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POLITICO New York Health Care, presented by New York's Hospitals and Doctors: Brooklyn health; deal close on opioid bill

06/14/2016 10:00 AM EDT

Good morning! You are receiving the complimentary synopsis of the POLITICO New York Pro Health Care newsletter. Pro subscribers are receiving an enhanced version of this newsletter at 5:45 a.m. each weekday, which includes a look-ahead and robust analysis of health care policy news driving the day. If you would like the Pro version of this newsletter, along with customized real-time insights on New York health care, please contact us here and we will set you up with trial access. Thank you for reading!

written by Dan Goldberg

BROOKLYN HEALTH - Gov. Andrew Cuomo's top health officials went to Brownsville Monday night soliciting community input for the future of health care in central and eastern Brooklyn, as they try to address one of the toughest health policy challenges facing the administration. The beginnings of a plan are already in motion with the state in April awarding Northwell Health $500,000 for a feasibility study to determine what it would take to replace four struggling independent hospitals - Brookdale Medical Center, Interfaith Medical Center, Wyckoff Heights Medical Center and Kingsbrook Jewish Medical Center, the only unaffiliated hospitals remaining in the borough - with a financially viable, integrated health system that will care for one of the least healthy, most densely populated communities in the state. http://politi.co/1XTMTAH

OPIOID BILL - With three legislative session days remaining, legislative leaders and Gov. Andrew Cuomo have come to a tentative agreement on how to address the state's heroin and opioid crisis, according to several people familiar with the planning. http://politi.co/1S2QJP0

SHARE ME: Like this newsletter? Please tell a friend to sign up. Give them this link: http://politi.co/25oHyoN

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

HOOSICK TASK FORCE - State Sen. Kathy Marchione wants to form a task force that could examine chemical pollution issues across New York in light of the water crisis in Hoosick Falls. Marchione, a Republican who represents the Rensselaer County village where hundreds of people were exposed to a toxic chemical used in industrial manufacturing, said she was open to legislative hearings to examine the state, federal and local response to the situation in Hoosick Falls. http://politico.pro/1S3luDt

NOW WE KNOW - Want to get people to wash their hands? Show them gross images of what's really on their hands. Watch a video here: http://bit.ly/1sC0peJ

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 dgoldberg@politico.com.

** A message from New York's Hospitals and Doctors: New York is home to many of the world's finest doctors and hospitals, but they spend billions annually on medical malpractice costs-by far the nation's highest. Let's make sure Albany doesn't make things worse by passing bills that will raise those costs even higher and damage patient care. Learn more at http://www.nymedmalreform.org **

BILL TRACKER:

-MEDICAL RECORDS - Incarcerated people may soon be able to grant family members or caretakers access to their medical records, after bills proposing the change passed both houses of the Legislature Monday. http://politico.pro/1S3ptQs

VALUE PLAY - WellCare of New York announced six value-based payment arrangements with providers on Monday, meaning more than one-third of the commercial insurer's provider network now operates under the kind of contract that both the state and federal government believe to be the model of the future.

IMPACT STATEMENT - New York State's minimum wage increase would cost Consumer Directed Personal Assistance $9.3 million during the first three months of 2017, according to a new report from CDPAANYS. The brief: http://bit.ly/1U9dSH3

GRANT LAND - Refuah Health Center - a federally qualified health center that serves Rockland, Sullivan, Orange and Ulster counties - received a $490,000 federal grant to help enroll eligible children in Medicaid and the Children's Health Insurance Program.

WHAT WE'RE READING:

-ORGAN DONATION - The White House announced new public and private efforts to reduce the organ transplant waiting list, including a $200 million investment in research and development to enable more transplants, according to POLITICO. http://1.usa.gov/1U9ebSn

-CO-OP SUES - POLITICO reports: "A Maryland health co-op is suing the Obama administration over how it calculated payments under Obamacare's risk adjustment program."

-UNDERPAYMENT - Florida Medicaid providers have been underpaid $433 million over the past two years because of an error in the way state health officials classified beneficiaries. http://hrld.us/1XTyDI8

-NEW RULES - Nearly all U.S. hospitals must meet new standards to reduce antibiotic overuse and improve health equity, among other changes, under a new proposed federal rule. Read the rule here: http://bit.ly/1S3l5ko

TODAY'S TIP - Comes from the Cleveland Clinic: "Adults ages 26-64 need at least seven hours of sleep per night. Set your alarm accordingly."

