State Senate and Assembly Budget Bills Add another Dimension to Budget Negotiations

More money for Medicaid, no additional MTA tax, repeal of a harmful Medicaid pharmacy benefit all help struggling hospitals

But health plan reforms, workforce initiatives also needed to ease financial pressures

The release of the State Senate and Assembly one-house budget bills in mid-March brings us that much closer to arriving at a final budget by the April 1, 2023 deadline. But these negotiations usually go to the eleventh hour, so it’s not unlikely that this year we may miss that April deadline.

In the meantime, between now and then, the hospital industry hopes the final budget will include the 10 percent increase in Medicaid rates proposed by both chambers, as well as the additional funding for distressed and safety net hospitals, and elimination of the governor’s proposed increase to the MTA payroll tax. Both budget bills also seek repeal of the 340B Medicaid managed care pharmacy benefit change that will result in financial harm and affect access to affordable prescriptions for vulnerable populations when the change takes effect April 1, 2023.

What’s in a Medicaid Dollar?

For hospitals, it is only 60 cents. That means 40 percent of the cost of care for Medicaid patients is not covered by the state. Hospitals have long argued and demonstrated that this gap erodes a hospital’s financial stability. As Medicaid enrollments have increased in recent years, due to the state’s expansion of eligibility income limits, reimbursement simply has not kept pace with this expansion. Except for a one-time one percent rate increase last year, Medicaid reimbursements rates have not budged in some dozen years or so. This is in spite of recent spikes in inflation, which all industries and all consumers have felt in higher prices for groceries, utilities, and other staple goods. To fill the gap, hospitals are forced to negotiate higher and higher prices with commercial insurers. Often, the result is higher premium prices for the rest of us. Safety net hospitals – the ones that care for very large numbers of Medicaid and uninsured patients – are really shortchanged because their commercial insurance base is minimal. This is why supporting these safety hospitals through enhanced funding is so critical in this budget.

A statewide survey conducted last fall details just how tight the finances are for hospitals. It found that 85 percent of hospitals expected to have negative or unsustainable operating margins in 2022. In our suburban regions of Long Island and the Hudson Valley, 98 percent expected this poor outcome.

The Little Known Pharmacy Benefit with the Big Payoff

The federal 340B drug program allows hospitals to purchase certain drugs at deeply discounted rates. The resulting savings help hospitals reinvest in community benefit programs, such as nutritional food assistance, transportation services, and even supportive housing needs for the most vulnerable and needy. Two years ago, as part of the enacted state budget, a provision was passed to change this Medicaid managed care pharmacy benefit back to a fee-for-service reimbursement model. The policy’s adoption was delayed two years and now takes effect April 1, 2023. Under the state fee-for-service model, the savings on 340B drugs would accrue to the state, not providers. The governor is committed to moving forward with implementation of this provision, unless the legislature acts to delay or repeal what is commonly called the Medicaid pharmacy benefit “carve-out.” Both the Senate and the Assembly proposed budget bills seek repeal of this Medicaid managed care pharmacy benefit. If left in place, it will result in financial harm to providers and affect access to affordable prescriptions for vulnerable populations.

Why Do Insurers Hold Payments?

For insurers, the practice of delaying or even denying payment for medically necessary in-network emergency care until a claims review is conducted has become commonplace. The governor’s proposed “pay and review” proposal is a common sense solution to this problem. However, neither chamber supported this proposal in their one-house bills. The governor’s proposal calls for payment upfront to the hospital while health plans conduct medically-necessary reviews post-payment. Health insurers continually post big profits, while hospitals continue to struggle with meeting daily operational costs. Insurers have an obligation to pay for medically necessary, in-network emergency care when that care is rendered, not many months later.

No MTA Tax Increase

Both the Senate and House budget bills reject the governor’s proposed increase in the metropolitan commuter transportation tax, otherwise known as the MTA tax, which was enacted in 2009. This is most important for hospitals in Rockland, Orange, Putnam, Dutchess, Westchester, Nassau and Suffolk counties because, as employers, they pay this payroll tax. There is little appreciable benefit to our regions from this tax. It is a tremendous burden on suburban hospitals and all employers in our regions.

Stepping Up to Workforce Shortage Challenge

Unfortunately, both chambers rejected the governor’s proposals to expand scope of practice for nurses, pharmacists, physician assistants, and others and the recommendation to join the Interstate Medical Licensure and Nurse Licensure Compacts. The proposal allowing temporary practice permits for clinicians licensed in other states was also eliminated. However, the legislature’s acceptance of the governor’s proposal to establish oversight of temporary staffing agencies and capping agency fees, as the Assembly bill proposes, is welcomed by hospitals. Agencies charge hospitals very high fees for temporary staff, especially nursing staff.

I can’t emphasize enough the financial and operational strain our hospitals endure due to this unrelenting workforce shortage.

Next Steps

The budget negotiation process is now well underway – with literally just days left until April 1. My hospital colleagues and I keep reaching out to our legislators to remind them, once again, of the importance of keeping these positive provisions in the final budget and adding others that will serve to strengthen healthcare in both of our suburban regions.

About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities. NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)

The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities. NorMet serves as the local and collective voice of hospitals in the Hudson Valley.

