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Grand hospital plan within reach after Bellevue deal

   Finally, some movement in the right direction on the health care front in Schenectady County:
   The state-imposed compromise announced Thursday, in which Ellis Hospital will take over Bellevue Woman’s Hospital in November makes a lot more sense than the previously announced Ellis plan to build a new women’s health care facility on its Nott Street campus, which would have rendered Bellevue superfluous. While the deal still doesn’t preclude Ellis from doing that, and from eventually closing the Bellevue campus, why would it want to spend $25 million for an addition that duplicates services it offers only a few miles away?
   The space Ellis was planning to use for the women’s facility could instead be used to add more beds, which might be needed if the 200 currently at St. Clare’s were sold to Schenectady County. On Wednesday, county offi cials indicated an interest in buying part of the hospital for a new nursing home. St. Clare’s is a good location for the nursing home — better than the existing one in rural Glenville; it’s on a bus line and is more accessible to employees and clients. And retrofi tting a hospital building for use as a nursing home is bound to be less expensive than spending $55 million to build a new one.
   Assuming that not all of the space at St. Clare’s would be needed for the nursing home, some medical services could continue to be offered there by the jointly run Ellis/St. Clare’s. That would be useful to the new nursing home’s patients, as well as the greater community. Meanwhile, money from the partial sale of the campus to the county could help solve the hospital’s $34 million pension liability issue.
   The above scenario seems like a good way for all parties to come away better off than they are now. Granted, Bellevue will no longer be independent; but at least its mission will be preserved and most of its jobs will survive. St. Clare’s would also be giving up a lot, but that was the Berger Commission’s mandate. And while Schenectady probably needs more beds than the 368 currently at Ellis, it doesn’t need a whole new hospital.
   The county probably needs more nursing home beds than the 168 mandated by Berger, but not the 240 it wants to build. So moving it to St. Clare’s seems like a reasonable compromise. And the above changes could probably be implemented for far less money than the various grandiose plans that have sprung up in the aftermath of the Berger report.

Quoted from bumblethru

And unionizing will help.....how?

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I ALSO SAY DONT SPEAK FOR ME.......

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Doctors shy away from Medicaid
Managed care aimed at helping low-income families needs physicians
BY JAMES SCHLETT Gazette Reporter

