Neil Abitabilo had a long run as the president and chief executive officer of NorMet (Northern Metropolitan Hospital Association). So it came as a surprise to some that he retired without fanfare on July 16.
Taking his place is Kevin Dahill of the Nassau Suffolk Hospital Council, where he has been president and CEO since 2002. While not merging the two organizations, Dahill will oversee the daily operations of both.
“NorMet”™s board, in deciding what future direction to take, entered into a management agreement with the Healthcare Association of New York State, where I serve as senior vice president … yes, it ends up being a cost-saving measure for a while ”“ but that was not the driving force.”
The partnership between the two hospital associations has been ongoing for nearly three years, Dahill said. “We both forged a strong, positive relationship with the business community, so we worked together on many issues unique to suburban hospitals. When business locates in the suburbs, they become involved in the community.”
Dahill says NorMet, which encompasses Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester counties, as well as the Nassau Suffolk Health Council, “are in reasonably good financial health. There are great staff members at both locations, and we”™ll leave things as they are now and really see what direction we”™ll go in together and make some decisions about further linkages.”
Dahill said he was working on plans for the two regions for next year and to form a joint coordinating committee. “We plan to have our first meeting in October. Each region will have its own work plan and share with the other;Â what we can work on together, we will.”
Dahill will alternate weeks, spending one in Newburgh where NorMet is headquartered and the other in NSHC”™s Hauppauge office.
Under the new legislation, the greatest challenges for hospitals, he said, is the “number of newly insured people will offset the reductions of payments to hospitals. When you talk to anyone in Washington who takes authorship of this bill, they will say, ”˜We”™ll cover anyone who is not covered.”™ The fact is, we have been very generous in New York and have a high number of undocumented people who are not spoken about in this bill ”“ but the hospital cuts will happen, regardless. Health care centers get subsidies for this service, but if an undocumented person needs inpatient care, the bill doesn”™t address that, Outside of very elective surgery, a hospital is required to provide one level of care to all ”“ if you want one formidable challenge, that”™s it. But there are many more.”
Exchanges where employers can buy health care insurance are another puzzle. “How will employers deal with it?” he asked. “Hospitals are employers, too. How will these exchanges really work? Unfortunately, we”™ve had the experience that when government sets up a structure, it can be complicated and confusing.”
Dahill said New York is burdened with crushing Medicaid expenses being passed on to counties. What can be done to alleviate the burden?
“The state Legislature did cap the expense a few years back ”“ at least they”™ve taken that step … counties know they are at a certain level. I think what”™s not been appreciated about this reform law is this is the first time the federal government has mandated thresholds around the country. It was up to the individual states to determine the level of eligibility.
“Other states that were less generous than New York will have to come up to 133 percent, but they will get added dollars to help them accomplish that. We”™ll be tracking that closely ”“ we”™ve let our congressional delegation know our stance. I guarantee there will be a lot of tweaking and re-visiting in this law.”
In practical terms, Dahill doesn”™t see the law being repealed. “There are not sufficient votes to overcome a veto … but there is already a lawsuit under way; several states have sued the federal government over the mandates. It is a constitutional question ”“ whether or not the federal government can require all citizens to purchase health care coverage. It”™s a civil rights issue and little doubt it will come up before the U.S. Supreme Court.”
The growth of private, for-profit practices is another hurdle for hospitals. How can they partner with these organizations without hurting their own profitability?
“There”™s a much larger question,” Dahill said. “How do we bring costs down in health care? Better that we align incentives between physicians and hospitals and get them to work together in the best interest of patients. Today”™s economic conditions have driven hospitals and doctors apart. Our goal in NorMet and the Nassau-Suffolk health alliance is to bring them together.”
Angela Skretta, vice president of NorMet and executive director of its Safety Institute, cleared up some misinformation about the age adult children can be carried on their parents”™ health plan.
While U.S. Rep. John Hall (D-Dover Plains) was on a recent visit in the Hudson Valley to talk about the new legislation, he reported coverage for adult children would continue to their 27th birthday, creating concern among parents who read the HVBiz article in the July 19 issue.
Skretta said it was part of the original bill the House had passed, but the Senate changed it to the 26th birthday. “There”™s a lot of confusion,” said Skretta, “because the bill is so complex.”
Tom Staudter, Hall”™s spokesman, said it was an oversight. But that”™s just one of many issues Dahill is expecting to arise as a result Patient Protection and Affordable Care Act.