Proposed State Budget: Digging into the Details

The 2023-2024 executive state budget released by Governor Hochul on February 1, 2023 proposes policies and programs that amount to a mixed bag for hospitals and health systems. The Hochul administration laid out its policy agenda in documents accompanying last month’s State of the State address with the stated intent of strengthening New York’s healthcare system. Items in the proposed state budget might make this a harder goal to achieve, when we look deeper into the details. I’ll touch on just a few.

Overall, despite a proposed five percent increase in Medicaid inpatient rates, the budget does not fully address the dire fiscal condition our hospitals face. As I mentioned in my last blog post, hospitals in our suburban counties endure a shortfall between what Medicaid pays for the cost of care and the actual cost of care. Medicaid pays 60 cents on the dollar. And while a five percent increase sounds good, it is well below what’s needed to close the payment gap. In fact, it doesn’t even keep up with the inflationary pressures of the last year. The state is supposed to keep Medicaid rates current with rising costs through what is known as the Medicaid trend factor, an annual adjustment to rates. However, state budgets for more than a dozen years have rejected the implementation of this annual adjustment, and rates have otherwise only increased by 1 percent over this time period.

Is It a True Increase?

Further, the five percent increase will likely be obliterated, or nearly so, for many hospitals by the administration’s desire to move ahead with a controversial policy change in the Medicaid pharmacy benefit program. The governor is committed to moving forward with implementation of a provision from 2020’s Medicaid Redesign Team II reforms that carves the pharmacy benefit out of Medicaid managed care plan coverage. The state would instead manage the pharmacy benefit for Medicaid beneficiaries directly. That will have a profoundly negative impact on hospitals participating in the federal 340B program. The 340B drug program allows hospitals to purchase certain drugs at deeply discounted rates. The resulting savings help hospitals reinvest in community benefit programs. Under this proposal, the savings on 340B drugs would accrue to the state, not providers. This policy becomes effective April 1, 2023, after having been delayed two years. Obviously, hospitals want this policy delayed once again or to go away completely.

More Cuts, More Taxes

The Medicaid payment increase is further eroded by a proposed reduction of $85 million in the indigent care pool to voluntary hospitals and an increase in the MTA payroll tax on downstate employers, including hospitals. Hospitals are major employers in their communities. The indigent care pool provides funding to hospitals to assist in paying for the cost of care for low income/uninsured individuals. In New York, 5.2 percent of the population remain uninsured. The proposed cut would disproportionately impact hospitals in the suburban regions.

The metropolitan commuter transportation tax, otherwise known as the MTA tax, was enacted in 2009. Hospitals in Rockland, Orange, Putnam, Dutchess, Westchester, Nassau and Suffolk counties pay this payroll tax. The current rate is 0.34 percent and the state proposes to increase that nearly 50 percent to 0.5 percent. The education sector has been exempt from this tax; hospitals have sought exemption and will continue to do so. There is little appreciable benefit to our regions from this tax. It is a tremendous burden on suburban hospitals and all employers in our regions.

Addressing the Workforce Shortage

There are a number of proposals in the governor’s budget designed to alleviate the workforce shortage that is crippling our hospitals. Our institutions need flexibility in order to meet staffing demands in the midst of this severe workforce shortage. We hope that New York will be given the green light to join the medical and nurse interstate licensure compacts, as proposed by the governor, and that scope of practice expansions for physician assistants, nurse practitioners, emergency medical services, pharmacists and others become a reality. Even if enacted in this budget, it would take some time for these programs to be implemented on a permanent basis, so we are also advocating that the state retain these provisions via executive orders in the interim.

We are also pleased to see proposals aimed at providing transparency into the practices of nurse staffing agencies. Many hospitals have had to turn to these agencies to fill positions on a temporary basis, often paying exorbitant fees for personnel. The governor’s proposals would establish minimum standards, impose penalties for non-compliance, and require quarterly reporting.

Health Plan Accountability

Hospitals have long sought reforms to managed care practices that are unfair to patients and providers. There have been successes along the way. One proposal forwarded by the governor in this budget would ensure hospitals are paid for services in emergency situations before an insurance company performs a case review. In what’s called a pay and resolve approach, payment remains with the hospital throughout the review process. That process involves time limits for delivery of case documents, a post-payment audit conducted by a joint committee and, if necessary, review by a mutually-agreed upon third party reviewer. Lots of steps, but the important point here is that payment for services is upfront and not delayed for a protracted period of time.

Our suburban hospitals are especially pleased to see the proposal to establish a health insurance guaranty fund. When insurer Health Republic collapsed in 2015, it took until 2023 for the bankruptcy proceedings to conclude. A sizable percent of Health Republic’s business was with providers in our suburban regions, resulting in loss of funds to hospitals. The guaranty fund would pay claims to providers in the event of a health insurance plan’s insolvency. Many states have such a fund. Typically guaranty funds require all licensed insurers to contribute to a fund to make providers and consumers whole.

