Testimonies/Reports

Regional Hearing: Report of the Commission on Healthcare Facilities in the 21st Century

Testimony before the State Assembly Health Committee on the Report of the Commission on Health Care Facilities in the 21st Century, December 11, 2006, Buffalo, NY.

Good afternoon. My name is Dennis Lindell. I am a registered nurse and co-chair of the New York State Nurses Association bargaining unit at Erie County Medical Center.

The process used to create the Berger Commission report was flawed from the beginning. The Commission was given the foregone conclusion that hospitals and nursing homes needed to be “right-sized.” It then manipulated data to support that assumption. This information was analyzed behind closed doors, with little or no input from the communities that would be affected.

As might be expected, we now have a flawed report which, if implemented, will hurt more than it heals. NYSNA is urging the State Legislature to reject these recommendations and use this opportunity to undertake a comprehensive review of the state’s healthcare delivery system. At the very least, the time period for implementing the recommendations should be extended to allow more time for public input and a thorough analysis of the impact of these proposals.

Our concern is that state leaders will implement these recommendations as a “quick fix” and fail to take other steps that are needed for true healthcare reform in New York.

The report’s executive summary states that “a fundamental driver of the crisis in our healthcare delivery system is excess capacity.” Without any documentation, the report claims that “hospitalizations expand in relation to the number of available beds” and accuses healthcare facilities of admitting patients solely to generate revenue.
Nurses, who provide most of the care to patients in hospitals, firmly disagree with this statement. The acuity of the patient population actually has increased over the past ten years. Due to pressure from insurers, patients are less likely to be admitted and are discharged from the hospital more quickly.

In general, NYSNA sees the following major problems with the Commission’s report:

1. The recommendations concern only hospitals and nursing homes.
   The continuum of care extends beyond these facilities to home care, ambulatory care, psychiatric facilities, and more. These settings must be included in any plan to revamp our state’s healthcare system. It is potentially devastating, for example, to close nursing home beds and not provide funding to expand and improve non-institutional care for the elderly, disabled, and mentally ill.
   
   
2. The report implies that excess beds mean excess staff.
   The facilities where our members work are far from overstaffed. A report released last January by Governor-Elect Spitzer found that a majority of nursing homes in the state were staffed below federal guidelines. Thousands NYSNA members working in acute-care and long-term care facilities have filed protests claiming that their patient load is too high and they are concerned about being able to provide safe nursing care.
   
   
3. The report does not address the inevitable displacement of nurses and its effect on the nursing shortage.
   Nurses will lose their jobs due to these recommendations. Contrary to popular opinion, it will not be easy for RNs just go work at another facility, nursing shortage or not. Nurses who are close to retirement have already told us they will not seek new positions in direct care. Others will require education – not just “retraining” – to perform effectively in new specialties and practice settings. Unless there is a funded program in place to meet their needs, these nurses will be lost to the profession and the nursing shortage will worsen.
   
   
4. The report is biased against public healthcare facilities.
   By recommending that public facilities merge with private ones, the report ignores the vital role played by publicly operated hospitals and nursing homes. These facilities allow government to fulfill its responsibility to ensure that the poor, the uninsured, and the underinsured are not left without care. For example, in the 1970s, when AIDS patients were being turned away from private hospitals, public hospitals admitted and cared for them. Public healthcare facilities are a safety net we can’t afford to lose.

Erie County Medical Center is an example of this type of facility. It offers a wide range of services to the residents of Erie County and surrounding communities. According to the Commission’s own report, ECMC has one of the highest case mixes in New York State. Each year, 12,000 patients are discharged and 48,000 are treated in the emergency department. The medical center has a skilled nursing facility, in addition to the long-term care beds at Erie County Home. The Commission acknowledges that all of these beds are occupied.

Most important, fully one quarter of the patients at ECMC are on Medicaid or have no health insurance. The medical center serves as a giant safety net for the region, admitting patients who have nowhere else to go and giving them top-quality care.

Despite these facts, the Commission recommends that ECMC be dissolved, along with Buffalo General Hospital, and that a new hospital governing entity be created. It is unclear why this is necessary, especially when the medical center is barely two years into operation as a public benefit corporation and projects a surplus for this fiscal year.

If, as the Commission insists, Erie County is “overbedded,” why not require a reduction in the number of beds, as it has done in other parts of the state? The proposed merger is extremely complicated. It would require the Legislature to pass legislation revoking the Public Benefit Corporation formed and cost millions of dollars in redesigning or building infrastructure.

One possible reason can be found in the Commission’s repeated reference to excess labor costs and fringe benefits that must be paid by ECMC to members of an unnamed public employee union. It is not surprising that the management of both hospitals would welcome a new entity where employees were not unionized. It is also not surprising that the CEOs of both Kaleida Health and ECMC were on the Commission’s Regional Advisory Committee.

NYSNA and its members urge the Legislature to reject this report and take action that will truly reform health care and reduce costs, such as:

• Establish universal healthcare coverage in New York to make affordable care available to everyone – one of the policy recommendations made by the Commission itself. A system based on coverage by private, for-profit insurance companies is a major driver of healthcare costs and does not improve the quality of health care.
• Ensure that comprehensive, quality health care can be accessed by all New Yorkers through the removal of barriers based on culture, ethnic background, geography, and language.
• Invest in ensuring an adequate nursing workforce now and in the future. Nurses are the most numerous healthcare providers and staffing shortages lead to more patient complications, longer hospital stays, and higher costs.
• Reform healthcare financing and address fundamental problems with the current reimbursement structure.
• Develop an effective system for monitoring and disclosing the quality of care provided in hospitals and nursing homes. Of particular value are patient outcomes that are specifically related to nursing care.

Thank you for the opportunity to submit testimony. NYSNA looks forward to working with the legislature to craft a healthcare system in New York that will be a model for the entire nation.

For more information, contact Governmental Affairs at 518.782.9400, ext. 283 or by e-mail.