With one in five New Yorkers enrolled in Medicaid, this expensive state commitment needs to be fixed sooner than later, according to Kevin Dahill.
And he should know, he”™s president and CEO of both Northern Metropolitan Hospital Association (NorMet) and Nassau-Suffolk Hospital Council (NSHC), whose members include 53 hospitals that he knows well from his constant travels in his car.
Hospital CEOs”™ concerns about ever-dwindling Medicare and Medicaid reimbursements are being addressed by the Medicaid Redesign Team, Dahill said during an interview with HV Biz.
“It has been working for months on finding a solution. One of the work groups focusing specifically on hospital reimbursements is co-chaired by two people very well-versed” in challenges to hospitals: Daniel Sisto, president of the Healthcare Association of New York State (HANYS), and William Streck, president and CEO of Mary Imogene Bassett Hospital in Cooperstown. “It is their top priority and focusing on the Patient Protection and Affordable Care Act payment reform and hospital performance guidelines.”
It is no coincidence the Medicaid Redesign Teams”™s speed has picked up, said Dahill. Gov. Andrew Cuomo is already preparing the 2012-13 budget and health care costs consume 65 percent of the state”™ operating expense. Established in New York in 1974 as a temporary aid to those caught without health insurance, the two programs have mushroomed out of control ”“ and the team is charged with finding a way to rein in that spending, Dahill said.
“Medicaid was never meant to be an ”˜entitlement”™ program, but that”™s what it”™s become. Today, even the wealthy, who have the means to pay their own way, feel they have worked all their lives, paid into the system and are therefore ”˜entitled”™ to free health care.”
It is a critical situation that needs to be changed, Dahill said, if the state is to ever get a foothold on fixing its failing fiscal health.
Among Congress”™ proposed changes is if a patient who comes back for treatment within 30 days of an event, he or she will not be covered. While that provision has not been enacted yet, the possibility of it becoming law will have highly negative implications, he said.
“If a patient comes in for a gall bladder operation, leaves the hospital and gets hit by a car and gets readmitted, should the hospital forego reimbursement?” Cahill asked. “There is a big difference between the person who is sent home with instructions on after care, fails to follow them and ends up back in the hospital. What is needed is a continuum of health care that follows up with patients to be sure they are sticking with the program. Unfortunately, changes to any system often cause the pendulum to swing farther in the other direction, farther than it needs to, and we end up with new problems ”¦the government”™s idea that ”˜one size fits all”™ does not apply to health care.”
The redesign team is working to establish how hospitals should be reimbursed, with those having the best outcomes receiving a bigger slice of the pie.”
The problem with that notion, said Cahill, is hospitals more financially healthy than others that can afford to add more bells and whistles to their care are going to have an advantage over hospitals in underserved and income-poor areas of the state. “There must be some balance when it comes to rewarding better outcomes. We run the risk of creating an uneven playing field if we simply look at numbers.”
To reduce the ”˜silos”™ of health care ”“ the physician, the hospital, the pharmacy, the home health aide agency and specialist who all work individually, prescribe individually is the implementation of electronic health records,” Dahill said. “That is how we will really be able to make sure every patient can have a better outcome ”¦ if the hospital prescribes one drug, and the doctor another, and the patient has a health emergency, the only way to find that out now is through the patient ”“ and that is the proactive patient, who is keeping diligent records ”“ most are not. EHR (electronic health records) will remove that obstacle. Yes, it is an expense for hospitals and all other providers to implement, but it is really the only answer to providing the best care and having the ”˜silos”™ combine information into one pool.” That continuum of care mentality needs to grow and be reinforced until it is second nature to anyone involved in the industry, he said.
“I do believe Governor Cuomo is sincere in his desire to change and improve the system. I give him credit to this point. He wants to fix Medicaid in a collaborative way”¦ and hope that he continues to stay on course. It is a difficult task, to be sure.”
Hospital chiefs who would like to see insurers regulated will have to keep that on their wish list.
“Frankly, I don”™t see that happening, although it would be a tremendous asset to the entire industry ”¦ the insurance companies are so powerful a lobby that I can”™t really see anything changing in that regard,” he said.
With that, he climbed into his “second home” and was off to Bronxville to visit Lawrence Hospital. Does he ever get a chance to really go to his brick and mortar residence? “Yes,” said Dahill, who moved to Rockland County to split his time among Long Island, the Hudson Valley and Albany. “On weekends ”“ sometimes.”