Behavioral Health Investment

Proposals in the budget seek to address the seemingly intractable mental health crisis in which we find ourselves. Insurance reforms that expand access to school-based mental health clinics, mobile crisis intervention, and opioid overdose reversal medication are all positives. Other provisions related to payment parity enforcement, removable of utilization review obstacles, and making telehealth services permanent will all help patients and providers.

What’s Next

The Assembly and Senate one-house budget bills are expected mid-March. In my next blog post, I will take a look at those proposals. The legislature is required to pass a budget by April 1, 2023.

About the Suburban Hospital Alliance of New York State

About the Nassau-Suffolk Hospital Council (NSHC)

About the Northern Metropolitan Hospital Association (NorMet)

Hospitals Feel the Painful Pinch of Inflation, Too

Underpayments, workforce shortages, and high labor costs, escalating supply, equipment costs hammer our hospitals

Hardly anyone has escaped the effects of rising prices and inflation. Heating a home is more expensive this winter. Groceries, including an item as mundane as a carton of eggs, now cost more. Households and businesses are sharing in this push and pull of supply and demand with higher utility costs, higher prices for supplies, equipment, and essential items, and, in some industries, higher wage costs fueled by workforce shortages. The hospital and healthcare sector, an especially labor-intensive industry, is plagued by all these factors. Moreover, for this industry in particular, historically insufficient reimbursement by way of Medicare and Medicaid makes the situation much worse.

Critical Condition

When you learn that hospitals in New York derive a significant portion of their revenue from these two government programs, it’s obvious why the math does not add up. In our suburban counties, 66 percent of hospital inpatient services were covered by Medicare and Medicaid in 2021. This is from Institutional Cost Report data that hospitals file annually. Yet, for each healthcare dollar provided in care by hospitals on Long Island and in the Hudson Valley, Medicaid paid just 60 cents on the dollar and Medicare paid 92 cents. There is a shortfall, and it is substantial for sure. In fact, New York State’s Medicaid Trend Factor, which is supposed to adjust for inflation, has not done so in nearly a dozen years, except for a one-percent bump in rates the legislature approved last year. This is despite rising costs, rising inflation, and rising enrollment in the Medicaid program.

Last fall, New York’s state and regional hospital associations sought to uncover just how dire the situation was. They sent a survey to New York’s not-for-profit hospitals and health systems questioning hospital leaders about hospital finances, nursing workforce needs, and patient volume for the period 2019 through projected 2022. Hospitals responded overwhelmingly and enthusiastically with a participation rate reflecting 90 percent of the annual revenue that New York’s hospitals and health systems generate.

The results showed an industry in crisis.

Four out of five hospitals reported negative or unsustainable operating margins
49 percent reported they reduced/eliminated services to mitigate staffing challenges while ensuring their most critical services remained available
Hospitals reported their drug costs are up 42 percent; supply and equipment costs are up 20 percent; and energy costs are up 21 percent

The alarming results led the analysts to sub caption the Condition Critical report as “New Yorkers are losing access to care as a fiscal crisis hammers hospitals statewide.”

These are the consequences of an ongoing fiscal crisis like this – diminished access to care for patients. It’s a situation no hospital wants to face. Hospital and healthcare workers are in the business of providing care no matter the circumstances – we learned that through the extraordinary efforts of these individuals during the height of the pandemic.

State Budget Must Support Hospitals

During her State of the State address earlier this month, Governor Hochul outlined a variety of policy and program ideas that touched on affordable housing, public safety, and mental health needs. These are a few of her administration’s ambitious priorities. These are all worthwhile endeavors, but hospitals also want to see money dedicated to bolstering New York’s fragile healthcare system. This would mean an increase in Medicaid reimbursement rates that keep pace with inflation, a sizable investment in workforce, more money to replace and upgrade infrastructure, and certainly no cuts to existing healthcare programs.

Sadly, the existing pre-pandemic workforce shortage was made worse by the physical and mental demands of the pandemic. So many talented staffers left due to fatigue, emotional stress, and burnout. In May 2022, the U.S. Surgeon General sounded what he called an alarm about healthcare worker burnout and how this phenomenon is exacerbating the workforce crisis.

The legislature and the executive branch can return the healthcare industry to “stable condition,” as they negotiate the upcoming 2023-2024 state budget. The pandemic changed all of us. Our world is a different place. Hospitals, which are still tending to the effects of the pandemic at the patient and operational level, now face persistent workforce shortages and the exorbitant costs associated with that, as well as severe underpayments, and rising costs for just about everything that is needed to run a hospital.

In my next blog post, which I’ll upload after the release of the executive budget proposal, I’ll take a look at what that budget has to offer hospitals and by extension, patients.

About the Suburban Hospital Alliance of New York State

About the Nassau-Suffolk Hospital Council (NSHC)

About the Northern Metropolitan Hospital Association (NorMet)

Give Yourself a Gift

COVID, flu, and respiratory viruses are on the rise this holiday season; gift yourself and family members with health and protection

Hospitals and counties urge flu and COVID vaccination

COVID-19 is by no means behind us. It’s just added to the mix of seasonal viruses that appear every year when cold weather sets in and we find ourselves gathering indoors. This is one reason why flu and respiratory syncytial virus (RSV) are more prevalent this year, even as COVID infection rates remain steady on both Long Island and in the Hudson Valley.

