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  • Special Report

    The 52 hospitals within the nine counties represented by the Suburban Hospital Alliance of New York State continue their preparedness efforts to treat infectious diseases, such as Ebola, and other medical emergencies related to natural and manmade disasters through routine and enhanced preparedness activities. These include system-wide drills with health care workers in the donning and doffing (removal) of personal protective equipment (PPE), review of communication protocols and triage practices to ensure understanding within care teams and throughout facilities, and review of identification/treatment/transfer processes with local health departments and other first responder agencies to ensure swift and secure coordination.

    Since the presentation in September of the first infected Ebola patient in Texas to the consequent infection of healthcare workers treating that patient, federal and state guidelines pertaining to the care of patients and protection of healthcare workers have been reviewed and revised by state and federal health agencies. While the chances of spread of the Ebola virus, which can only be transmitted via the bodily fluids of an actively symptomatic infected person, remain highly remote, hospital workers in the Suburban Alliance counties are well-trained and ready to deal with an infectious agent as virulent as Ebola.

    Earlier this week, the Centers for Disease Control and Prevention (CDC) issued enhanced guidelines for healthcare workers treating Ebola patients. These include the wearing of full body suits with no skin exposure and use of a respirator at all times. CDC Director Thomas Frieden advised that healthcare workers undergo rigorous and repeated training in the donning and doffing of the gear until it becomes “ritualized.” The CDC also recommends that hospitals have a trained monitor to observe workers as they put on and take off the personal protective equipment. Learn more about the CDC’s enhanced guidelines for healthcare workers at their website.

    The New York State Department of Health (NYSDOH) has also taken a very proactive stance on hospitals’ Ebola preparedness. An October 16thorder of action from the NYSDOH offers more detailed and exacting descriptions of infection control practices, drilling and training timelines – specifically requiring monthly assessments of staff competence in donning and removing PPE – and stringent protocols for identification, isolation, and transport of patients suspected of Ebola infection. It further defines procedures for medical waste disposal, treatment personnel logs, and point-of-contact mechanism to track the disease’s origin and spread. State Department of Health staff are traveling now to hospitals in the state to survey and assess their readiness and to offer assistance, if needed. The DOH designated eight hospitals located in strategic geographic regions throughout the state to serve as Ebola treatment facilities for identified patients. Go to the state’s website for more details about the NYSDOH order and the Ebola virus.

    “The hospitals throughout the Hudson Valley region and on Long Island adhere to strict infection control protocols in all disease outbreak situations,” said Kevin Dahill, president/CEO of the Suburban Hospital Alliance of New York State. “Table top drills and simulations take place on a prescribed basis, as required by state and federal emergency preparedness mandates. Drills and training exercises at our hospitals were ramped up in the past few weeks, even before the state’s recent order, and our facilities are prepared to handle wide scale emergencies and disease outbreaks.” 

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    State Update

    The deadline for the state fiscal year 2017 – 2018 budget is April 1, 2017 and negotiations continue. The Senate and Assembly budget versions differ and concur in a variety of areas. However, the hospital industry continues its push that the final budget must include money for capital investment and upgrades, a healthcare regulatory modernization workgroup, and funding for financially struggling and vulnerable hospitals.

    Both the Senate and Assembly budgets reject Governor Cuomo's payment cuts to hospitals for preventable emergency room visits. The Senate version rejects the governor's and the Assembly's $10 million reduction to the hospital quality pool.

    The governor's proposal extends the Health Commissioner's "super powers" regarding the piercing of the global Medicaid spending cap and a subsequent Medicaid Savings plan developed by the state without legislative input. And, more importantly, the legislature and hospital industry are opposed to the "super powers" the governor's proposal bestows upon the Department of Budget to reduce health and non-healthcare related programs, if revenue from the federal government is less than expected.

    A detailed chart provides more in-depth comparison between the proposals, which can be found at www.hanys.org/government_affairs/state/state_budget.

     

    Federal Update

    The inability of the House to garner the 218 votes necessary to pass the American Health Care Act means that the Affordable Care Act (ACA) remains the law of the land for now. However, the ACA remains vulnerable to regulatory and rule changes from the Department of Health and Human Services and appropriations reductions emanating from Congress. In addition, there remains an appetite in Washington, DC to reform Medicaid and to perhaps eventually attempt another overhaul of the ACA.

    The House bill ultimately failed because of oppositional factions within the House GOP. Clashing ideologies about the role of government in healthcare led to a fight that became more about politics than policy. Particularly worrisome was the Medicaid amendment that New York Representatives Faso and Collins embraced. This amendment would have only affected New York State by adding an additional $2.3 billion burden on the state's budget by shifting the counties' portion of the Medicaid bill to the state.

    This is why it remains crucial that the hospital industry continue to emphasize the gains the ACA made in reducing the number of uninsured Americans and the payment and delivery reforms stemming from the Center for Medicare and Medicaid Innovation that are showing reductions in the cost of care. The now defunct House bill would have caused 24 million Americans to lose insurance, according to the Congressional Budget Office. In mid-March, Secretary Tom Price delayed the implementation of several bundled payment models from July 1 to October 1, 2017. The delay is tied to the Trump administration's review of regulations affecting healthcare providers.

    In New York State, 3.7 million New Yorkers obtained coverage through the ACA. Medicaid expansion due to enhanced eligibility criteria and matching federal dollars accounted for 66.6 percent of the insured, while another 18 percent gained coverage through the Essential Plan. Nationwide, about 81 million Americans are currently covered by Medicaid, about 24 percent of the population.

    Medicaid reform remains a likely target.