Which Way Safety Net

Aljazeera America has published an important article about NYC Health + Hospital finances and the state of the safety net hospitals in New York State.  The article Medicaid Cuts Imperil Hospitals That Serve the Poor outlines the especially challenging conditions that face safety net hospitals in New York State.  One of the key problems they identify is the very loose definition that “safety net hospital” has in the New York State.  Aljazeera writes:

“A state-run program intended to help fund safety net hospitals, which treat many low-income and uninsured patients, defines ‘safety net’ so broadly that 42 of 47 hospitals in New York City meet the requirements for aid. That grants many well-off nonprofit and academic hospitals access to the program’s limited money. The list of qualified facilities includes Mount Sinai Hospital, which has assets of $2.6 billion and sees on average only half as many Medicaid recipients and uninsured patients as HHC hospitals.”

Reflecting on the state run program, the Chair of the NYC Council Health Committee,  Councilman Corey Johnson says “This is embarrassing. That the state is behaving this way toward the best public hospital system in the United States, shortchanging us as a city, shortchanging the people who need H.H.C.”

The lack of a useful and honest definition of a safety net hospital on the state level is an important issue.  As the Commonwealth Fund points out the definition of a safety net hospital is important because “it highlights the revenue streams most relevant to the financial health of safety-net hospitals and informs how these funding streams might best be configured and allocated among institutions.” If the definition does not speak to public policy and how to best fund vulnerable populations it is hard to understand what “safety net” means, if anything.

A further problem for HHC, recently rebranded NYC Health + Hospitals, is its own budget issues.  According to the Aljazeera article

“A May 2015 review of HHC’s finances by the City Council executive budget committee says the corporation plans to cut the equivalent of 1,000 additional full-time staff in the next 18 months to save another $100 million a year.” This is on top of the expected drastic cuts in federal DSH money.

At the same time that HHC is being asked to make these cuts OneCity Health, NYC Health and Hospitals Corporation (HHC)-sponsored Performing Provider System (PPS) under DSRIP, is planning on expanding its services.  Its stated goal is to: “expand access to primary and ambulatory care, break down silos and integrate care across the continuum, increase patient self-care ability, close gaps in the continuum, especially in the delivery of behavioral health services and at transitions in care.”

This contradiction between constricting budgets and expanding service creates confusion on all levels of the system.  The NYC Health + Hospitals mission as well as patient needs call for expansion while the political/fiscal voices seem to call for contraction.  At the end of the day it is the patients and providers who are caught in the middle of this confusing tug and pull and are left to fend for themselves without an overarching vision for the safety net system.