Now’s the Time

Vaccination is a gift you can give yourself and your family members right now during this holiday season. Both flu and COVID-19 vaccines prevent infection and lessen severity of illness if you happen to catch either one of these seasonal bugs. That’s why the Suburban Hospital Alliance and its member hospitals are urging anyone eligible to get vaccinated now. The association launched a campaign in November with the theme Now’s the Time and is encouraging COVID-19 vaccination among the youngest members of our population sooner rather than later.

Protect Your Kids – Gift them with Vaccination

Children who are in school and congregate settings are especially vulnerable to catching germs. The COVID-19 vaccination rate for children six months and above is lagging substantially. In New York, only 3.3 percent of children younger than two years of age and 5.5 percent of children two to four years of age received the complete COVID-19 vaccine series. The rate is a bit better in the five to 11-year-old age group at 40 percent. However, booster coverage is even worse – only 2.2 percent for children five to 11 years of age and 4.8 percent for 12 to 17 year olds. The Centers for Disease Control and Prevention (CDC) has a great interactive map by state that displays COVID vaccination coverage.

Get Ahead of the Flu Bug

The gift of vaccination also works for the flu. Anyone six months and older who is eligible to receive the flu vaccine should do so now. Unfortunately, flu cases are rising across the state. The situation is under control, however, and hospitals and public health experts want to keep it that way. That’s why vaccination is so crucial, and it also prevents our healthcare system from becoming overwhelmed.

Hospitals and local county health departments always encourage flu vaccination and even more so this year. Last year, less people caught the flu because masking and social distancing were still commonplace. This year it’s a different story and a different flu season.

The flu vaccine and COVID-19 vaccine can be administered together. Both are safe and effective, offer protection, and will keep you and your family healthy this holiday season.

Vaccination Resources

Flu and COVID Vaccine Finder

NYS Department of Health

Centers for Disease Control and Prevention

County Health Department Directory

About the Suburban Hospital Alliance of New York State

About the Nassau-Suffolk Hospital Council (NSHC)

About the Northern Metropolitan Hospital Association (NorMet)

Community Input Drives Health Programming

Concerns about chronic disease and mental health still top concerns

Hospital and county health departments in New York State are in the process of completing their triennial Community Health Needs Assessments and the subsequent plans for implementation of programs and interventions that will meet the needs uncovered in those assessments. It’s part of the state health department’s Prevention Agenda initiative and its quest to become the healthiest state in the nation.

The current three-year cycle includes the pandemic years. As such, hospital leaders and public health experts expected to see concerns related to infectious diseases rise to the top. But chronic disease and mental health and substance misuse are community members’ leading concerns – again. These issues surfaced to the top in the previous assessment cycle for the two counties on Long Island – Nassau and Suffolk – and the seven counties in the Hudson Valley – Westchester, Putnam, Rockland, Orange, Sullivan, Dutchess, and Ulster. (There was a measles outbreak in late 2018 in Orange County. This may have influenced community and public health concerns and that county’s choice to also focus on communicable diseases.)

Mental Health Needs Prevail

Medical providers say it is not surprising that these issues prevail at this point in time, especially mental health needs, because the stress and strain of the pandemic exacerbated anxiety, depression, and substance misuse. Teens and young adults were especially hard hit. Fair Health looked at private healthcare claims for pediatric mental health, comparing month by month 2020 to 2019, and uncovered staggering results. In claim lines denoting overall mental health, intentional self-harm, overdoses and substance use disorders, incidence increased significantly.

Delayed Care Has Consequences

Delay in seeking care during the pandemic was more widespread than medical providers may have thought. For those with chronic diseases, which is 6 in 10 adults in the United States, delayed care often has negative and devastating consequences. In the earlier months of the pandemic, polls reflect delayed care for perceived serious medical issues and all types of medical care in general was widespread. Results of reviews of several polls found that one in five adults (20 percent) reported their household members delayed getting care. That report is in the Journal of the American Medication Association (JAMA).

Since age is one of the leading indicators for chronic disease incidence, older adults are at greater risk of complications from chronic disease, if routine care is ignored. The National Poll on Healthy Aging found that in 2021, nearly one in three people over 50 with a scheduled procedure, primary care visit or dental visit in 2021 had a COVID-related delay and many had not gone back for care as of late January 2022, when the poll was conducted. Accessing preventive screenings – for cancers, high blood pressure, and diabetes – catches these diseases in early stages when they are more treatable and less costly. Regular physician visits help patients better manage their chronic conditions, leading to better outcomes and a better quality of life. Hospitals and other providers in our suburban counties say visits for routine care are picking up. That’s good news.

Patient/Public Feedback Important

Gathering primary data on consumer perception is a requirement for every region. In Nassau and Suffolk counties on Long Island, an ongoing Community Health Assessment Survey (English, Spanish) is distributed to residents 18 years and older. It collects zip code-level, primary data about Long Islanders’ health concerns for themselves and their communities. The data is used by hospitals, county health departments, community-based organizations and other social and health services providers to offer programs that best meet the needs of communities

Results from the Long Island region survey show that communities are most concerned about cancer. Many cancers are now considered chronic conditions. This was followed by drug and alcohol abuse, mental health depression/suicide, with heart disease/stroke high on the list. The survey looked at responses collected January – December 2021.

