Our institution, New York Hospital Queens, welcomes true “Medicaid Reform.” We are impressed and hopeful that our new governor is coming into office with both a mission and the framework for a plan to tackle what so many have been reluctant to even broach. Real reform will not be easy.
We are confident that the right experts are being tapped to ensure that “reimbursement reduction” will not be portrayed as “reform.” Real reform is a huge undertaking and will not be accomplished in the short term – the systems are simply too complex. Patience and persistence will be required to plan and then implement reform that will eventually strengthen the health care delivery system, not further damage it.
The health care delivery infrastructure can’t survive a reform approach that is based upon rate reductions. There are few (if any) not for profit or public New York hospitals today that have a margin that can handle a reduction of any magnitude in the current Medicaid reimbursement rates, which are well below adequate. Neither can the core delivery system that includes the very primary care physician base that needs to be strengthened in order to achieve necessary reforms in this state, and federally. The reform approaches that are intended to push collaboration, access and resulting efficiencies throughout the continuum of patient care (Medical Homes, Accountable Care Organizations) require that both hospitals and the primary care physicians be viable.
Hospitals simply cannot provide safe patient care with an uncertain but declining revenue stream. At what point is this fragile industry to be considered in serious danger like the auto industry and banks were when they required bailouts not all that long ago? We can plan and budget for uncertainty, but not for unlimited uncertainty. Continued cuts have helped cause the demise of many local hospitals in recent history. There will likely be more closures unless there is relief – relief that supports the process of real reform, including what we all need to do in this state, and then on the federal level.
Stephen S. Mills, President and Chief Executive Officer, New York Hospital Queens.