Politics

Urgent Care: $8 Billion Medicaid Waiver Driving Reinvention Of Brooklyn's Hospitals

There were protests. There was outrage. The future mayor of New York City was arrested. 

In 2012 and 2013, the long-simmering problem of cash-strapped Brooklyn hospitals boiled to the surface. Long Island College Hospital was on the brink of closing, and Interfaith Medical Center began bankruptcy proceedings. 

In the heat of the moment, Bill de Blasio, who as public advocate would call for the creation of a Brooklyn Health Authority to transform the system and bring the borough’s hospitals into the 21st century, was memorably led away in handcuffs from a protest against the proposed shuttering of LICH. 

Yet as mayor, de Blasio has not taken any steps, at least publicly, toward following through on that proposal, and his office has not indicated whether he will create a health authority for the borough. Moreover, experts say that city has little actual influence to alter the landscape of Brooklyn’s hospitals and healthcare delivery. 

Still, a major transition is now in progress. There is a move away from inpatient hospital care, and toward comprehensive networks of preventive, primary and urgent care facilities. But rather than policy changes instituted by de Blasio or Gov. Andrew Cuomo, it is New York’s $8 billion Medicaid waiver, which the federal government gave final approval to in April, that will potentially allow Brooklyn’s hospitals to collectivize, reorganize and transform into a more complete and functional healthcare system. 

In 2011, a state-commissioned report found that Brooklyn is plagued with high rates of preventable hospitalizations and chronic illnesses, gratuitous emergency room visits, the inefficient handling of mental health issues and competition with academic medical centers in Manhattan. “We don’t have a healthcare system, we’ve got a sick care system which has all the wrong incentives,” said Stephen Berger, the report’s lead author and chairman of Odyssey Investment Partners. 

Instead of taking action to address these problems, individual hospitals have been preoccupied with their own survival, critics say. Berger described the mindset of hospital boards as “if I can hang on by my fingernails long enough, and the other guys fail, my job is to keep my institution alive.” 

“It’s not that everybody is wrong,” Berger said, referencing different groups of healthcare players like doctors and unions. “It’s just that by everyone defending their own interests, it’s almost impossible to change a system that really has to be changed.” 

Like patients who wait too long to get treatment, hospitals have used all their resources merely to stay alive, and are thus unable to focus on charting a new, long-term strategy. “You need to have an existence that goes beyond sort of just keeping your head above water, worried that you’re going to make payroll this month,” said Dennis Whalen, president of the Healthcare Association of New York State. 

Enter the Medicaid waiver. 

The waiver is earmarked to help the state reform its healthcare system by creating the Delivery System Reform Incentive Payment program, or DSRIP, the goal of which is to help hospitals plan and manage their next incarnation and avoid a series of chaotic closures that will disrupt the lives of thousands. 

Under DSRIP, hospitals and healthcare providers will submit applications to become Performing Provider Systems, also known as PPSs. Some hospitals will continue operating as they do now, while others, some reformers hope, will turn into a non-hospital part of the healthcare network. Applications for the waiver money are reviewed by the state Department of Health and the process runs through December. Currently, the program is in Year Zero; Year One starts on April 1, 2015. 

In addition, Interim Access Assurance Fund (IAAF) money from the waiver has been given to several hospitals and healthcare networks in dire straits in order to maintain critical services, including $152,401,533 to New York City’s Health and Hospitals Corporation (HHC), $20,395,749 to SUNY Downstate and $36,882,960 to Interfaith. 

One of the goals of the Medicaid waiver is to reduce inpatient hospital admission by 25 percent over the next five years. Inpatient numbers are already on the decline, but experts feel more needs to be done to control costs. “We know a substantial number of people who are in inpatient beds in these hospitals don’t belong there,” Berger said. 

The Medicaid waiver comes with a matrix of recommendations and requirements, some of which are easier to follow than others. “The hardest program is the transformation program,” said Whalen, “because it says … you fundamentally are going to be different at the end of this project.” He added, “You may become one of those free-standing emergency departments, you may become a long-term care provider, you may become a clinic, but you’re going to transform yourself from your current state.” 

If hospitals and other healthcare providers do not use the money the way it is intended, funding will be cut off. “[DOH] told us that, and they are dead serious,” said Berger. 

The City of New York is primarily involved in shaping Brooklyn’s healthcare landscape through HHC, which runs three hospitals in the borough: Coney Island Hospital, Kings County Hospital Center, and Woodhull Medical and Mental Health Center. The new challenge for HHC will be to branch out beyond its own network, and become part of the local community’s health ecosystem. 

“Discussions are ongoing as to how the city can most productively support and guide the transformation of the Brooklyn healthcare delivery system into one that is of highest clinical quality, improved accessibility and fiscal sustainability,” said Maibe Ponet, a spokeswoman for the mayor’s office. 

Perhaps the most important role that the city can play, however, is to sell the public on the notion that quality healthcare can be provided outside of a brick and mortar hospital setting. 

“Is having … a bunch of PPSs start up and do this stuff the right answer, or do you need a more… global overarching solution?” mused Whalen. “I think … the political situation at the moment, where everybody is kind of running for re-election … [has] kind of modified the approach.” 

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.