To address these issues, survey respondents overwhelmingly want screenings, education, and information about mental health, substance misuse, and heart disease, particularly blood pressure and cholesterol screening. The usefulness of these results is not lost on hospitals and health departments. As they have in the past and will continue to do so in the future, hospitals and health departments create new programs and/or modify existing ones to meet the needs of communities. This is why it’s so important that everyone voice their concerns through assessment surveys, patient satisfaction surveys, in focus groups and via any other vehicles that solicit feedback.

Hospitals Call for Enhanced Medicaid Reimbursement

Medicaid reimbursement your local hospital receives plays an important role in every patient’s life, even if you are not enrolled in the program, because it’s important to hospitals. It’s the healthcare safety net for more than one-third of New Yorkers with modest incomes, children, the aged and the disabled.

Because the program covers the sickest and most vulnerable populations, its 7.4 million beneficiaries often need hospital care. But Medicaid reimbursements only cover 61 percent of what it costs to provide that care, and reimbursements haven’t increased in 14 years. This threatens the fiscal stability of providers, which in turn jeopardizes access to care in the communities they serve.

State legislators could address this problem in the 2022-23 state budget by increasing Medicaid reimbursements to reflect rising costs and ensuring that rates will continue to adjust in the future on par with inflation.

One of the many consequences of the COVID-19 pandemic is that costs are rising sharply, especially labor costs. Healthcare is facing significant shortages for key roles such as nurses, nurse’s aides, and laboratory techs, which raises costs even higher. Bringing Medicaid rates in line with actual costs helps providers invest in their workforce to overcome the current crisis and build a pipeline for the future. With New York State projecting a multibillion-dollar budget surplus, now is the time to invest in the quality and sustainability of New York’s healthcare system.

Hospitals on Long Island and in the Hudson Valley are urging the state legislature to ensure the final budget agreement includes additional Medicaid funding, beyond what has been proposed, for hospitals, health systems and nursing homes.

Protect your hospital care by reaching out to your local legislator and urging them to invest more into the Medicaid program for the sake of all New Yorkers. Use these simple links to find your Senate and Assembly member and send them an email. And, share this blog post on your social media platforms.

Learn more about hospitals’ state budget priorities here.

Getting It Right for Our Patients

Data-informed tool helps hospitals appropriately staff in the moment and in the future

Guest bloggers Patricia Dilley, Director of Clinical Information Systems for AcuityPlus, a division of Harris OnPoint, and Deann Shaver, Principal Consultant for the AcuityPlus product, take a look at New York’s recently enacted clinical staffing committee law and what it will mean for hospitals and patients. Patient safety and flexible staffing are at the heart of the legislation, as is an acknowledgement that variations in case severity are in constant change, requiring a health outcomes and data-informed approach to staffing. This has never been truer than during the past 20 months, when hospital staffing was stretched to the max by the demands of the pandemic.

New York’s hospitals are prepping for the implementation of the state’s clinical staffing committee law, which takes effect January 1, 2022. That’s when each hospital officially begins working on forming a multidisciplinary committee and subsequent staffing plan – the annual document that will serve as a multidisciplinary staffing blueprint for each facility. The legislation was signed into law this past spring by former Governor Cuomo. Importantly for hospitals, it recognizes that a one-size fits all staffing plan is not the best approach for patients. Patient mix related to severity of illness, co-morbid conditions, and uncontrollable fluctuations in patient volume all affect the appropriate staffing levels at hospitals.

The devil is in the details and that’s always the case with nursing duties and patient needs on different hospital units. Nursing workloads are as varied and diverse as the patients in a hospital, which is why Harris OnPoint realized back in 1975 that a more real-time solution to staffing was needed. We also knew that it had to be nurse driven, based on research and science, and maintained by clinical nursing staff.

When you look at the nursing process, you realize that there are an infinitesimal list of tasks and skills that are in play – some of the time, part of the time, or maybe even all of the time. Tasks such as assessment, intervention, planning for care, and even time spent talking with and caring for patient’s family members happen around-the-clock. Prescriptive patient-staff ratios, such as those enacted in California, attempt to uniformly quantify staff needs, but the approach ignores one major component of the nursing process – all patients are different, all cases are different. Research shows that mandated ratios are not necessarily the answer, which brings us back to the patient diversity and workload diversity reality.

As nurses, we knew there had to be a better solution. Data-driven, semi-artificial intelligence platforms have grown out of a desire to more accurately pinpoint unit activity and needs and, more importantly, to predict what clinical staff will be needed where and when. The AcuityPlus tool is one product that is taking the guesswork out of staff planning for hospitals. AcuityPlus users have the flexibility to look at patient workload and adjust staffing accordingly as patient care and nursing workload changes (for example, pre-shift, during shift and for the forecasted future). In the end, this improves patient care and outcomes and improves the hospital’s bottom line. One AcuityPlus user reduced overtime by $230,000 because the tool allowed the hospital to better allocate their staff, relying less on traveling nurses and overtime. This is one way to counteract the exorbitant and unexpected labor costs brought on by the pandemic.