STUDY THIS:

-WHY DO BISEXUAL MEN STAY IN THE CLOSET? - Researchers from Columbia University's Mailman School of Public Health and Public Health Solutions sought to understand why men who have had sex with both men and women choose not to disclose their sexual orientation to their wives and girlfriends. http://bit.ly/1sBZkmZ

-COST HIKES - Kaiser Health News reports on another study that found consolidation raises costs. http://bit.ly/1sBYdnA

MISSED A ROUNDUP? Get caught up here: http://politico.pro/1Vxuqrf

** A message from New York's Hospitals and Doctors: Everyone agrees: New York's hospitals and doctors deliver world-class patient care. But out-of-control medical malpractice costs that are by far the nation's highest are stark proof of a deeply flawed system. Let's make sure Albany doesn't make things worse with harmful, misguided legislation. Join us in urging the New York State Legislature to reject any bills that would raise medical malpractice costs even higher and weaken the ability of doctors and hospitals to deliver high-quality care. http://www.nymedmalreform.org **

To view online:
http://www.politico.com/states/new-york/tipsheets/politico-new-york-health-care/2016/06/brooklyn-health-deal-close-on-opioid-bill-004303

Stories from POLITICO Pro

Cuomo tries again to address Brooklyn's health care woes Back

By Dan Goldberg | 04/22/2016 05:28 AM EDT

The Cuomo administration announced on Wednesday that it was awarding $500,000 to Northwell Health to study the longstanding problem of Brooklyn's cash-strapped hospitals, taking another stab at one of the most challenging health care problems confronting the governor.

The feasibility study is meant to explore options for Brookdale Medical Center, Interfaith Medical Center, Wyckoff Heights Medical Center and Kingsbrook Jewish Medical Center, the only unaffiliated hospitals remaining in the borough. It will also look at options for University Hospital, which is part of SUNY.

Health care in central and northeast Brooklyn has dogged Andrew Cuomo throughout his six years in office, and there are no quick fixes. These hospitals are a critical element of the safety net, serving some of the poorest residents in the state.

That makes them both vital and expensive. Propping them up has cost state taxpayers hundreds of millions of dollars.

Cuomo tried to address the issue during his first year in office, commissioning a report that outlined the very same challenges the state health department mentioned on Wednesday. 

It is unlikely that the study will break any entirely new ground, since t he problem has been thoroughly studied and is easy to diagnose.

The health department summed it up nicely when it announced the grant. There is a large number of residents on Medicaid with poorer-than-average health outcomes who use the emergency room for primary care at disproportionately high rates.

"Previous studies have also noted that the financial condition of the most troubled institutions is, to a large extent, a product of an inefficient expense structure, revenue challenges associated with a patient mix that approaches 90 percent public payers and charity care, and overwhelming liabilities (including debt issued long ago for physical plant improvements that, in some cases, are obsolete)," the health department said in its announcement.

And solutions have also been presented.

In 2011, Stephen Berger, an investment banker who had previously led a task force on Brooklyn hospitals, issued a report focusing on the same set of hospitals as well as Long Island College Hospital, which was eventually sold to real estate developer Fortis Property Group.

The very first page of that comprehensive report said it was supposed to begin the process of reshaping the health care delivery system in Brooklyn.

"The monumental task in front of us, which can no longer be avoided, will demand redefining the roles and relationships among health care providers and between providers and patients," said the report, which was commissioned by the state health department.

The report also found that "Interfaith, Brookdale, and Wyckoff are experiencing financial crises and require aggressive action," and recommended both merging services and restructuring hospitals.

That did not sit well with the boards of those hospitals - or the communities they serve - and several fought implementation, embarrassing the Cuomo administration.

Berger's report also recommended changing the flow of indigent care pool dollars and called for capital grants, which would provide hospitals tools to increase revenue but the restructuring dominated the discussion.

In the years since, Cuomo has spent hundreds of millions of dollars maintaining the status quo, a situation that will only grow more expensive in the years to come.

The state projects that Brookdale, Interfaith, Kingsbrook and Wyckoff will require nearly $300 million in direct operating assistance to remain open. And the state would have to spend nearly $2 billion through 2022.

