Roundtable Examines Health Care In Qns.
The future of hospitals in Queens –and the potential impact of the new federal health care reform law upon them- were the focus of a joint meeting of the Health Committees of Queens Community Boards 4 and 5 on Monday night, Oct. 15, at Queens Borough Hall in Kew Gardens.
With four medical centers having closed in Queens since 2007 and health care costs continuing to climb for all parties involved, members of the committees-as well as representatives of several hospitals serving the borough-discussed the economic challenges facing hospitals and exchanged ideas on how they may be able to survive and thrive in the current market.
“There’s a systemic problem with local hospitals in Queens,” said Robert Cermeli, chair of Board 5’s Health Committee, who presided over the session. He stated that the closure of four hospitals-St. John’s in Elmhurst, Mary Immaculate in Jamaica, Parkway in Forest Hills and Peninsula in Far Rockaway-leaves just 10 medical centers to serve about 2.3 million Queens residents.
“I can tell you from what I’ve been hearing that it’s a very complex situation,” Cermeli said regarding health care in the borough. “There are no easy answers.”
Much of the problem is the skyrocketing costs in the health care industry from hospital stays (Cermeli noted that many hospitals charge patients over $1,000 a day) to malpractice insurance for doctors and health insurance plans for employers.
“It used to be a thing of pride for companies to give health benefits” to their workers, Cermeli added, noting that in recent years, the cost of insurance plans have become “so prohibitive” that many public and private companies have stopped providing benefits altogether.
The Patient Protection and Affordable Care Act of 2010-the federal health care reform law referred to by many in the public as “Obamacare”- aims to address the rising costs of health care in the U.S., but Cermeli stated that the law itself “needs to be fine tuned.” Though its passage and enaction has proven controversial, he observed that “at some point, if nothing is done-if we left everything as is-we’re going to hit a breaking point” financially due to out-of-control health care costs.
The hospital perspective
Providing insight on operations at Wyckoff Heights Medical Center on the Brooklyn/Queens border in Ridgewood were Dr. Stephen Carryl, chief of surgery, and Board 5 Chairperson Vincent Arcuri, who sits on the hospital’s board of trustees.
Carryl, who previously served as chairperson of Brooklyn Hospital Center, stated that Wyckoff Heights is working to become a community hospital serving the basic health needs of residents on both sides of the borough line. Along with administrative changes, new physicians are being brought into Wyckoff Heights, and others with independent practices are becoming affiliated.
“We have the opportunity to do something special in a community hospital,” Carryl said, adding that the medical center would no longer focus on being a “destination hospital” treating certain conditions. “But we can be good at the things which the community needs.”
Cermeli and Board 4 District Manager Christian Cassagnol read statements by representatives of New York Hospital Queens (NYHQ) in Flushing and Forest Hills Hospital regarding the potential impact of “Obamacare.” The representatives of the two medical centers were not able to attend Monday’s session.
Debra Pagano Cohen of NYHQ, in her email to Board 5, stated that the creation of health insurance exchanges within the state “will not have a large impact on the population or the hospitals in Queens,” as the “borough is saturated with Medicaid managed care coverage.” She indicated that the exchanges may help those who have lost health benefits as a result of losing a job “acquire less expensive health coverage through the exchanges, which will help hos- pitals care for these individuals and facilities.”
The new law also contains “more requirements to provide quality with no funding available to support it,” including expanding information technology and training of new resident physicians, Cohen also wrote.
Theodore Lehmann of North Shore-LIJ, the parent company of Forest Hills Hospital, declined to offer specifics on “what-if scenarios about how the new health care laws” will effect the medical center.
“I can tell you what we have been doing programmatically to better position ourselves for success in the current environment,” Lehmann stated. He pointed out that the hospital has worked to improve efficiency by offering tests and procedures beyond the normal weekday business hours, improving patient education, creating support groups for patients with diabetes and cancer and expanding outreach efforts throughout the community.
What’s ailing local hospitals?
Arcuri elaborated on the fiscal challenges facing Wyckoff Heights, pointing out that the administration is still paying a $140 million mortgage from the state “at 8.5 percent interest” for the facility’s expansion in 1993. Reductions in reimbursements from the state for patients on Medicare or Medicaid have also impacted the hospital, he added.
“Eighty-six percent of our clients” are on Medicare or Medicaid, he added. Wyckoff hopes to make up for the reduction in federal and state reimbursements by adding more patients with health insurance coverage from affiliated doctors in Queens.
“Unfunded mandates” enacted by the state and federal governments for various hospital procedures from electronic record filing to tracking infections have also proven costly to Wyckoff Heights and other hospitals around the city and state, Arcuri added. Also hurting Queens and Brooklyn hospitals are private insurance reimbursement rates; Arcuri pointed out that Queens hospitals get “about a third of what a Manhattan hospital” would receive for the same procedure.
Treating individuals without health insurance is also costly, but as Arcuri and Board 4 Health Committee Chairperson Priscilla Carroll pointed out, medical centers are obligated by law to treat anyone who walks into an emergency room, regardless of their insurance status.
“We take care of you first and worry about the bill later,” Carroll said. Arcuri added that “it’s a hardship, but we’re in the business of caring for people.”
The loss of the five hospitals in Queens has taken a toll on Elmhurst Hospital Center and the nine other medical facilities in the borough, according to Carroll, who also works at the facility. She noted that Elmhurst Hospital is regularly “overcrowded,” with a lot of emergency patients- most of whom, she claimed, are undocumented- visiting “because they have nowhere else to go” to receive care.
Compounding the rising costs of health care are “out of this world” malpractice insurance rates paid by doctors, Arcuri said. He advocated for the state to pass tort reform to change the liability faced by hospitals, adding that this would cut hospital costs by nearly one-third alone.
As one example, he explained that whenever a child is born in a hospital in New York State, the medical center and the delivering physician may be held liable under law for any physical or mental issue a child may face until he/she turns 18 years old.
Finding a proper cure
Asked by Cermeli about possible solutions to these problems, Carryl stated that “like every complex problem, the solution will be complex.” He stated that hospitals such as Wyckoff Heights will be able to improve their care and their finances by expanding its outreach and hiring high-quality doctors and nurses.
Reforming malpractice law and lifting the cap on Medicaid and Medicare reimbursements would also help local hospitals thrive while reducing health care costs, Carryl added.
Cermeli then asked members on what action the committees should take regarding the state of health care in Queens. Board 5 member Rosemarie Johnson suggested that the panels draft a joint resolution with all other community boards in the borough calling on local, state and federal lawmakers to look at the situation in Queens and form solutions to keep hospitals open.
“When a hospital is in financial distress, the solution is not to close a hospital,” she said.
Cermeli and Carroll agreed to hold another joint meeting of the committees at a future date, during which a resolution will be drafted and later presented to the community boards.