Kathy Matson, the nursing administrator of nursing resources for Mayo Clinic Arizona says “AcuityPlus builds a bridge between nursing and finance, enabling the 24 x7 world of nursing to be understood by the 8 x 5-hour finance team.”

But a nursing-focused, patient-centered staffing solution offers way more than just savings to the hospital. Clinical nursing staff are involved in the selection of unit parameters that will be used in the platform’s algorithm, which empowers and recognizes their clinical skills and decision-making abilities. This leads to more satisfied nurses, more satisfied patients, and ultimately, a competitive edge for the hospital in this tough workforce environment. (One survey found that the average cost of turnover for a bedside RN is $40,038.) The tool also produces a data book, allowing the hospital to benchmark how its staffing data aligns with other hospitals in its market, regionally, and even nationally.

New York’s clinical staffing committee law will put pressure on hospitals to really get their staffing plans right. Those hospital committees that include highly-skilled nurses that understand the staffing process and its challenges, are well-respected by their peers, and have buy-in from leadership will easily develop plans that include built-in flexibility and are designed for the way each unit operates.

About the Suburban Hospital Alliance of New York State

About the Nassau-Suffolk Hospital Council (NSHC)

About the Northern Metropolitan Hospital Association (NorMet)

Suburban Counties Report Higher Cancer Incidence Rates

What will be the pandemic’s influence on future analyses

In both Nassau and Suffolk counties on Long Island and in five counties of the seven in the Hudson Valley region, the all cancer incidence rate (2015 – 2017) per 100,000 of the population is higher than the state rate, according to the state’s Community Health Indicator Reports. The situation improves somewhat when we look at the age-adjusted rates. In that case, for five of the seven counties in the Hudson Valley region, the rate dips below that of the state’s but this does not hold true for Long Island’s Nassau and Suffolk counties. That finding gels with the concern residents expressed about cancer incidence in a recent survey conducted by the Long Island Health Collaborative (LIHC).

The Community Health Assessment Survey (English Version) and Spanish version, is an ongoing survey that collects zip code-level, primary data about Long Islanders’ health concerns for themselves and their communities. The data is used by hospitals, county health departments, community-based organizations and other social and health services providers to offer programs that best meet the needs of local communities. An internet search did not reveal a similar zip code-level needs perception survey for the seven counties in the Hudson Valley region – Westchester, Putnam, Rockland, Orange, Ulster, Sullivan, and Dutchess.

Granted, the Long Island survey reports on perception and, historically, there have been gains in cancer mortality through the years due to better and earlier screenings, advanced therapies and interventions, and more widespread insurance coverage. The state’s Community Health Indicator Reports bear witness to this, as the all cancer mortality rate (2015 – 2017) per 100,000 is at or below that of the state’s rate for all but three counties – Orange, Sullivan, and Ulster in the Hudson Valley, with the latter two counties significantly above the state rate. Unfortunately, the picture does not improve for these three counties even when we look at the age-adjusted rate. Suffolk County’s age-adjusted mortality rate just eclipses the state rate.

Cancer as Chronic Condition

Physicians will tell you that more and more cancers are becoming chronic conditions and are treated as such. They will also tell you that certain modifiable risk behaviors, such as lack of exercise, poor diet, smoking tobacco, among others, are running up the numbers of cancer diagnoses. The hospital systems on Long Island and in the Hudson Valley all either have dedicated cancer institutes or units focusing on these intractable but treatable conditions. Most also offer adjunct therapies ranging from nutrition counseling to mindfulness training to help with fitness goals.

Pandemic’s Effect

The Long Island survey analyzed data collected during 2020. Many individuals delayed care during this time, including routine cancer screenings. It is too soon to look at data that would give us some insight regarding cancer incidence and care delay. It will be interesting to see if the pandemic had any effect on the gains made in reducing cancer incidence and mortality. We already know that life expectancy declined 1.5 years from 2019 to 2020, according to data released by the Centers for Disease Control and Prevention’s National Center for Health Statistics. The drop in life expectancy in 2020 was the largest one-year decline since World War II, when life expectancy declined 2.9 years between 1942 and 1943.

According to the American Cancer Society (ACS), one in three people will be diagnosed with a cancer in their lifetime. Cancer is the second leading cause of death behind heart disease.

Reducing Risk

Environmental exposures and genetics do play a role in cancer incidence. But an unhealthy diet and lack of exercise are equally to blame. These, however, are modifiable risk factors. If more people engage in healthier behaviors, outcomes will change over time as will perceptions about concerns. Medical providers and public health experts in the Long Island region want to keep track of this hopeful trend, and it’s why residents are encouraged to complete the ongoing Community Health Assessment Survey online.

Having said that, now is a good time to get back on track with your routine cancer screenings. Contact your local hospital – some even offer convenient screenings in community settings, like libraries and churches – or connect with your primary care physician.

