That’s how the U.S. Department of Health and Human Services described the overall health care quality in New York compared to other states in a report released late last month.
The findings came as no surprise to officials at the New York State Department of Health. They’ve long been aware that the quality of health care in New York is strong in some areas, but falls behind in others, most notably preventive care.
The 2008-09 state budget seeks to reverse that trend. The state will shift over $170 million in Medicaid dollars from inpatient care to hospital clinics, emergency rooms and ambulatory care, while also investing $170 million in community clinics, physician services and primary care enhancements for services such as diabetes and asthma educators and weekend/evening hours at clinics.
“The goal is to move health-care money from the inpatient to outpatient system,” said Deborah Bachrach, Medicaid director and deputy commissioner of health in charge of the Office of Health Insurance Programs. “We are trying to shift the focus from inpatient to outpatient care. You’re always going to need inpatient care, but the balance is wrong. … That’s why we look weak on performance measures for things like diabetes and asthma and chronic illness care.”
The budget also revamps the Medicaid reimbursement system by changing how services are reimbursed. Right now, the rate of reimbursement is the same no matter what the purpose of the visit; under the new system the reimbursement rate will be based on the “intensity of service” provided. This means that the reimbursement rate will be higher for, say, a comprehensive physical exam than a hospital visit to receive treatment for an ear infection.
Medicaid funds less than 30 percent of the state’s health-care costs, “but we believe we can influence the care that is delivered to all patients in New York,” Bachrach said.
The state also has started identifying communities with the highest rates of preventable illnesses to figure out where the areas of greatest need are. Most of these communities are located in urban and rural areas that lack access to doctors, Bachrach said.
The state snapshots from the U.S. Department of Health & Human Service’s Agency for Healthcare Research and Quality simply confirm other reports indicating that New York is spending a lot of money to treat people for health problems that might have been prevented with decent primary care, Bachrach said. In a 2006 Commonwealth Fund report, New York ranks 39th out of the 50 states on “avoidable use and costs.” This ranking could be improved, Bachrach said, “if people had better access to preventive care.”
AHRQ’s state snapshots examine health care in three areas: type of care, setting of care, and by clinical areas.
In the state snapshot, New York is labeled weak when compared to all states for overall health care quality. The state was considered weak in a number of areas, including chronic care, diabetes, maternal and child health and respiratory diseases, and strong in other areas, such as nursing home care and cancer.
“The data came out a week or two ago, but it drives home the timeliness and importance of this budget,” Bachrach said.
Karen Ho, a researcher at the Agency for Healthcare Research and Quality, said each state has varied results. “It’s different for every state,” she said. “Some are slightly better. Some are slightly worse.”
The purpose of the state snapshots, now in their third year, is to provide policy makers with information that can help them measure how their state is doing in terms of providing health care, Ho said. “No state does well in all areas,” she said.
The budget also creates a $15.6 million “Doctors Across NY” program that includes loan repayment of up to $150,000 of medical school loans for new physicians who make a five-year commitment to practice in medically underserved communities, and two-year grants totaling $100,000 to support new physicians who establish or join practices or clinics in medically underserved communities.
One quarter of New York’s population lives in areas considered underserved by health care providers. Typically, these areas are rural or urban.
In a statement, Gov. David Paterson said, “Today we took an important step forward in transforming our health care system to lower costs, increase access and invest in primary and preventive care.”
To see AHRQ’s state snapshots, visit www.ahrq.gov
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