"There are real human consequences to the status quo," the state said in its press release announcing the grant.

For more than a year, the Cuomo administration has searched for a partner, a large institution capable of population health management, that could lead these struggling hospitals to the promised land.

Cuomo's carrot was $700 million, first put forward in January of 2015.

That money could be used to rebuild Brookdale Hospital with something more suited for the needs of the community, Cuomo's then-budget director Bob Megna said at the time.

But the $700 million was only for capital and many large private health systems were wary because of the debt these independent hospitals were carrying. Any health system that became too entangled could see its access to capital markets, the lifeblood of many systems, compromised.

There was also the messy politics.

State officials want to "right size inpatient capacity and expand access to ambulatory care."

That's not very different from what Berger proposed, but it means replacing inefficient hospitals with primary care offices, clinics and outpatient facilities.

That may make sense to health wonks, and it aligns with the state's overall public health goals, but it causes deep angst in communities that fear losing their hospital and equate hospitals with health care.

And the concern isn't just about health care delivery.

Jobs are at stake, too. Hospitals are often among the largest employers in these neighborhoods, many of which do not have a large pool of middle-class jobs.

Cuomo knows this from first-hand experience and appears to have learned a few lessons from earlier fights.

First, turning the study over to Northwell provides some degree of separation from the Cuomo administration should the results prove unpopular. And Northwell reserves the right to walk away for the same reason. The only commitment is to present a plan, although state health officials hope Northwell sticks around to help implement the strategy it devises.

Northwell's involvement should not be discounted, Berger said, because unlike commissions filled with experts who have no real-world power, Northwell can take a lead role if it chooses to do so.

"That it's not being done by a commission but by Northwell is very important," Berger said.

Second, the state already has announced the participation of the management teams and boards of trustees at all five hospitals.

"Brookdale, as a major health care provider in East Brooklyn, supports the State's decision to have Northwell Health conduct a feasibility study," Mark Toney, the hospital's CEO, said in a statement. "We look forward to working with local leaders, residents, physicians, staff and unions on this opportunity for better access to better medical care in Brooklyn. This is a necessary and important step towards solving our borough's difficult but fixable health care challenges."

Cuomo officials described it as a "coalition of the willing."

Third, Cuomo officials believe they have the support of 1199 SEIU, the largest health care union in the state and a driving force behind many of the protests and rallies that centered on Brooklyn health care during Cuomo's first term.

Those first four years demonstrated just how politically perilous Brooklyn health care can be. 

Long Island College Hospital, after a protracted battle that helped Bill de Blasio secure the mayoralty, is a shadow of its former self. But before it was replaced by a free-standing emergency department operated by NYU Langone Medical Center, it came to epitomize the challenges of "right-sizing."

Months of courtroom drama, rallies and protests cost the state millions of dollars.

Interfaith, which filed for bankruptcy protection and nearly closed, was an even thornier problem because of its location.

LICH was in Cobble Hill, and with the notable exception of Red Hook, the neighborhoods that surround that hospital are fairly well off. The neighborhoods surrounding Interfaith are made up of lower-income, non-white families that typically have less access to primary and preventive care, which forces a greater reliance on the hospital.

Interfaith was too vital to let fail but unable to stand on its own.

And when asthmatics and diabetics don't have access to a doctor, they use the emergency room as an entry point, which typically means they don't receive proper follow-up care, leading to repeat visits for a treatable and preventable ailment.

"People are getting hospitalized for things they could be getting care for in the outpatient setting," former health commissioner Nirav Shah said in 2013.

That's what Jason Helgerson, the state's Medicaid director, has often said was one of Brooklyn's largest problems and why the state is eager to find a large health system to partner with the weaker central Brooklyn hospitals.

The state floated the idea of combining services at Interfaith and Kingsbrook Jewish Medical Center during Interfaith's bankruptcy, but the idea never gained traction, in part because it was too rushed and in part because it only solved one piece of a much larger problem.

There was no intelligent design.

Both LICH and Interfaith became magnets for "Shame on Cuomo" chants, and rallying cries for de Blasio, who was then running for mayor.

De Blasio went so far as to get himself arrested, while 1199SEIU and the New York State Nurses Association organized a series of protests at which Cuomo was the go-to villain.

