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POLITICO New York Health Care, presented by The Healthcare Education Project: FQHC 'crisis;' Cuomo's capital

Dear readers: POLITICO New York Pro subscribers receive an enhanced version of this email at 5:30 a.m. each weekday. If you'd like to receive it, along with a customized real-time news feed of New York health care policy news throughout the day, please contact us at and we'll set you up for trial access.

written by Dan Goldberg

INADVERTENT CRISIS —Time is running out for the state and federal government to close a $54.4 million funding deficit imperiling Federally Qualified Health Centers in New York. “The waiver authority for this program was inadvertently allowed to sunset by the State, which eliminated the State’s ability to receive vital federal matching funds,” the state’s Medicaid CFO wrote to the Centers for Medicare and Medicaid Services. Read my story here:

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AND MAKE SURE YOU FOLLOW Josefa and me on Twitter @J__Velasquez & @DanCGoldberg. And for all New Jersey health news, check out @katiedjennings

CUOMO’S CAPITAL — The Cuomo administration on Friday awarded $1.2 billion in capital funding for hospitals and clinics, money that executives had been anxiously awaiting since it was first approved two years ago.

...The governor’s office also released $355 million in Essential Health Care Provider Support funding, which hospitals can use to pay down debt, a move that might make them more attractive to a larger health system. A full list of recipients is here: A list by region can be found here:

NOW WE KNOW — There are a lot of executives and decision-makers who read this newsletter, so it is important to note that science has determined that employees would prefer their bosses be consistent jerks as opposed to someone whose rage is unpredictable.

** A message from The Healthcare Education Project: What’s a Health Insurance Guaranty Fund? It protects you if your health insurance plan goes broke. New York’s the only state without one.

Tell Albany we need a Health Insurance Guaranty Fund to ensure that families keep their coverage and healthcare providers aren’t left with massive unpaid bills. Visit: **

WE'D LOVE TO HEAR FROM YOU: This roundup is for you, so please tell us how we can make it even better. Send tips, news, ideas, calendar items, releases, promotions, job postings, birthdays, congratulations, criticisms and corrections to

MONDAY’S MUST READ — Chris Bragg of the Times-Union tries to figure out why Physicians’ Reciprocal Insurers appears to be receiving special treatment from the state.

...Bragg’s article also reveals a startling lack of transparency from the state’s Department of Financial Services: A spokesman “refused to say why the reports had not been released, even as competitors' reports have often been made public. … ‘I can't speculate on why they haven't been posted (online),’ said the agency's spokesman, Ron Klug.

CONSOLIDATION REPORT — Lake Shore Health Care Center and Brooks Memorial Hospital in the Southern Tier announced their intention to affiliate with Buffalo-based Kaleida Health, the largest health care provider in Western New York.

...It’s really important to remember that the Cuomo administration is encouraging consolidation among providers by helping clean up the balance sheets of smaller hospitals. Market forces were pushing this outcome anyway but the administration is making it easier for larger hospitals to affiliate and/or acquire smaller ones, and using state money to achieve that end.

CHECK THIS OUT — The Manhattan Institute is hosting a conference March 23 on hospital consolidation and competition in New York State. Distinguished health care experts, from academia, business, and nonprofits, will examine various tools that policymakers can use to deliver better outcomes across New York’s vast health care ecosystem, including regulatory reforms to boost competition, better state and federal antitrust oversight, and value-based purchasing strategies.

...I’ll be moderating the first panel and want to know what you think I should ask and/or discuss. Email me at

NORTHWELL AND BROOKLYN — Crain’s reports: “Northwell Health is in talks with the Cuomo administration about managing a new network anchored by the borough’s most distressed community hospitals, according to people briefed on the discussions.”

SALT WARS — The New York Times’ Gina Bellafante offers her opinion on the city’s efforts to warn consumers about excess sodium in menu items from chain restaurants. “Years from now, in whatever TV series emerges to mock early-21st-century cultural habits, we will almost certainly be invited to laugh ironically at people eating cheeseburgers and fries and drinking salted caramel milkshakes (some containing close to 3,600 milligrams of sodium), just as we were expected to sardonically process Don Draper’s chain smoking in ‘Mad Men.’”

...That’s a smart analogy but remember, the sodium mandate is now a legal question, not a public health one. Limiting sodium, sugar, calories, fats are all good ideas. The question before the appellate court is, does the city’s Board of Health have the authority to mandate restaurants post a warning that associates the intake of certain foods with chronic health problems. That’s a more complex question than simply asking whether the policy is a good one.

NO SMOKING — County Executive Mark Poloncarz wants Erie County to be the first county in New York State to ban pharmacy retailers from selling cigarettes and e-cigarettes, according to The Buffalo News.

HEALTH DISPARITY — New Yorkers living in high-poverty areas are more likely to be diagnosed with HIV/AIDS, chronic hepatitis B and C, malaria, as well other infectious diseases, according to a data brief released Friday by the city’s Department of Health and Mental Hygiene. The report is available here:

HAPPENING TODAY — Lenox Hill Hospital is opening an Epilepsy Monitoring Unit and admitting its first patient. The unit is headed by Dr. Souhel Najjar, who you can read more about here:

ACROSS THE RIVER: POLITICO New Jersey’s Katie Jennings unpacks the biggest health insurance fight in the state. Legislators are examining Horizon’s decision to create a tiered insurance network. Tier 2 hospitals complain their new status could put them in financial jeopardy. But Jennings explains the Omnia fight is symptom of a much larger problem for smaller community hospitals — changing payment models are forcing insurers and large hospital systems into value-based contracts that work better when larger populations are under one umbrella. That hurts independent hospitals. For decades, the fee-for-service model allowed commercial payers to subsidize Medicaid rates, which was a boon for hospitals in urban areas with poor payer mixes, and many legislators would like to preserve that system. But Horizon is betting large, vertically integrated health care systems such as Barnabas Health and Hackensack University Medical Center can better manage a large population.

