Strengthen, don’t shred, safety-net hospitals
Dr. Donna-Marie Manasseh
New York Daily News
Dr. Donna-Marie Manasseh
New York Daily News
After the last two years, one thing is clear: The American health-care system is poised for change. While we face profound challenges driven by the COVID-19 pandemic, a rapidly shifting economic landscape and evolving patient needs, we also have an opportunity and responsibility to reshape the way we treat patients. This is a critical moment to build a system that is more equitable, inclusive and community-centered.
To do so, we must fundamentally change how health care is financed.
My hospital, Maimonides Medical Center in Brooklyn, offers a case study in contrast, where the very best of American medicine lives side by side with the structural challenges rooted in how our health-care system is organized and funded. As Brooklyn’s largest hospital, Maimonides anchors a health system serving a diverse set of communities across the borough, including many of the most vulnerable New Yorkers. We have introduced numerous services that did not previously exist in Brooklyn, including the borough’s first fully-accredited breast center built by Dr. Patrick Borgen, which I have the privilege to lead with him and Dr. Christina Giuliano.
Our core principle is simple: The people of Brooklyn should be able to access the highest-quality care, in a culturally competent manner, right here in their backyard. In pursuit of that goal, we have recruited talented clinicians from across the country, invested in the latest medical technology, and built meaningful bridges to diverse communities.
The results speak for themselves: We have been able to achieve some of the nation’s best outcomes for patients in a number of specialties, all while delivering that care in a way that is responsive to the enormous variety of languages, religious traditions and cultural preferences in the communities we serve.
But over the past two decades, our commitment to delivering high-quality health care to all has become complicated by an outdated reimbursement system. Half of our patients are insured by Medicaid, making Maimonides a critical part of the health-care safety net for hundreds of thousands of Brooklynites. Measured against inflation, Medicaid reimbursement levels have been drastically cut over the years, creating a gap between what Medicaid pays hospitals and the actual cost to deliver care. As of last year, Medicaid covered just 61 cents for every dollar of care provided — whereas private insurance generally covers the cost of care and sometimes much more.
The outcome of this broken funding model is predictable and only serves to deepen longstanding inequalities. Institutions like ours that disproportionately serve lower-income communities simply have far fewer resources than those predominantly serving affluent neighborhoods. This means we must pursue our mission to deliver care to those who need it most with older, more crowded facilities, fewer amenities, and the resulting lower patient satisfaction scores.
While safety net hospitals face the unique problem of being historically underfunded, this is layered onto systemic challenges facing hospitals writ large, including an archaic and fragmented fee-for-service payment system focused too much on volume rather than outcomes. We are forced to navigate the complex requirements of hundreds of different insurance plans just to get paid for our work delivering care. Add in a staff facing unprecedented burnout and post-traumatic stress, as well as skyrocketing supply costs and labor shortages, and the challenges faced by every hospital system are clear as day.
Given the increasingly difficult environment we are navigating, it should come as no surprise that residents of areas served by safety net institutions are demanding a more responsive, equitable system and a better experience when they get care. Thanks to health-care workers and ever-advancing knowledge and technology, we can proudly say that a patient with a life-threatening condition has a better chance of survival than ever before. At the same time, that patient’s experience of care is very much marked by the strain under which the system is operating.
Fortunately, leaders in Albany have recognized the value of our services and the inequities of a payment model that punishes hospitals built to serve underserved communities. I applaud our state leaders who are making the first systematic attempt to address this issue in at least a decade, accompanied by significant investments in safety-net hospitals. My colleagues and I are committed to working with every well-meaning stakeholder to right this wrong.
Undermining institutions like mine, which function within a deeply imperfect system, will not lead to better care or a more equitable allocation of health care dollars; if anything, it will set these efforts back. Even as we seek change, we need to build on, not sacrifice, our strengths. It is essential that all of us who care about creating better, more equitable health care focus on how we can support systemic change that will truly work for all communities.
Manasseh is the chief of the division of breast surgery and director of the Maimonides Breast Program in Brooklyn.
If you are a Maimonides employee and/or live or work in Brooklyn, let your elected officials know how this misleading campaign makes you feel, and advocate for a more equitable model of healthcare funding distribution. Find who your representatives are at mygovnyc.org.
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