Cuomo officials, speaking on background, don't believe they will face the same level of opposition this time around.

In part, that's because there is no impending crisis that is forcing action.

No closures are imminent. No one is in court. They are not withholding operational support and are offering significant capital money.

Also, notably absent from the discussion is Kings County Hospital and Woodhull Hospital, two members of the New York City Health + Hospitals. State officials point out that those two hospitals are already part of an integrated system - the city's public hospital system - so they needn't be included in this feasibility study. That may, in the end, make the solution less comprehensive but it also steers clear of city politics.

The other difference, which the Cuomo administration hopes will ward off any community resentment, is that there is a $700 million pot of money ready to be spent.

The state government isn't promising a payment in some far-off budget cycle; the money has been approved, and the Cuomo administration is happy to show what this community will gain before it talks of taking anything away.

How persuasive the state can be will determine how successful it will be, Berger said on Thursday.

"You got to start building the outpatient facilities before you start tearing things down," he said. "To show it's not government bullshit."

Back

State officials discuss Brooklyn health care plans with residents Back

By Dan Goldberg | 06/14/2016 05:31 AM EDT

Gov. Andrew Cuomo's top health officials went to Brownsville Monday night to solicit community input for the future of health care in central and eastern Brooklyn, as they try to address one of the toughest health policy challenges facing the administration.

The beginnings of a plan are already in motion, with the state in April awarding Northwell Health $500,000 for a feasibility study to determine what it would take to replace four struggling independent hospitals - Brookdale Medical Center, Interfaith Medical Center, Wyckoff Heights Medical Center and Kingsbrook Jewish Medical Center, the only unaffiliated hospitals remaining in the borough - with a financially viable, integrated health system that will care for one of the least healthy, most densely populated communities in the state. The study will also consider what to do with University Hospital, part of SUNY.

How this new health care delivery model is organized, what services it provides and who is in charge won't be decided for some time, but whatever transition is to come, the Cuomo administration is anxious to avoid the kind of prolonged, ugly battles that characterized the fights over St. Vincent's in Manhattan and Long Island College Hospital in Brooklyn.

State Health Commissioner Howard Zucker, Deputy Secretary of Health Paul Francis and Deputy Commissioner Dan Sheppard spent more than two hours listening to local residents at I.S. 392, and assuring them no decisions would be made without first weighing their concerns.

"We're here to hear what you feel you need from the health system as we move forward to transform," Zucker said. "The whole thing here is to fix central and north east Brooklyn's health care, and as I've said before, no one should have to leave Brooklyn to get care."

The forum, part of the state's Voice Your Vision campaign, was hosted by Brookdale, which, along with Interfaith, Kingsbrook and Wyckoff will require nearly $300 million in direct operating assistance this year to remain open, according to state officials. And the state would have to spend nearly $2 billion through 2022.

Letting these hospitals go bankrupt could devastate their communities, which have high rates of diabetes, obesity and gun violence.

Brookdale, which lost approximately $35 million last year, provides the only trauma center in the area, said Mark Toney, the hospital's CEO.

"We're underserved in primary care and we're underserved in urgent care," Toney said.

Dozens of residents mentioned other needs including more mental health care, fresh food, a burn unit, an arthritis center, primary care, mobile health vans and aquatic therapy.

Zucker nodded along and promised to look into these deficiencies while Francis and Sheppard took notes.

In some ways, the conversations taking place in Brooklyn over the next several months will mirror those taking place on the Lower East Side of Manhattan, where Mount Sinai Health System also wants to transform health care delivery, proposing to replace Beth Israel Medical Center with a much smaller inpatient hospital as well as additional ambulatory care sites.

In an early sign that Sinai's plan may not encounter the kind of resistance that plagued St. Vincent's, fewer than two dozen people showed up last Thursday to an informational meeting hosted by Community Boards 3 and 6. Like Zucker, Mount Sinai representatives said they wanted to hear what the community needed before cementing their plans.

The future of central and east Brooklyn health care is far more complicated than that of lower Manhattan, but in Brooklyn there are also few signs so far of the protests and anti-Cuomo chants that echoed around threatened health care sites throughout 2013 and 2014.

