more affordable, improve reimbursement rates and enhance health plans’ networks of providers. The Suburban Hospital Alliance supports these proposals.

Strong hospitals and health systems are an essential component of the state’s recovery. Hospitals in the suburban regions generate an estimated $33.3 billion in economic activity and create 160,000 jobs. They also provide a stabilizing force in economically distressed communities.

Keeping these institutions strong requires investment in their growth and in the communities they serve. The struggles of COVID — access to care for vulnerable populations, social supports for patients beyond the hospital, the capacity to do testing and contract tracing, delivery of the vaccine — have exposed the fragility of our public health infrastructure

Community Reinvestment – For-profit health plans should also be required to make a commitment to the health of the communities where they do business. We propose that for-profit plans be required to dedicate a percentage of their considerable profits to addressing the needs of vulnerable individuals and ensuring access to care on a regional basis, similar to the Community Reinvestment Act requirements for the banking industry.

• 51 hospitals in nine counties
• Range from major academic medical centers to rural community hospitals
• $33 billion in economic activity
• 160,000 jobs
• $2 billion in community benefits and investments
• $5.1 billion in tax dollars generated

Population Health – We also urge the state to renew its commitment to regional population health planning in its next federal Medicaid waiver submission.

Over the past year, clinicians and scientists have made enormous progress in the effective treatment of COVID-19. We also have had nearly a year to assess the impact of COVID on healthcare operations and identify areas for improvement.

Regulatory Flexibility – Among the lessons learned is that response to a healthcare emergency of this magnitude required considerable flexibility from existing state regulations. The Legislature could ease administrative and operational burdens on providers by permanently rolling back many of these regulations such as:

• Allowing for acceptance of clinical credentials across state lines,
• Expanding the scope of practice of nurses and other professionals to the fullest extent of their training,
• Allowing for rapid deployment of retirees willing to volunteer,
• Expanding access to telehealth,
• Facilitating transfers between hospitals,
• Allowing for expansion of capacity and construction of alternative facilities, and
• Suspending administrative billing requirements to facilitate care and expedite payment.

The hospital sector has demonstrated that it can operate safety and effectively with these regulations waived. We would welcome the opportunity for further discussion of these issues.

All of these flexibilities required the issuance and re-issuance of executive orders, of which there have now been more than 90, that generally need renewal every 30 days. This lack of predictability slowed the initial response to COVID and has created an ongoing administrative burden to ensure continued compliance. We urge the Legislature at minimum to consider statutory changes that would allow for a package of regulatory waivers to be invoked by a governor or commissioner of health in the event of declared public health emergency.

Our dynamic healthcare system demands a modern and flexible workforce.Never has that been more evident than during the response to COVID, as clinicians and non-clinicians alike worked heroically in teams to respond to the rapidly evolving crisis.The state should support worker retraining, stronger education requirements and expanded scopes of practice to ensure that that teams of nurses and ancillary professionals are prepared to provide the best care for patients and have the opportunity to grow and add to their skills.

Proposed legislation, The Safe Staffing for Quality Care Act, instead would freeze the healthcare workforce in time, by mandating inflexible nurse staffing ratios that every provider would be required to maintain.The same cookie-cutter approach would apply to every unit of every hospital in the state, every hour of the day, without any flexibility to account for the severity of their patients’ illnesses or the skill set and experience levels of their workforce.Appropriate staffing levels should be determined by management in consultation with its nursing workforce — as has been the case in recent high-profile collective bargaining agreements — not by legislators.The Suburban Hospital Alliance urges your opposition to the bill.

Hospitals and health systems are achieving what was asked of them by the first MRT — reductions in preventable admissions and readmissions, improvements in quality and patient access, and investments in their communities and social determinants of health, all of which contribute to lower Medicaid costs — while operating on restrained reimbursements. The work of the 2020 MRT should be focused on those segments of healthcare that have failed to bend the cost curve, not hospitals.

