February 24, 2011
Dear Elected Official:
The most important health care issue facing New York State is the need to reduce Medicaid costs without compromising health care quality and access to care. Reductions and provider taxes are not the answer. The best way to accomplish that is through program redesigns not reimbursement cuts.
The lack of true Medicaid reform has played a major part in the loss of hospitals and nursing homes in just the last ten years. No other sector has been more disproportionately hit by repeated cuts. More cuts will generate more closures, compromising access and eliminating jobs.
New York Hospital Queens agrees with the following recommendations on improving New York State’s Medicaid Program and I urge you to consider these as you and your colleagues make the crucial decisions that you must:
High-Cost Populations – Starting immediately, all high-cost populations should be included in a care coordination program that strengthens the management of care. According to the Department of Health (DOH) about 20% of Medicaid enrollees drive 75% of Medicaid expenditures.
Dually- Eligible Beneficiaries – The state should implement state and federal initiatives to better manage and coordinate care delivery and reimbursement for services provided to dually-eligible beneficiaries.
Long-Term Care- The state should strengthen existing programs with a proven track record of care management, including managed long-term care. Personal financial responsibility in paying for long-term care must also be incentivized.
Reform the Medical Malpractice System
One of the most important reforms that needs to be made is Malpractice reform. This reform alone would eliminate millions of dollars in expenses from the health care system. Medicaid would experience significant savings from reducing defensive medicine, establishing a fund to support the care for neurologically-impaired infants, establish broader court early resolution tribunals and encourage early acknowledgement to patients that a compensable event has occurred.
Redesign the Certificate of Need Process
A streamlined CON process has the potential to save health care millions of dollars. The process needs to be overhauled and duplicative surveillance activities need to end by the state, saving money and reducing operational burdens on providers.
Maintain Legislative Control of Medicaid
The Legislature should maintain its powers and policy role, not surrender its authority to the Executive Branch. The Legislature provides important checks and balances that must be maintained.
No Cap on Medicaid Spending
There should not be a cap on future Medicaid spending growth. The major cost drivers in Medicaid are enrollment and utilization of services, factors over which hospitals have no control. If state government continues to grow enrollment, health care providers could be held financially responsible for Medicaid cost-drivers over which they have no control, including the economy and the aging of New York’s population.
Protect Safety Net Providers
There needs to be support for safety net providers. Some of the suggestions that make sense are to provide operational and restructuring assistance to safety net hospitals. HEAL dollars can be provided to encourage hospital mergers and development of needed primary and community based services. Support should be given to not only those who provide care to high volume of Medicaid patients but also to those who have a high volume of uninsured patients.
I am available to discuss any and all aspects of NYS Medicaid Reform.
Stephen S. Mills
President and Chief Executive Officer
New York Hospital Queens