   The boy was 1 year old. Skin was peeling all over his body.
   His single mother late last year took the child to Dr. Robert Paeglow’s family practice in Albany’s West Hill neighborhood. The doctor diagnosed the boy with eczema, an inflammatory skin condition. There was little more he could do.
   “We weren’t able to get a dermatologist. We called around to a few places, but we couldn’t get him in,” said Paeglow, Compassion in Action/Koinonia Primary Care’s founder who also goes by “Dr. Bob.”
   Paeglow was unable to find a skin specialist to treat the boy because the boy’s health coverage was provided by Medicaid, a government insurance program for low-income parents, children, seniors and people with disabilities. Sixty percent of patients at Paeglow’s practice are covered by Medicaid.
   Paeglow years ago knew a dermatologist at Albany Medical Center who would treat Medicaid patients, such as the boy suffering from eczema. But that specialist has established a practice outside the hospital and no longer accepts Medicaid.
   With no one else to turn to, Paeglow prescribed oral steroids for the boy. While the drugs helped the boy, the doctor called it “a Band-Aid approach.”
   “Your resources are extremely limited when you’re dealing with a patient who has Medicaid,” Paeglow said.
   Over the years, Paeglow said he has seen those medical resources all but dry up. Doctors in the Capital Region say it is nearly impossible to find dermatologists, orthopedic surgeons, dentists and psychiatrists who accept referrals for Medicaid patients.
   The specialty care dilemma has been exacerbated by the state’s low Medicaid reimbursement rate for physicians. Nationwide, doctors who treat Medicaid patients are becoming harder to find.
   “We balance the budget on my back, and who can do that? So many [medical] groups have said we’re not going to do it,” said Paeglow, who treats a lot of his patients for free.
PHYSICIANS BACKING OUT
   Between 1997 and 2005, the percentage of physicians nationwide who reported receiving no Medicaid revenues rose from 12.9 percent to 14.6 percent.
   Twenty-one percent of physicians by 2005 had stopped accepting new Medicaid patients — a rate fi ve times higher than for privately insured patients, according to a 2006 study by the Center for Studying Health System Change, a Washington D.C. research organization.
   The nation’s physician flight from Medicaid is not a new trend for the state. “The other states are catching up with New York,” said Moe Auster, a staff attorney for the Medical Society of the State of New York, a Lake Success-based trade organization.
   Paeglow said he receives about $30 per visit for fee-for-service Medicaid patients. The same visit would net about $60 under a Medicaid managed care plan, and a private health plan could pay signifi - cantly more than that amount.
   In the CSHSC survey, five out of six doctors who stopped accepting new Medicaid patients blamed inadequate reimbursement rates for that cessation in care.
   “Specialty care is probably more challenging, particularly for people with Medicaid and especially for people without insurance,” said CSHSC spokeswoman Alwyn Cassil.
   More than 79,200 doctors in private practices participate in New York’s Medicaid program. Between April 1, 2006, and March 31, 2007, physicians withdrew from the program, according to the state Department of Health, which supervises the Medicaid program.
   To address those defections, the Health Department might include provisions in its 2008-09 budget that would enhance Medicaid reimbursements for ambulatory care, said Health Department spokesman Jeffrey Hammond. The agency might also develop incentives based on quality performance to lure more doctors into the Medicaid program.
MANAGED CARE PLANS
   Doctors’ growing aversion for Medicaid threatens to hamper lawmakers’ attempts to reform the health program. Medicaid covered 4 million New Yorkers at an estimated cost of $46 billion during the 2006-07 fiscal year.
   For more than a decade, the state has been requiring some counties to adopt mandatory Medicaid managed care enrollment plans. Managed care plans deliver benefits through health maintenance organizations, clinics, hospitals or physician groups.
   In the spring, Schenectady, Washington, Fulton and Montgomery counties abandoned voluntary Medicaid managed care plans for mandatory ones. By July, 39 percent of Schenectady County’s 14,310 residents eligible for Medicaid had been enrolled into managed care plans for the government program. The county expects to reach up to 80 percent enrollment within a year.
   The Medicaid managed care drive is intended to encourage lowincome and disabled New Yorkers to receive more preventative care treatment, such as annual physicals and other routine checkups. Those services can catch health problems early, lowering the chances patients will end up making expensive trips to hospital emergency rooms.
   As managed care plan rolls grow, more Medicaid patients are being steered toward physicians who practice in large groups, hospitals, academic medical centers and community health centers. Between 1997 and 2005, the percentage of solo and two-physician practices that didn’t accepted new Medicaid patients increased from 29 percent to 35.3 percent, according to the CSHSC study.
SOME GAINS, SOME LOSSES
   “We don’t know if that’s harmful. We have reason to be concerned. Access is getting tighter,” Cassil said of the concentration of Medicaid care.
   Capital District Physicians’ Health Plan, the region’s leading Medicaid managed care plan with 4,600 providers, has seen some doctors withdraw from its Medicaid network in recent years.
   “There have been no major influxes. There’s been some losses. There has been some gain,” said Kristin Marshall, a spokeswoman for the Albany health insurance company.
   Fidelis Care provides Medicaid coverage in 32 counties for 14,000 New Yorkers. It has 8,700 Medicaid managed care members in Albany, Saratoga, Schenectady, Rensselaer, Fulton and Montgomery counties.
   Fidelis’ Medicaid members in that six-county region are served by 585 doctors. In recent months, Fidelis has added 50 physicians to its Medicaid network, said Peter Avvento, an assistant vice president of marketing for the Catholic insurance company.
CONTRIBUTION CAP
