Provides quality out-patient specialty care for patients of academic medical centers regardless of source of payment or insurance type and improving access to specialty care

Summary of provisions

Section 2 creates a new sub-section in the public health law that prohibits 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 also requires that outpatient specialty care be provided by integrated teams of medical professionals, consisting of both attending physicians and resident doctors receiving on-site supervision from faculty physicians. This section will not apply to the New York City Health and Hospitals Corporation.

Section 3 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 4 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 hospital are credentialed by the available plans. Section 4 also requires hospitals to submit a strategic plan describing their goals and efforts to meet the requirements of this section.

Section 5 provides for an effective date 270 days after enactment and gives the department the power to promulgate regulations.

Justification

This bill requires private academic medical centers to implement an integrated system of outpatient specialty care. Under this integrated system, academic medical centers will be required to treat all patients who contact the hospital for specialty outpatient care in the same place and at the same time, regardless of insurance type or source of payment.

Currently, academic medical centers operate a two-tiered system of out-patient specialty care, in which patients are sorted into the medical centers' faculty practices or clinics depending upon their source of payment or insurance status. Within this two-tiered system of out-patient specialty care, privately insured patients are treated at faculty practices while Medicaid and uninsured patients are

treated at the hospital-based clinics, even if both types of patients are seeking care for the same problem.

Once separated into different systems of care, the Medicaid and uninsured patients are not given access to the same services as privately insured patients. For example, privately insured patients are able to see highly experienced faculty physicians to whom they have twenty-four hour access, resulting in continuity of care and good care coordination. Medicaid or uninsured patients, by contrast, only have access to rotating student doctors, who are less able to provide the continuity of care or care coordination that is so critical for patients who suffer from chronic or serious medical conditions.

Furthermore, these student doctors often lack adequate supervision from attending physicians, who are not required by the academic medical centers to spend sufficient time supervising residents and caring for patients in the clinics. In cases of emergency, Medicaid and uninsured patients only have access to the hospital's emergency room, and not to a 24-hour call service as the privately insured patients do, which contributes to emergency room overcrowding as well as higher health care costs.

The difference in access to care experienced by patients based on their insurance status contributes to disparities in racial and ethnic disparities in health outcomes, particularly since blacks and Hispanics are disproportionately represented among Medicaid beneficiaries and the uninsured. In addition, the system is economically wasteful, as it allows two systems of care to operate within one facility and it causes Medicaid and other state dollars to be spent on inferior care. Finally, the system runs counter to current state health policy, which is increasingly focused on patient-centered medical homes and similar innovative strategies to achieve care coordination for Medicaid beneficiaries and cost reduction for the state's health care system.

It is therefore the intent of this bill to eliminate this separate and unequal system of care by requiring private academic teaching hospitals to care for all patients, regardless of insurance type or source of payment, in the same place and at the same time. The objective is to ensure that academic medical centers, which receive millions of dollars every year through the Medicaid program and the state's indigent care pool, do not limit access to care and services to patients in whose name those funds are given.

Lastly, this bill will ensure that all patients are made aware of hospital financial assistance policies through the hospital's website and patient referral line and require that New York general hospitals make reasonable efforts to negotiate with Medicaid managed care plans in their social services districts to ensure that all medical service providers employed by the general hospitals are credentialed by available plans.

Legislative history

S.7807 in the 2009-10 Legislative Session

Fiscal implications

None to the state.

Effective date

On the two hundred and seventieth day after it shall have become law.