What’s in a Name?

What is a safety net hospital?  The Institute of Medicine’s 2000 report America’s Health Care Safety Net: Intact but Endangered – define a safety net hospital as:

“Those providers that organize and deliver a significant level of health care and other health-related services to uninsured, Medicaid, and other vulnerable patients. “

They go on to explain the idea of a core safety net provider

“These providers have two distinguishing characteristics: (1) by legal mandate or explicitly adopted mission they maintain an “open door,” offering access to services to patients regardless of their ability to pay; and (2) a substantial share of their patient mix is uninsured, Medicaid, and other vulnerable patients.”

New York has its own definition of a safety net hospital.  The state uses the percentage of business generated by Medicaid to define a safety net hospital. The threshold is 35% of all patients and 30% of inpatients.  There is also an exception offered on a case by case basis.

This definition leads to a rather strange situation.  According to the Institutional Cost reports filed with the New York State Department of Health  of the 187 statewide hospitals 149 are safety net institutions.  Of the 47 New York City hospitals 42 are safety net institutions. Of course what is at stake here is money.  One example is DSRIP–the 6 billion dollar program whose “primary goal of reducing avoidable hospital use by 25% over 5 years.”   To be eligible for DSRIP funds a hospitals needs to be a safety net provider. 

Given New York City’s Health + Hospitals mission not to turn anyone away and its financial hardships it is hard not to wonder if all 42 hospitals deemed safety net hospitals by the state of New York are equally deserving of funds.