-TIMING IS EVERYTHING — The New Jersey state attorney general's office on Friday afternoon said Horizon Blue Cross Blue Shield of New Jersey’s OMNIA Health Alliance does not violate state law. Read the letter here:

PHARMA REPORT: Senator Al Franken, a Democrat from Minnesota, introduced legislation that would end the tax break that drug makers can take for advertising medicines to consumers, according to Ed Silverman at STAT.


-FEELING SICK — ProPublica has been reporting on the struggle Navy veterans are facing after being exposed to Agent Orange during the Vietnam War. Veterans seeking compensation need to prove they were there. The problem is the U.S. government doesn’t know which ships travelled where.

-PAY ATTENTION TO THIS — POLITICO reports that a bipartisan group of House Ways and Means Committee leaders are raising concerns about the Obama administration's proposed Medicare Advantage payment policies for 2017. In particular, the legislators raise questions about a change to the funding formula for employer-based MA plans that's expected to reduce payments by 2 to 4 percent, according to an analysis by Wells Fargo. They also raise questions about changes to the risk adjustment formula for determining how much plans are paid.

-JOBS REPORT — POLITICO’s Dan Diamond tells us that health care wonks, insurers, doctors, providers, etc. should take comfort in Friday’s job numbers from the Labor Department. The health care industry added 38,100 jobs in February and has added roughly 480,000 positions in the last year — the largest growth of any sector. At this pace, health will be the biggest jobs sector in the United States within three years.

-HISTORY PROBLEMS — A former Air Force officer chosen to fix the VA's problem-plagued suicide hotline has been running other agency phone banks that have a poor record of service, dropping as many as one in five calls from veterans, according to internal data provided to USA TODAY.

-DON’T DO THAT — KWQC in Iowa found that a local hospital operated on the wrong side of patients four times in 40 days.

-THE WAR ON DRUGS — Austin Frakt has a really smart take on the best ways to combat addiction. Think about this: “Almost one million American physicians can write a prescription for an opioid painkiller like Vicodin and OxyContin — one pathway to opioid addiction. But, because of regulatory hurdles and other factors, fewer than 32,000 doctors are permitted to prescribe buprenorphine, a medication to treat such addiction. … The Obama administration intends to increase access to it — and its proposed budget would commit hundreds of millions of dollars to do so — but it won’t be easy.”

-ZIKA PLAN — Reuters reports: “The White House and the U.S. Centers for Disease Control and Prevention will gather state and local officials next month to urgently craft a plan to attack the hard-to-control mosquito that spreads the Zika virus.”

TODAY'S TIP — Comes from the Community Healthcare Network, who would like to remind you that March is Colon Cancer Awareness Month! Eating less red meat, food with antioxidants, and more fiber can help prevent colon cancer.


-TECH SCENE — Fitness devices can be a boon for orthopedists, according to NYU Langone researchers who presented their work last week at the 2016 annual meeting of the American Academy of Orthopaedic Surgeons. Dr. Claudette Lajam, an orthopaedic surgeon at NYU Langone Medical Center, said data generated by fitness devices can be applied across different levels of orthopaedic care.

-SEEMS TO WORK — Bundled payments for total joint replacements are paying off, according to a three-year study from NYU Langone Medical Center.

CAUSE AND EFFECT — Severe migraine attacks may be a sign that women are more likely to have complications during pregnancy such as preterm delivery, preeclampsia and low birthweight, according to researchers from Montefiore Health System.

-A MODEST AMOUNT — Kaiser Health News reports on a study from the Health Care Institute that seemed to disprove the idea that consumers can save themselves and the health care system money if they become savvier shoppers for health care services.

WHERE SHOULD WE PUT OUR MONEY? — Would it be better to invest in new treatments for cancer or research way to prevent cancer? Dr. Alfred I. Neugut, the Myron M. Studner Professor of Cancer Research and professor of Epidemiology at Columbia University’s Mailman School of Public Health, and co-author Dr. Cary P. Gross, from the Yale University School of Medicine, say it might be worth thinking about prevention.

-THAT’S NUTS — Evidence is accumulating that food allergies in children might be prevented by feeding peanuts and other allergenic food to infants in their first year of life, according to The New York Times.

** A message from The Healthcare Education Project: What’s a Health Insurance Guaranty Fund? It protects patients and healthcare providers if a health insurance plan goes broke. 49 states have one. New York is the only state that doesn’t. The recent failure of Health Republic left consumers scrambling for new coverage, and hospitals and doctors statewide are still owed hundreds of millions for care they already provided. We need a Guaranty Fund to protect patients and healthcare providers before it’s too late.

The New York State Legislature should create a Health Insurance Guaranty Fund to ensure that families keep their coverage and healthcare providers aren’t left with massive unpaid bills. To learn more, visit: **

MISSED A ROUNDUP? Get caught up here: 3/4, 3/3, 3/2, 3/1, 2/29

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