Provides out-patient care for patients of academic medical centers regardless of source of payment or insurance type; provides improved notification to patients

Summary of specific provisions

Section 1 creates a new sub-section in the public health law which requires that the outpatient services of general hospitals in New York City be provided in the outpatient clinic that is owned and operated by the general hospital. This section prohib- its general hospitals from referring, steering or otherwise directing patients to private physicians' practices, including faculty practice corporations that are not licensed by the Department of Health, unless the general hospital does not accept the patient's insurance. This section will not apply to the New York City Health and Hospitals Corpo- ration.

Section 2 requires that patients be informed about the availability of hospital financial assistance through a notification on the hospital's website and through its physician referral line.

Section 3 requires general hospitals to make best efforts to negotiate with Medicaid managed care plans in their social service district to ensure that all medical service providers employed by the general hospi- tal are credentialed by the available plans. Section 3 also requires hospitals to submit a strategic plan describe their goals and efforts to meet the requirements of this section.

Section 4 provides for an effective date 270 days after enactment and gives the department the power to promulgate regulations.

Justification

In 2002, the Institute of Medicine (ION) published its Unequal Treatment report, which cast a strong national spotlight on the complex causes of racial and ethnic disparities in health care. The report described "how the financial and institutional arrangements of health systems have disparate and negative effects on minorities' abili- ty to attain quality care.

In New York City, private teaching hospitals operate a two tiered system of outpatient specialty care. Patients with private insurance are treat- ed in the hospitals' faculty practices. Patients who have Medicaid or

are uninsured are treated in the hospital-based specialty clinics. In the private teaching hospitals, faculty practices have more highly trained providers, greater communication between providers, 24-hour phone access, continuity of care, and accountability to both the patient and the referring primary care provider. Patients at specialty clinics, on the other hand, are far more likely to receive care from residents who are rotating in and out of clinics and are less able to provide the continuity of care that is critical to patients with chronic or serious conditions. Since insurance status is so closely linked to race in New York City, the sorting of patients into two separate and unequal systems of care contributes to the pervasive racial and ethnic disparities in health outcomes that have been documented by the IOM and others.

By contrast, New York City's public hospital system does not operate two separate systems of specialty care within its facilities.

This legislation will bring the private teaching hospitals operating in New York City in line with the integrated specialty care already being offered by the public system by requiring private hospitals to provide care in the same place at the same time to all regardless of insurance status. Specifically, this bill requires the expansion and improvement of the clinic-based system by requiring private hospitals to treat all patients, publicly insured, privately insured and uninsured, in the clinic setting. It would also prohibit private hospitals from steering patients into one care setting or another based on the type of insurance they have. This bill, by calling for the creation of a single locus of specialty care in the clinic setting, would ensure that all New Yorkers have access to the highest quality of care our health care institutions have to offer.

Prior legislative history

None.

Fiscal implications

None to the state.

Effective date

This bill shall take effect on the two hundred and seventieth day after it shall have become a law.