Saturday, November 9, 2013

Contrasting "Narratives" on Medicaid, Hospital Budget Cuts Under Obamacare

#Gov1%, Hospital Budget Cuts, Medicaid Redesign Team, Stephen Berger, and GOP-Controlled States Take Toll on Life-Saving Emergency Care

Dr. Herbert Pardes, former CEO and President of New York Hospital-Columbia Presbyterian Hospital

Dr. Herbert Pardes, who used to lead New York-Presbyterian Hospital as president and CEO, earned $4.3 million in 2010, boosted by a $339,101 SERP payment. That came on top of a $6.8 million SERP payment that vested in 2008. (SERPs up! Hospital execs win big : Deferred plans boost chiefs' 'longevity pay' by millions of dollars * Crain's)

Dr. Pardes gave an interview on Channel 13 today, where he sounded pretty desperate to spin a win-win situation for patients under Obamacare. But there was a competing article published in The New York Times on the same day as his interview. The article showed that cuts to hospital budgets, caps on Medicaid, and refusals to expand Medicaid, and hospital closings was leading to serious life-threatening healthcare emergencies. Yet, Dr. Pardes remained ignorant of public health disaster caused by the wave of hospital closings instigated by Gov. Andrew Cuomo under Stephen Berger's Medicaid Redesign Team.

HERBERT PARDES: … I think to his credit, the Governor in New York did a good job in terms of putting a cap on the Medicaid budget. And he worked collaboratively with the providers and brought the cost down substantially.

So, the whole story isn’t beautiful, but there are parts which are.

RICHARD HEFFNER: But you’re saying, I gather … and that’s a beautiful point, if, if I understand correctly … that service is not going down, costs are not leveling because people are being less well served.

PARDES: Well, that’s exactly the kind of combined focus that people should undertake. Which is to say, bring costs down, but not at the expense of a clinical care of the patients. And we feel very strongly about that. So wherever we’ve taken out costs and there’s another part to this story, which is New York Presbyterian simply taking out costs … we’ve done it, but protected the clinical care aspect of our hospital. So … (More about the Dim Future of American Medicine * Thirteen.org)

If uninsured or underinsured patients have no insurance under Obamacare because Republican-led states opted out of expanding out of Medicaid, how do Obamacare supporters explain the draconian, scorched-earth campaign by Gov. Andrew Cuomo and Wall Street banker Stephen Berger's efforts to close hospitals, which are used as safety net care by the poor, before primary care is set up as a replacement ? Conveniently, it always goes unsaid how the closing of emergency rooms, full-service hospitals, and trauma centers will impact patients' likelihood of survivals (their healthcare outcomes) in life-threatening medical emergencies, when the next nearest full-service hospital or trauma center is further away ?

… A government subsidy, little known outside health policy circles but critical to the hospitals’ survival, is being sharply reduced under the new [Obamacare] health law.

The subsidy, which for years has helped defray the cost of uncompensated and undercompensated care, was cut substantially on the assumption that the hospitals would replace much of the lost income with payments for patients newly covered by Medicaid or private insurance. But now the hospitals in states like Georgia [, which like other Republican-led states, refused to broaden Medicaid after the Supreme Court in 2012 gave states the right to opt out, ] will get neither the new Medicaid patients nor most of the old subsidies, which many say are crucial to the mission of care for the poor. ...

… The cuts in subsidies for safety-net hospitals like Memorial [in Georgia] — those that deliver a significant amount of care to poor, uninsured or otherwise vulnerable patients — are set to total at least $18 billion through 2020. The government has projected that as much as $22 billion more in Medicare subsidies could be cut by 2019, depending partly on the change in the numbers of uninsured nationally.

The cuts are just one of the reductions in government reimbursements that are squeezing hospitals across the country. Some have already announced layoffs. In Georgia, three rural hospitals have closed this year. … (Cuts in Hospital Subsidies Threaten Safety-Net Care * The New York Times)

New York’s Ongoing Blackout: Hospitals in Lower Manhattan (Pro Publica) * St. Vincent’s Is the Lehman Brothers of Hospitals (New York magazine) * Governor Cuomo’s Medicaid cuts may kill 10 city hospitals (The New York Post)

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