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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

    Hospital leaders and hospital trustees traveled to Albany on February 28 and March 1, 2017 to meet with lawmakers to discuss their top concerns about the proposed 2017 – 2018 budget. A proposed payment penalty for potentially preventable emergency room visits, a $10 million funding reduction to the Hospital Quality Pool, and "super powers" language allowing the budget department to reduce payments if revenues fall short were key items on the agenda. The budget deadline is April 1, 2017.

     

    Federal Update

    The recently released House Republican bill leaves in place all of the Affordable Care Act (ACA)-authorized Medicare and Medicaid cuts on hospitals, without the promise of reductions in uncompensated care. The bill also effectively eliminates the expansion of Medicaid eligibility. New York State greatly expanded its Medicaid program under the ACA, which dramatically lowered the number of uninsured in the state over the past three years. About 25 percent of the state's population is covered by Medicaid. The hospital industry says the House legislation will result in more uninsured and underinsured and will make insurance less affordable. The plan eliminates current means-tested tax credits and cost sharing subsidies and replaces them with limited tax credits based on age, not income. According to an analysis just released by Governor Cuomo's office, New Yorkers will lose $400 million in tax credits.

    More importantly, the House plan will fundamentally alter the structure of the Medicaid program, shifting a much greater burden to the states, local governments, and hospitals – about $4.5 billion in added costs here in New York, according to the Governor's analysis. The plan ends Medicaid's entitlement status and instead proposes a per-capita capped program. This leaves no flexibility for costs related to enrollment surges, such as we experienced during the Great Recession, or increases in the provision of healthcare. The only alternatives are for states to curtail benefits and eligibility and reduce payments to healthcare providers, driving up the numbers of uninsured and underinsured. Despite the ACA expansion of Medicaid coverage to adults and children with modest incomes, about 70 percent of the Medicaid spend continues to be for the elderly and disabled of all ages, putting these vulnerable populations at risk under the per-capita caps.

    "The House bill neither truly repeals nor meaningfully replaces the Affordable Care Act," said Kevin Dahill, president/CEO of the Suburban Hospital Alliance. "This is bad news for New York – capping Medicaid funding will be financially devastating to the state budget and to the thousands of New Yorkers with modest incomes, many of whom are elderly or disabled, who will no longer be guaranteed coverage. It also puts already-vulnerable hospitals at risk from steep Medicare and Medicaid cuts, rising uncompensated care, and pressure from insurers to reduce reimbursement rates." The Congressional Budget Office has not yet weighed in on the cost of the House plan, but that cost is expected to be steep given that the GOP plan repeals almost all of the ACA's tax revenue provisions. The CBO analysis also will estimate the bill's effect on the federal deficit. Many lawmakers from both parties say the non-partisan CBO's analysis is needed in order to fully consider the components of the bill. The proposal now heads to the House Budget Committee. House Speaker Paul Ryan says his chamber is on track to bring the bill before the full House by the end of March.