NYAPRS Note: As a Brooklyn hospital with a large behavioral health inpatient and outpatient capacity announces plans to close, state and City advocates are clamoring for CMS action to approve the state’s application to invest $10 billion in savings from our Medicaid Redesign plan into shoring up our community based systems of care. Such funds could be used to accelerate our plan to bolster community outreach, prevention, diversion and outpatient capacity to reduce the need for costly inpatient beds.
Where's the Waiver?
Crain’s Health Pulse August 2, 2013
The one-year anniversary of the state's 1115 Medicaid waiver amendment application is Aug. 6. That infusion of capital is critical—both politically and in the interests of quality health care.
"We must figure out how to raise capital so people in Brooklyn see new buildings rising and not old ones razing," said Stephen Berger in reference to the need for more primary care facilities, and to looming hospital closures. "We need the waiver."
But Mr. Berger thinks there is only one guy up to the job. "Our most valuable person in Washington is Chuck Schumer. I don't see anyone else doing it," he said. "To move the waiver someone has to get ballistic and tell CMS they must get this done."
CMS got a nudge yesterday from City Council Speaker Christine Quinn and Councilmen Brad Lander, Steve Levin and Al Vann, who sent an Aug. 1 letter to CMS' Cindy Mann and HHS' Kathleen Sebelius.
The politicians wrote that Interfaith and Long Island College Hospital "are teetering on the edge of closure now. The state's plan to infuse capital, technical assistance and restructuring funds to our hospitals must be fully funded in order to protect the safety of our most vulnerable residents."
Brooklyn Hospital Closings a Blow to Psychiatric Care
By Nina Bernstein New York Times August 1, 2013
Two years ago, a group appointed by Gov. Andrew M. Cuomo warned that Brooklyn would suffer a series of free-falling hospital bankruptcies and closings unless health care in the borough was restructured, with harsh consequences for a place where more than one in five of the 2.5 million residents live below the poverty line.
Now the imminent closing of Interfaith Medical Center, a hospital in Bedford-Stuyvesant that is among the largest providers of acute psychiatric care in Brooklyn, is threatening the borough with a severe shortage of inpatient mental health care, other hospital officials said. With Coney Island Hospital still out of commission after Hurricane Sandy, the loss of the 120 psychiatric beds at Interfaith, which also handles about 67,000 outpatient psychiatric visits a year, is going to create a crisis, hospital officials said.
The latest developments underscore how prescient the Cuomo group was, and also how little success it had in forestalling the crisis. Few of its recommendationshave been acted upon, including the merging of several of the hospitals and a change in state law to loosen restrictions on private ownership.
“Not only is this a bad situation for patients,” said Pamela Brier, the chief executive of Maimonides Medical Center, reflecting on the abrupt loss of Interfaith on the heels of the shuttering of Long Island College Hospital in Cobble Hill, “but it has to be considered a harbinger of more to come.”
Maimonides, now widely considered one of the only financially solid private hospitals in Brooklyn, has been operating its psychiatric beds at capacity or above since the storm, which knocked out several of the city’s largest psychiatric hospitals, disrupted outpatient services and flooded scores of coastal nursing homes and adult homes, where many mentally ill people had found housing of last resort.
Though more attention and protest has been focused on the loss of acute-care medical beds and the emergency room at Long Island College Hospital and Interfaith, which together serve more than 250,000 people, the disappearance of Interfaith’s 160 so-called behavioral health beds, including 40 detox and rehabilitation slots, may have more far-reaching repercussions, veterans of the mental health system said.
The state recently announced a plan to downsize its own roster of mental hospitals, to 15 from 24. The state’s Medicaid redesign plan calls for more outpatient services and supportive housing to prevent mental health crises that require hospitalization. But such resources take time and money to create, and are in short supply.
Dr. Nirav R. Shah, the state health commissioner, was traveling and unavailable to discuss the issue on Thursday, according to Bill Schwarz, a spokesman. Mr. Schwarz later sent an e-mail statement from Dr. Shah, saying the department, along with the State Office of Mental Health and the State Office of Alcoholism and Substance Abuse Services, “are committing extensive, collective efforts to assist Interfaith Medical Center in its efforts to develop a comprehensive closure plan that will ensure the health care needs of all current patients as well as those in the community are met.”
The schedule calls for the closing to begin on Aug. 15, the date of a hearing in bankruptcy court in which Interfaith will seek approval for the shutdown. By mid-September, all inpatient services would end, and by mid-November, outpatient services would cease.
“Closing hospitals is not a health policy,” said Bill de Blasio, the public advocate and a Democratic candidate for mayor who has made Brooklyn’s health care crisis a central issue of his campaign. “If we don’t stop this crisis at Interfaith, we’ll face it at Brookdale. If we don’t stop it there, we’ll face it at Kingsbrook, and the list goes on. “
Mr. de Blasio’s plan for health care in Brooklyn, issued last week, includes creating a Brooklyn health care authority, its members appointed by the mayor and the governor, with the power to reshape the delivery of care to better serve community needs, change leadership of hospitals and expedite mergers. The authority would have control over money that the state is seeking from a federal Medicaid waiver, including funds to stabilize safety-net hospitals.
That federal waiver application could bring up to $10 billion statewide, but it has yet to be approved. Christine C. Quinn, the City Council speaker and a mayoral candidate, issued a letter on Thursday urging federal officials to approve it.
“In New York City, we are faced with a crisis in our health care delivery system,” she wrote. “The $10 billion waiver would not only allow the state to invest in innovative models of health care delivery, but it would also allow our hospitals to continue providing the care that saves the lives of our residents.”
Stephen Berger, an investment banker who has long advised the state on health policy, said the waiver money was one step toward a solution, and that parts of the de Blasio plan were worth serious discussion, particularly the city-and-state collaboration.
“What’s happening in Brooklyn is a massive tragedy,” Mr. Berger said. “We have no way to keep alive institutions that are fundamentally financially broke and losing dollars.”