   The Medicaid program is a federal-state partnership that has become increasingly burdensome on all levels of government. In 2004, New York picked up 32 percent of its Medicaid bill and counties paid 17 percent of that total. The federal government picked up the remaining 51 percent of the bill.
   Ballooning health care expenses two years ago prompted the Legislature to cap counties’ contribution to Medicaid. In 2004, Schenectady County’s bill was $174.8 million. Last year’s bill totaled $196.1 million, according to the Health Department.
   The Health Department is chiefly responsible for federal compliance and spending matters, though it controls only a portion of the program. The agency’s Offi ce of Medical Management largely administers the program. It oversees eligibility policy, benefits systems, federal relations, practitioner fees and pharmaceutical reimbursements, according to the Medicaid Institute at United Hospital Fund, a New York City health services research organization.
DEMAND FOR DOCTORS HIGH
   Essential to New York’s managed care strategy is ensuring there are enough doctors to treat Medicaid patients. The recruitment of those physicians is more pressing in places such as Fulton County, which lacks a large-scale community primary care health center that exclusively treats the uninsured and Medicaid populations.
   John Rogers, the director of fi - nancial assistance for the Fulton County Department of Social Services, said the county has been struggling to find doctors for Medicaid patients. The search for local specialists is more dire because they are already in short supply for private health plan patients.
   Between January and July, the number of Fulton County residents enrolled in Medicaid managed care plans has more than doubled from 1,052 to 2,752. During the same period, Schenectady County’s managed care ranks have grown by 13 percent from 4,982 to 5,623, according to the Health Department.
   MAXIMUS, a Reston, Va., provider of government program management, consulting, information and technology services, is helping Fulton and Schenectady counties enroll residents in managed care plans. The transition to a mandatory Medicaid managed care system will last about 12 months. Schenectady County Department of Social Services Commissioner Dennis Packard said the county seems to have enough physicians who accept Medicaid to meet the increased demand for preventative care services.
   “We haven’t heard anything about any stressors on the network,” said Packard.
   While that is true for primary care services, local medical experts said that is not the case for specialty care.
   The managed care push promises to be a boon for Hometown Health Centers in Schenectady.
   The community health center, with more than 50 practitioners last year, had 28,000 visits from Medicaid patients for family practice, pediatric, dental and dental outreach services. That Medicaid population accounts for 55 percent of Hometown’s business.
   “If we lose our current Medicaid market, then our future survival will be seriously threatened. It is therefore imperative that Medicaid patients are assigned to Hometown Health Centers under Medicaid managed care,” Hometown Executive Vice President Angella Timothy said in a prepared statement.
   “We are fully prepared to continue to serve Medicaid patients in Schenectady County in the new Medicaid managed care market,” she added.
SOME IMPROVEMENT
   In 1997, Albany, Saratoga and Rensselaer counties adopted similar mandatory Medicaid managed care programs. Schoharie County has a voluntary program.
   Jim Sinkoff, president and chief executive officer of Whitney M. Young Jr. Health Services, said the managed care push has improved Medicaid patients’ access to primary care services in Albany County. The Albany-based nonprofit community health center mainly treats the uninsured and people on Medicaid.
   “It’s helping, but it’s not solving the problem, because some of the specialists are not taking the program,” said Dr. Peter Forman, a family practitioner with Community Care Physicians in Albany.
   Forman in September will open a private family practice in Delmar. Citing a moral obligation to help the poor, Forman said he will accept Medicaid patients at his new practice. He said he understood why other physicians would refuse those patients, because the Medicaid reimbursements do not cover the cost of care.
   “It’s quite a conundrum,” said Forman, who is also the director of pre-doctoral education for the Department of Family and Community Medicine at Albany Medical College.
   The unavailability of specialists in some areas has severely curtailed Medicaid patients’ access to care, especially in the mental health field.
   Only 11 percent of the 5 million New Yorkers covered by Medicaid or the state children’s health insurance program received mental health services in 2006. Prescriptions made with neither the service of a specialty practitioner nor a mental health diagnosis accounted for a third of those treatments, according to a June report commissioned by the state Office of Mental Health and conducted by the Public Consulting Group.
   In the 2006-07 state budget, the Legislature ordered the study on New York’s mental health reimbursement system.
   The study found that primary care physicians attempt to fill the specialty care gap, “but they have neither the time nor, in some cases, the expertise to keep people out of jeopardy.”
   Although outpatient mental health services are the least expensive, they remain underutilized by the people who most need them. Outpatient services represent a “small slice” of New York’s mental health landscape, the report notes.
   “The current reimbursement system for mental health outpatient services is a complex matrix that is not working,” the report states. “ … Care must be given to do no harm to consumers and to ensure that changes do not create an environment that results in increased homelessness, arrests or hospitalizations. This work should continue with attention given to redesigning the reimbursement system in concert with the state’s reform agenda.”
   Hammond, of the Health Department, said his agency is reviewing patient accessibility to health care and to providers. Its review will identify regions where specialty care is needed most and then step up recruitment efforts in those areas.

