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June 12, 2009 News Headlines

Business Group and Hospitals Protest Empire’s Payment Policies

At a news conference yesterday in White Plains hosted by The Westchester County Association, hospital and business leaders joined forces to draw attention to Empire Blue Cross Blue Shield’s inadequate payment policies. Helen Turchioe, Executive Director, Pinnacle Healthcare, said that its contracts with Empire are set to expire June 30 and that little progress has been made in negotiations. Pinnacle includes three hospitals: Hudson Valley Hospital Center, The Mount Vernon Hospital, and Sound Shore Medical Center of Westchester.

“The main issue is Empire’s reimbursement rates to our hospitals, which are unreasonably low. In these tough economic times, our community hospitals can no longer accept Empire’s payments that are far below what other insurers pay for the same high quality care,” said Ms. Turchioe.

“The business community shares the financial pain of the hospitals’ plight. Each year, employers are being hit with double-digit increases in their health insurance premiums. The hospitals are not being fairly reimbursed by the insurance companies and businesses keep paying higher premiums every year. Where is all this money going?

Into the pockets of the big insurance companies,” said William Mooney, President, The Westchester County Association.

“Empire is trying to create a cookie-cutter approach to health care as they step over our patients and our hospitals and claim themselves as the self-appointed stewards of the health care dollar. They are trying to push every state in the union into one box and create a health care system that works for them--not for the patient or those who provide the care,” said Neil Abitabilo, President, Northern Metropolitan Hospital Association.

Pinnacle and hospital officials also voiced concern about significant changes Empire has proposed in the new contract that would reduce or eliminate payment for major patient care services. John C. Federspiel, President and Chief Executive Officer, Hudson Valley Hospital Center, said, “By financially punishing hospitals for treating patients in accordance with the medical judgment of their medical doctors, Empire wants to decide what’s best for your health care. We believe that a physician--not an insurance company bureaucrat--should make decisions about a patient’s medical care.”

John Spicer, President and Chief Executive Officer, Sound Shore Medical Center, said there has been a dramatic rise in the number of policies instituted by insurance companies such as Empire that result in denial or reduction of payments to hospitals and doctors. “This is unfair, not just to providers, but also the purchasers and consumers of health care coverage,” he said.

Ms. Turchioe said Pinnacle would continue discussions with Empire and make a good faith effort to reach agreement on a new contract as soon as possible. Contact: William Van Slyke

Obama Administration Approves New York’s Expansion of Child Health Plus

The Obama Administration has approved federal funds to support the expansion of New York’s Child Health Plus program, paving the way for New York to receive $64 million in new federal funding. The approval is retroactive to September 2008.

The expansion of Child Health Plus has already occurred; today’s announcement means that the federal government agrees to provide matching funds for the expansion. The expansion was part of the 2007-2008 state budget, increasing the income eligibility for the program from 250% to 400% of the federal poverty level. The eligibility expansion made approximately 70,000 additional uninsured children eligible for coverage, representing a change from approximately $46,000 annual income for a family of three to $73,000 for a family of three.

As of May 2009, Child Health Plus covered 386,000 children in New York State. Since the expansion to 400% of the federal poverty level last September, an additional 22,000 children have been enrolled. Under New York’s Child Health Plus program, health care is delivered by commercial health plans. Except for children in families with the lowest incomes, participation in Child Health Plus requires personal contributions by families in the form of monthly premiums based on a sliding scale according to family income.

Proposal to Mandate Flu Vaccines for Health Care Personnel Moving Quickly

A proposed regulation that would require annual influenza vaccines for all health care personnel in hospitals may be finalized as early as August, when the State Hospital Review and Planning Council (SHRPC) is scheduled to vote on a final version.

The rule would also apply to employees of diagnostic and treatment centers, certified home health agencies, long-term home health care programs, acquired immune deficiency syndrome home care programs, licensed home care services agencies, and hospices. It is not yet clear how this regulation might have to be altered in the event a vaccine for the new flu strain, H1N1 (swine) flu is developed. The Commissioner of Health told SHRPC last week that DOH is expecting that the swine flu vaccine would be a separate shot and would not be available until the end of 2009 at the earliest.

The most recent draft of the regulation is available for review on HANYS’ Web site, along with a DOH slide presentation on the proposal, presented at the June 4 meeting of SHRPC.

A separate proposal that would require mandatory flu vaccines for personnel working in nursing homes is currently under consideration in the State Legislature.

DOH also presented a slide presentation at the June 4 SHRPC meeting on the H1N1 flu. Contact: Karen Roach

DOH Provides Clarification on Rural Stroke Center Designation

At the June 11 meeting of the State’s Rural Health Council, the Department of Health (DOH) provided guidance for rural hospitals seeking stroke center designation. In 2006, to enhance access to timely stroke care in rural areas of the state, DOH began a rural telestroke initiative. Based on a model in place in Georgia, a system of “hub” hospitals was developed and connected to “spoke” hospitals through a telemedicine link. Using technology, neurologists located at hub hospitals can assess results of tests performed at rural hospitals and visualize patients to direct treatment at the remote location.

Rural “spoke” hospitals have raised concern that patients transported by emergency medical services are bypassing their facilities and are being transported to a designated stroke center. At yesterday’s meeting, DOH representatives indicated that if all other stroke center designation requirements (including treatment time requirements, staff training, and data reporting requirements) are met and the specialist coverage is provided via telemedicine, stroke center designation will be granted. DOH also pledged to work with hospitals to help them overcome obstacles to meet designation requirements where possible. Contact: Frederick Heigel