We also urge that the Medicaid global cap be adjusted to accommodate policy decisions the Governor and Legislature have made in the past decade. Increased enrollment in Medicaid under the Affordable Care Act, increased minimum wage, additional home-based care options and efforts to better manage the care of aged and disabled populations are all worthy initiatives, but they all increase Medicaid expenditures. The global cap should accurately reflect programmatic changes that have occurred since the global cap was initiated.

$2.5 billion in cuts will be painful, whatever the outcome of the MRT’s deliberations. This pain should be shared, not disproportionally targeted at certain regions of the state. Last year’s Executive Budget proposal essentially eliminated indigent care pool funding for a very specific group of downstate hospitals, many of them on Long Island and in the Hudson Valley. While the proposal was not included in the final budget agreement, it set a dangerous precedent that we are concerned may be revisited this year. Hospitals in the suburban regions face the same burden of caring for Medicaid, uninsured and underinsured patients as do more rural and urban areas of the state — in fact, 28 percent of all visits to Suburban Hospital Alliance member institutions are paid by Medicaid.

The state has made great progress in recent years in transitioning from volume to value. Much of this work has been funded with federal dollars, the future of which is now uncertain. We urge the MRT and the Legislature to consider a transition plan for these initiatives in the 2020-21 budget, to ensure that the progress made in the last five years is sustained. Continued investments in facility modernization, community-based care, social determinants of health interventions, behavioral health and substance abuse treatment, and the healthcare workforce will pay off in more efficient, effective and convenient care in the future. Reasonable market rules for health plans and continued regulatory flexibility also contribute to a stable glide path.

The Suburban Hospital Alliance strongly opposes the New York Health Act, which would replace the current system with state-administered coverage for all New Yorkers, including for those currently covered by Medicare and employer-provided insurance.

The Suburban Hospital Alliance opposes the “Safe Staffing for Quality Care Act,” which would legislate mandatory staffing levels that every provider would be required to maintain without any flexibility to account for the severity of their patients’ illnesses or the skill set and experience levels of their workforce. Appropriate staffing levels should be determined by nurse leaders in consultation with their nursing workforce, not by legislators.

Emergency rooms are crowded with patients in crisis for whom insufficient resources are available in the community to address their needs. The Suburban Hospital Alliance urges legislators to increase Medicaid reimbursement, allowing institutions to invest in increased inpatient capacity, promote the growth of community-based care providers and increase the behavioral health workforce. We also encourage increased regulatory flexibility to establish new models of care.

The Suburban Hospital Alliance urges strong oversight of the stability of New York’s health plans and their market conduct and supports the establishment of a health insurance guaranty fund to ensure providers and patients are not harmed if a health plan fails.

The Suburban Hospital Alliance urges the Legislature to restore fairness to New York’s malpractice laws. Medical liability laws should balance patients’ rights to fair compensation for genuine injuries against the need for rational procedures and limitations to make malpractice premiums affordable.

The Suburban Hospital Alliance successfully advocated against funding cuts that would drastically impact hospitals in the suburban regions.

The amended 2019-2020 state budget proposal disproportionately targeted health care providers for funding cuts, rolling back a promised 2% Medicaid rate increase and reducing reimbursement across-the-board by an additional 0.8%.

The final state budget reinstated the promised 2% rate increase and rejected the 0.8% across-the-board cut.

The governor’s amended budget included a $285 million cut to Indigent Care Pool funding targeted expressly at downstate hospitals. Instead of introducing a new statewide formula for the program or proposing equitable cuts, the executive budget called for an artificial cap of $10,000 for certain hospitals located on Long Island, in the Hudson Valley and in New York City. Of these hospitals, 18 are located in the suburban regions and provided more than $1 billion in uncompensated care and other community benefits last year.

The final budget extended the current distribution methodology another year and did not include the targeted cut to downstate hospitals.

The governor’s proposed budget called for the elimination of the Population Health Improvement Program, which was established by the Legislature in the 2014 budget to engage community partners in addressing social determinants of health. The Nassau-Suffolk Hospital Council’s PHIP has convened more than 100 community stakeholders, including all of the hospitals and the two county governments, all aligned in their efforts to reduce obesity and chronic disease incidence.

The final budget rejected the elimination of the PHIP.