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Spitzer signs bills on health care, 911 service
The Associated Press

   Gov. Eliot Spitzer has signed bills into law that will provide added consumer protections to people in the health care system and alert consumers about potential shortcomings of Internet phones.
   One law broadens the rights of health care consumers, physicians and hospitals associated with managed care health plans and streamlines rules so medical decisions can be made and acted upon faster.
   “This legislation secures important new rights for health care consumers, doctors and hospitals and represents the type of coordination among all stakeholders in the health care system that will be necessary in our march toward universal health coverage for all New Yorkers,” said Governor Spitzer.    The law limits a health plan’s ability to deny care it had preauthorized and empowers consumers to appeal decisions to deny a request to see a specialist who doesn’t participate in the health plan, among other measures.
   Sen. Kemp Hannon, who sponsored the bill in the Senate, said: “Improving the processes for payment and access are essential steps to improving delivery of quality healthcare services for all New Yorkers.”
   Assembly Health Committee Chairman Richard Gottfried called the measure “an important step ahead for making sure health care decisions are based on what is right for the patient, and for protecting patients and health care providers in dealing with health plans.”
   Daniel Sisto of the Healthcare Association of New York State called the measure an important piece of reforming managed care. “It will help bring more accountability to managed care organizations and greater protections for consumers and providers,” he said.
   Spitzer also signed a bill that requires companies selling Internet phone service to clearly inform consumers of the limits of 911 emergency call service. Although the federal government requires Internet phone services to provide enhanced 911 emergency response access, when customers move to another community they often don’t realize their 911 call would go to their former home area.
   “This law is necessary to make people realize that not all 911 telephone services are the same,” said Assemblyman Richard Brodsky of Westchester. He sponsored the bill with Sen. Andrew Lanza, a Staten Island Republican.
   “We have an obligation to make sure all people are protected, especially with something as important as 911 emergency services.”  

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National health care needs to be the focus

   The health-care system in this country is seriously broken — if not dead. The chasm between the salaries and perks of the CEOs of the health-care corporations, and the fact that millions of Americans are uninsured or underinsured, is unconscionable.
   Real solutions must be provided. We can no longer wait to fix this system that is filled with corporate greed. Our representatives in Congress must address this issue and discontinue playing the game of politics. People are dying needlessly.
   The presidential candidates should take this opportunity to lead the way — and forge a new path to health care. The people of the United States are due no less.
Show the American people that we matter — not politics. Health care for all Americans!
BONNIE KOSHOFER
Schenectady  

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August 1, 2007     
Contact:  Lisa Blumenstock, Press Secretary
     
McNULTY: HOUSE MEDICARE BILL INCLUDES $28 MILLION FOR AREA HOSPITALS (Washington, DC) - Congressman Michael R. McNulty announced today that the House passed H.R. 3162, the Child Health and Medicare Protection (CHAMP) Act of 2007, which includes an additional $28 million for area hospitals due to an adjustment in the Medicare wage index for Albany, Schenectady, and Rensselaer county hospitals.“For a number of years, the Medicare program has underpaid hospitals in our area for the wages they pay their employees. This inequity has made it difficult for hospitals in the Capitol Region to recruit and retain nurses and other heath care professionals. I am pleased that the House has approved this increase, which will result in $28 million more for hospitals in Albany, Schenectady and Rensselaer counties. This is a major victory not just for the hospitals, but also for the entire community,” said McNulty.Hospitals in the Capital region face stiff competition from hospitals in nearby counties for nurses and other critical staff. Emergency room nurses and other hospital staff can travel 30 to 40 minutes to hospitals in nearby counties and earn 30 to 40 percent more than they can in the Capital Region. In addition, area hospitals must compete with local insurance plans, doctor’s offices, state government and others businesses for nurses and other health professionals.Hospitals in the Capitol Region and around the country have been experiencing a shortage of staff because nurses and other health care staff can often find better paying jobs in real estate, in retail establishments, or in offices.The Medicare program has allowed hospitals in other parts of the country to appeal for higher payments. Unfortunately, the way the federal Medicare program is structured, Capitol District hospitals did not have this option. As a result, local hospitals were receiving Medicare payments far below other areas in the region. The passage of this bill is an important first step in rectifying that inconsistency. The bill passed the House today by a vote of 225 to 204. The Senate must now pass the bill before it is sent to the White House for the President's review.Below is an estimate of the potential increase in Medicare reimbursement for area hospitals:Hospital     Amount
St. Clare’s     1.5 million
Albany Medical Center     9.0 million
Seton Health     2.2 million
St. Peter’s     7.7 million
NE Health     4.1 million
Ellis     3.5 million
Total     28 million# # #

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The health-care system in this country is seriously broken — if not dead. The chasm between the salaries and perks of the CEOs of the health-care corporations, and the fact that millions of Americans are uninsured or underinsured, is unconscionable.
   Real solutions must be provided. We can no longer wait to fix this system that is filled with corporate greed. Our representatives in Congress must address this issue and discontinue playing the game of politics. People are dying needlessly.
   The presidential candidates should take this opportunity to lead the way — and forge a new path to health care. The people of the United States are due no less.
Show the American people that we matter — not politics. Health care for all Americans!
BONNIE KOSHOFER
Schenectady  

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the fact that millions of Americans are uninsured or underinsured, is unconscionable