About the Suburban Hospital Alliance of New York State

About the Nassau-Suffolk Hospital Council (NSHC)

About the Northern Metropolitan Hospital Association (NorMet)

Bank Fee Review Leads to Savings for Hospitals

Guest blogger Jonathan Addeo, Executive Vice President for F.E.DiBacco, Inc., sheds light on the huge savings companies can gain by combing through the multitude of small bank fees that add up over time. For not-for-profit hospitals that operate on razor thin margins and whose resources have been stretched to the brink by COVID-19, such savings are a welcome relief.

Bank fees. We all pay them – and sometimes without even knowing it.

As technology has evolved and the world of banking has digitized just about every aspect of its business, all sorts of bank fees have insidiously evolved as well. One hospital, for example, could have well over a million bank charges on its bill. There is a fee to deposit each mobile check, followed by a scanning fee for each check, a fee to file with the bank, and a fee to store the image of the check. Multiply these charges by the hundreds of thousands of transactions a hospital encounters in just a week’s time, and you can see how seemingly inconsequential bank fees add up to big bucks.

Why Banks Bank on Fees

Bank fees are a stable way for banks to earn money, particularly during times of volatility. Often, the top 10 most profitable companies in the U.S. are banks. Last year, four of the top 10 were banks. This has a lot to do with fees charged. The Office of the Comptroller of the Currency, an independent branch of the U.S. Treasury Department, charters, regulates, and supervises most banks in the U.S., ensuring that banks operate in a safe manner, comply with applicable banking laws and regulations, and treat customers equitably. But, for the most part, banks are free to charge the fees they deem necessary.

This brings us back to the dilemma faced by hospitals that are transacting with multiple banks. It’s nearly impossible for finance directors to review every item in their hospital system’s bank statements or to even know what charges to look for. This, coupled with inaccurate transaction volumes, unnecessary services, and the cost of keeping inefficient accounts, is a daunting task.

Uncover Hidden Costs and Inefficiencies

Several decades ago, the founder of my company, Fran DiBacco, a banking expert, realized the burden bank fees were to businesses. He developed a proprietary, patented software system to analyze bank accounts. The software finds line item pricing discrepancies, duplicated services, and other practices that cost organizations money. And, all the work is billed on a contingency basis, which means the project funds itself. A few years ago, the analyzer saved one regional hospital $500,000 in the first year and has since saved that hospital over two million dollars on line item issues from just one bank.

Hospitals have incurred extraordinary costs fighting the pandemic. A bank fee review is almost always guaranteed to save hospitals money and is just one step in the process to better financial health. Reducing volume inefficiencies and instituting some operational changes, all connected with the hospital’s banking practices, are other ways to save money. With a report in hand, a hospital finance officer has the choice to approach each financial institution and negotiate better rates or, in the case of my firm, turn to someone like me who will work with the banks and negotiate on behalf of the hospital.

According to the Healthcare Association of New York State, not-for-profit hospitals in New York State have the second narrowest average operating margin in the country. This calculation occurred prior to the pandemic, so margins are probably even worse now.

I think it’s time for a bank fee review.

About the Suburban Hospital Alliance of New York State

About the Nassau-Suffolk Hospital Council (NSHC)

About the Northern Metropolitan Hospital Association (NorMet)

A Health Disparity Exposed on Our Roadways

Guest blogger Cindy Brown, executive director of the New York Coalition for Transportation Safety (NYCTS), examines the health disparities that exist on our roadways and the resulting cost to life and society.

More often than not, bicyclists and walkers hit by a car end up in the hospital emergency room. Unfortunately, many never leave the hospital because they die from their injuries. New York State’s Statewide Planning and Research Cooperative System (SPARCS) data show that throughout New York State, excluding New York City, 35,796.98 individuals per 100,000 — or roughly 4,006,610.16 people— were hospitalized from 2016-2018. Of those ~four million hospitalizations, 755.35 per 100,000, or roughly 84,543.25 of them were the result of a motor vehicle crash. That’s just over two percent. While this may not seem like a large percentage, consider that such hospitalizations were avoidable.

Even more striking is new research that shows glaring health disparities exist even in the realm of pedestrian and bicyclist crashes. A recent report from the Governor’s Highway Safety Association analyzed traffic fatalities by race and ethnicity, and identified a new-found health disparity— traffic crash fatalities disproportionately affect black, indigenous and people of color (BIPOC).

Why would this be?

It all harkens back to the social and behavioral determinants of health that we all have come to understand have an immense bearing on a person’s health. Not even a walk in the neighborhood or leisure bike ride on our roadways shields us from the effects of outside forces. In this case, transportation is the social determinants of health factor at play. Neighborhood and built environment are key determinants in pedestrian, cyclist, and motorist accident outcomes on our shared roadways.

Report Findings

American Indian/Alaskan Native persons have a substantially higher per-capita rate of total traffic fatalities compared with all other racial groups. Of all races/ethnicities, American Indian/Alaskan Native persons have the highest annualized, age-adjusted traffic-related pedestrian death rates. The analysis also found that a disproportionately large percentage of fatalities are accounted for by motor vehicle traffic crashes, especially among Native American and Hispanic persons.

Black persons have the second highest rate of total traffic deaths, including pedestrian and bicyclist traffic deaths. Black children ages 4-15 have the highest rates of fatalities of all motor vehicle accidents. Asian persons have the lowest per-capita rate of involvement for virtually all categories of traffic deaths, and white persons generally have lower traffic fatality rates than BIPOC (with the exception of motorcycle driver and passenger deaths).

