A Healthy Budget? Is Cuomo's Healthcare Infrastructure Plan the Best Remedy?

Gov. Andrew Cuomo’s executive budget earmarks $1.4 billion for healthcare infrastructure: $700 million for central and east Brooklyn, $300 million for Oneida County and $400 for rural health facilities.

Yet key details remain vague, prompting questions from lawmakers and advocates about how the state’s healthcare dollars are being spent.

According to the budget summary, the $300 million to revamp healthcare delivery in Oneida County would help reduce unused patient beds. Another $400 million would be used on debt consolidation and “other capital projects” to spur consolidation in rural areas.

The $700 million in funding for Brooklyn is similarly aimed at cutting back on “unnecessary inpatient beds” while improving patient care and increasing access to “community-based” medical services.

A Cuomo official said recently that a new hospital would need to be built in Brooklyn, a goal seemingly at odds with the goal of reducing patient beds. But there has also been speculation that the money would be spent on a new facility to replace the financially strapped Brookdale Hospital, a nonprofit teaching hospital.

The Cuomo administration offered few additional details amid concerns about its proposals.

The Community Health Care Association of New York State (CHCANYS), which represents health centers operating 600 primary care sites across the state, said it was “dismayed” that the governor planned to invest $1.4 billion in hospitals without reserving resources for the community-based care sector the state is counting on to transform healthcare as part of its ongoing Medicaid reforms.

The state plans to use its $8 billion federal Medicaid waiver to consolidate and integrate hospitals with primary, behavioral and other community health providers, with the ultimate goal of reducing avoidable hospitalizations by 25 percent over five years.

Beverly Grossman, CHCANYS’ senior policy director, said she supports the state’s efforts. But although the administration claims that its latest investments will increase access to community-based care facilities, Grossman said that such providers were being overlooked while the state reinforces “the existing inpatient-focused health care delivery system.”

“Although only the $400 million intended for upstate rural providers is specifically restricted to hospitals, it is our understanding that the additional billion is intended for hospital transformation in Brooklyn and Oneida County,” Grossman said in prepared remarks delivered at a Feb. 2 state budget hearing. “We have significant concerns, based on our repeated past experiences, that this money will not flow beyond hospital walls to community based safety net providers.”

State Sen. Kemp Hannon, the chair of the Senate Health Committee, also questioned the prudence of the capital expenditures during a time when the state is seeking to reduce hospital admissions.

Hannon said there was a need to review whether Brooklyn and Oneida were the most appropriate sites to receive $1 billion and whether construction at those sites had to be 100 percent financed by the state.

“There is a major program that’s going on called [Delivery System Reform Incentive Payment program], which would reconfigure all health care provider relationships, and there would be a proposed reduction of 25 percent of hospital admissions,” Hannon said. “It would seem to be more logical that you’d have to be looking to using existing facilities if you’re going to have reduced admissions.”

At a recent budget hearing, state Medicaid Director Jason Helgerson said $300 million was directed to Oneida County because providers there requested funding to replace antiquated facilities with a modern alternative that had fewer inpatient beds. He also said the government was still tweaking its definition of rural, but intended to spend the $400 million assisting providers in non-urban settings whose debt threatened their existence.

Executive Deputy Health Commissioner Sally Dreslin said federally-qualified health centers— nonprofits that provide comprehensive primary care in underserved areas— would have the opportunity to seek a share of the money and it was not necessarily limited to hospitals. She said a nonprofit might even be able to partner with a larger Brooklyn hospital project.

Stephen Berger, who chaired a 2005 state commission charged with reviewing the changing health care delivery system, said replacing aging Brooklyn hospitals with streamlined, modern alternatives would be wise.

In 2011, a state-commissioned report recommended closing 1,235 hospital beds in Brooklyn because many were vacant and others could be emptied by using more robust primary and preventive care to drive down the borough’s high rates of preventable hospitalizations and emergency room visits.

Berger, the report’s author, argued that there was nothing contradictory about Cuomo’s approach and that investing the money to replace Brookdale’s aging facility would make sense.

“You have a whole bunch of hospitals that are really in terrible shape, and you really should wave a wand and make them go away,” Berger said. “You could easily take out two or three institutions in Brooklyn, replace them with one new acute care facility and network, and the quality of care would be immediately improved.”

Medical Measures

Gov. Andrew Cuomo’s spending proposal includes a number of healthcare measures.