Mount Sinai promised to keep all 4,000 union jobs and won the support of 1199 SEIU, the state's largest health care union. State officials believe they have the union's support for Brooklyn's transformation as well. 1199 SEIU and the New York State Nurses Association, the state's largest nurses' union, were instrumental in the protests surrounding the closure of LICH and Interfaith bankruptcy.

If they hold their fire, local residents who oppose whatever transformation plan is settled upon are robbed of their most potent weapon.

The state is also in a position to help build new facilities before taking anything away. Though no new construction has been proposed, Cuomo did set aside $700 million in capital money for Brooklyn, and former budget director Bob Megna said the money could build a brand new Brookdale.

That doesn't guarantee the community ends up with the same number of inpatient beds but it does prevent the kind of sudden closing that threatened Interfaith when it declared bankruptcy in 2012.

The challenge for the Cuomo administration - similar to what Mount Sinai is facing - is convincing a community that ambulatory care can replace inpatient care.

Sitting toward the back of the auditorium, making notes of their own, were executives from Northwell Health, which has made no secret of its interest in the Brooklyn health care market, a rapidly growing space that is changing both demographically and economically.

Northwell, which has so far committed to no more than a feasibility study, is the most likely health system to lead the transformation envisioned by the Cuomo administration.

Northwell tried unsuccessfully to take over LICH in 2014 and last year partnered with Maimonides Medical Center, which covers Southwest Brooklyn. Having a presence in central and eastern Brooklyn would make sense for the Long Island-based system, which has been shut out of the north by the city's other large health systems.

Taking over the struggling hospitals seems far-fetched given how much debt Northwell would have to assume and what that might to do the system's credit rating.

It could, however, sign a management contract that lets it play an active role without becoming an active parent.

What Northwell officials do not want is to become the focal point of community anger. The outreach from Zucker and Francis is effectively a demonstration that the Cuomo administration is willing to explain to the community why change is needed and to bear at least partial responsibility for whatever criticisms inevitably arise.

"It tells the community the governor is invested," said Senator Roxanne Persaud, who represents the area. "His investment now is not just lip service."

Back

Tentative deal reached on heroin and opioid response Back

By Josefa Velasquez and Dan Goldberg | 06/13/2016 02:58 PM EDT

ALBANY - With three legislative session days remaining, legislative leaders and Gov. Andrew Cuomo have come to a tentative agreement on how to address the state's heroin and opioid crisis, according to several people familiar with the planning.

Under the tentative deal, there would be a seven day limit on the number of days an opioid can be initially prescribed, a 72-hour involuntary hold for incapacitated individuals and no prior authorization from commercial insurers or Medicaid for medications used to treat addiction, several people briefed on the proposal told POLITICO New York.

The Assembly Democrats, who are in Albany Monday, are expected to conference the tentative deal during their closed-door meeting later Monday afternoon where it's subject to change. The Senate is due back in Albany Tuesday.

The deal being presented to Assembly Democrats and Senate Republicans would also require that prescribers take a three-hour course on addiction, pain management and palliative care every three years, in tandem with the Drug Enforcement Agency's requirement to renew practitioner registrations for those who prescribe controlled substances.

Advocates had fought against increasing the involuntary hold from 48 hours to 72 hours, arguing that addicts are more likely to overdose when released.

Under the tentative deal negotiated between the Republican-controlled Senate, Democrats who control the Assembly and the governor, the commissioner of the Office of Alcohol and Substance Abuse Services will designate the facilities where addicts will stay during their 72-hour hold. To ensure that addicts receive the proper treatment when they leave, hospitals will be required to provide discharge planning, people briefed on the plan said.

Not included in the tentative deal is a measure to advertise the sale of clean needles to drug users, a proposal that has been favored by advocates and was included in a program bill the Cuomo administration had drafted earlier this month.

Como's draft bill also included changes to education law that would require superintendents and teachers to to complete at least two hours of coursework training on addiction, but it was not immediately clear whether that was part of the final package.

Republicans in the Senate had also made a push to address the state's heroin and opioid crisis earlier this session. The GOP released a report which included more than two dozen legislative recommendations on how to prevent opioid and heroin use, and for treatment and recovery for addicts.

Earlier Monday, Cuomo wrote a letter to the Legislature spelling out his priorities for the remaining days. On the top of that list was "combating the heroin epidemic."

A spokesman for Cuomo did not immediately reply to a request for comment.

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