There are measurably higher levels of vehicle traffic in census tracts where low-income and BIPOC populations are more concentrated. The report also references two studies, one of which found people who live in areas of high economic hardship have an increased risk of being in a severe crash and dying in traffic crashes more often and at a higher rate than residents of more affluent neighborhoods; the other found that injury risk for pedestrians and cyclists is 20-30 percent higher among children of manual workers than those of intermediate and high-level salaried employees, which illustrates an effect of socio-economic status on crash involvement.

Causal Factors

The report draws compelling conclusions about why this is happening, and how we can work to eliminate this disparity. This issue is deeply entrenched in other factors that affect crash risk and access to life-saving care after a crash. Existing health inequities, lack of infrastructure such as lighting in low-income areas, and the effect of socio-economic status all point to existing, underlying disparities as the main driver of the disproportionate number of BIPOC represented in fatal traffic crashes. In many instances, individuals with low income cannot afford a car, and therefore utilize walking, biking, and public transportation as their main forms of transportation. Public transportation hubs are typically located in high traffic areas.

Historically, in an effort to move motor vehicles faster, existing communities were often divided to build new high speed roadways that would ease congestion and meet the needs of drivers. It resulted in the creation of wide, multi-lane streets with high speed limits and traffic signals blocks apart. Right turns on red were permitted and bicycle lanes were non-existent. Shopping and other types of services were frequently on one side of the road and housing was on the other, either because of zoning restrictions or political influence. When these roads were built, the needs of all users were not a consideration. Today “all users” are to be considered when new roadways are built, or old ones are rebuilt. However, many of these existing roads have yet to be rebuilt and are still traveled daily. Without assessment and investment in improving these roads, they remain dangerous for those who must travel them.

Actionable Ways to Work toward Equity in Traffic Safety

Eliminating these underlying disparities may seem like an insurmountable task, but we have the collective power to work toward mitigating this particular issue by digging deeper and working to address the root of the problem. The report emphasizes this point, calling for a more equitable allocation of resources to address pedestrian safety needs in BIPOC communities. On state and community levels, leaders must prioritize planning and investing in infrastructure within the areas and neighborhoods that have suffered from years of discrimination and disinvestment. Addressing other underlying issues such as poverty and lack of access to mental health services could also be useful in addressing crash prevention.

While we wait for these better roads to be built, we can take action now to keep ourselves safe. There are dozens of pedestrian safety laws in New York State. Unfortunately, many people are unaware of these laws and enforcement is spotty. One simple law is to walk facing traffic when a sidewalk is not available. Why? Because the driver can make a psychological connection with the pedestrian’s face. Studies document that this reduces crash incidence. Unless we know this law exists, would anyone consciously think about what side of the road to walk on? Dozens of laws similar to this one can be found on the state’s website and on NYCTS’ website dedicated to raising awareness about pedestrian safety.

Pedestrian safety is another pressing public health issue. Our community and state leaders must adopt the same view and treat traffic crash involvement as the health disparity issue it truly is. This means more diverse representation within the leadership of our state and city transportation agencies and traffic safety committees. More diverse representation in leadership would also foster more effective safety education campaigns and outreach efforts to address the specific needs and cultures of BIPOC communities.

The report also calls for some additional research needs, such as better public health data, state level Fatality Analysis Reporting System (FARS) data analysis, and a deeper understanding of the role of race in crash outcomes by examining the National Emergency Medical Services Information System (NEMSIS) database that collects State and Territorial EMS injury and fatality data from 911 calls.

The Road Ahead

The term “social determinants of health” may be relatively new, but the reality of the concept is as old as time. BIPOC have endured bias and disparity in nearly every aspect of society for centuries. Unfortunately— but unsurprisingly—the issues of pedestrian safety and traffic fatality are no exception to this trend. The GHSA’s new report is eye-opening and confirms the need to take strides toward more equitable roadways.

About the New York Coalition for Transportation Safety )

The New York Coalition for Transportation Safety is a non-profit, statewide organization originally established in 1982 as the New York Coalition for Safety Belt Use, Inc. The Coalition was founded jointly by the Medical Society of the State of New York and the American Association for Automotive Medicine.

Initially the Coalition was a single focus group that sought to reduce motor vehicle related trauma in the State of New York by increasing the use of safety belts by motorists. In time it became apparent that many factors contribute to the complex picture that is motor vehicle injuries. We expanded our scope to include safety programs for pedestrians and bicyclists, as well as motorists, and changed our name to the NY Coalition for Transportation Safety to better reflect our expanded our efforts.

Our mission is to reduce the number of injuries and fatalities occurring on our roadways through outreach and education programs aimed at pedestrians, bicyclists and motorists. During its thirty-eight years of operation, the NY Coalition has received grants from federal, state, local and private agencies. Grant funds are used to develop and conduct public information and education campaigns in a variety of locales.

About the Suburban Hospital Alliance of New York State

About the Nassau-Suffolk Hospital Council (NSHC)

About the Northern Metropolitan Hospital Association (NorMet)