PNY, MHC: Hospitals Ramp up Outpatient Dept's, Health Plan Unloads FFS Physicians

NYAPRS Note: Signs of the times: amidst the move to reduce inpatient use and in the wake of associated mounting financial difficulties, hospitals are looking to reinvent themselves into community service providers. At the same time, independent FFS physicians who are not poised to go to value based at risk arrangements are being dropped by health plans and will be looking to form Independent Practice Associations.

Parallels: community behavioral healthcare providers are looking at increased competition from hospitals and are increasingly looking to form IPAs.     


Executive Directors at Four City Hospitals to Retire Next Month

By Dan Goldberg  Politico NY  November 29, 2015


Big changes are coming to the leadership of New York City's public hospital system.

The executive directors of Woodhull, Coney Island, Harlem and Elmhurst hospitals will retire at the end of this year, and a search is on for their replacements, as NYC Health + Hospitals (formerly HHC) attempts to transform its lines of business and adapt to a growing need for ambulatory care.

"As we move our health system in a bold new direction from a hospital centric model to ambulatory and community health, we are phasing out the hospital network structure and four network leaders have decided to retire," said Ram Raju, president and CEO of Health + Hospitals….

Raju's vision, which aims for a financially stable public hospital system in 2020, relies primarily on growing revenue, particularly in outpatient facilities and through MetroPlus, the insurance arm of Health + Hospitals…..



NYC Health and Hospitals Sees Operating Loss Soar

By Melanie Evans  Modern Healthcare  November 26, 2015


NYC Health and Hospitals' operating loss leaped to $263.6 million during the first quarter of its fiscal year as patient revenue declined and operating expenses edged upwards… 
Dr. Ramanathan Raju, CEO of the public system, has said the struggling system's viability will depend on its ability to compete more aggressively for patients.



EmblemHealth's New CEO Explains Move To Reduce Network

By Dan Goldberg   Politico NY   November 30, 2015


EmblemHealth's new CEO explained to the state's financial services department last Wednesday why she is choosing not to renew contracts with approximately 750 in-network physicians.

The decision, said Karen Ignagni, was made in an effort to ramp up the insurer's value-based business and move away from fee-for-service doctors.

Ignagni's move may signal a larger looming fight between insurers and independent physicians. Insurance companies want more risk-sharing agreements, which could penalize physicians if a patient is poorly cared for. Independent physicians, who are either unable or unwilling to join larger groups or health systems, don't have the patient base to engage in those types of value-based contracts and rely on fee-for-service relationships to stay in business…. 

The New York County Medical Society is advising its physicians to either join larger organizations such as an Independent Practice Association, which are groups of doctors that contract with insurers, or tell their patients to find a new insurance company.