New Report Cautions That Hospital Closures Could Exacerbate Primary Care Capacity Gap in New York City

New York, NY —The Primary Care Development Corporation (PCDC) and the New York City Health and Hospitals Corporation (HHC) released a new report today that shows a primary care physician capacity shortage in New York City. Among other findings, the report indicated that more than half of communities in the City have a significant shortage of primary care physicians serving low-income New Yorkers. The report also highlights that 32% of the City’s primary care physicians available to low-income residents––528 of 1,665 physicians––are based in hospitals, making access to care for low-income New Yorkers highly vulnerable to hospital closures unless that capacity is replaced by an alternative source of primary care.

The analysis also found that unnecessary emergency room use and avoidable hospitalizations are particularly high in low-income communities and that New York City’s ambulatory care system is significantly underdeveloped compared to its inpatient system. This is true despite ample national research that shows that, while preserving and enhancing primary care capacity requires up-front investment, it produces health system savings and improved health outcomes over the mid- and long-term.

"If part of the problem is overspending on ‘sick’ care––meaning acute inpatient care, emergency room, and institution-based long-term care––then we must acknowledge that a central cause of that problem is insufficient access to true ‘health’ care––meaning, effective primary and preventive services that help communities stay healthy," said HHC President Alan D. Aviles. "Early detection and treatment of heart disease, cancer, HIV/AIDS and other serious health conditions not only extends and saves lives, it saves money by reducing the need for acute care and emergency services."

New York State currently is engaged in a long-awaited policy discussion about the size and shape of its health care system. A significant catalyst of this effort is the Commission on Health Care Facilities in the 21st Century. The Commission’s final report, due at the end of 2006, will include specific recommendations on hospital and long-term care facility restructuring and closures. Primary care has not yet been a priority focus of the Commission’s deliberations. With the approval of the Federal-State Healthcare Reform Partnership (F-SHRP) Medicaid §1115 waiver, however, the opportunity exists for real healthcare delivery system restructuring, which should include a deliberate plan to address primary care access.

The PCDC and HHC conducted an analysis of primary care physician availability and population vulnerability in New York City. The report includes an analysis of primary care physician capacity available to New York City’s residents, particularly low-income New Yorkers; primary care physician availability that may be affected by hospital closures; and considerations that policymakers should take into account to ensure that low-income or vulnerable New Yorkers’ health care access is not compromised when making hospital closure decisions.

In the report, PCDC and HHC call upon New York State policymakers to develop a comprehensive primary care strategy, including reforming the State’s reimbursement system which currently underpays for primary care and which, at a minimum, preserves or replaces existing primary care capacity if hospital restructurings/closures take place.

The current reimbursement system has not kept pace with how healthcare should be delivered today. HHC provides a full array of outpatient services, including comprehensive primacy care, at 11 acute care hospitals and six Diagnostic and Treatment Centers. A patient’s primary care visit at an HHC facility may include x-rays, lab work, and prescription drugs. These all-inclusive visits cost $275. The current New York Medicaid clinic reimbursement rate for HHC hospitals is $82 and $150 for our Diagnostic and Treatment Centers.

“Although great strides have been made over the last decade in expanding the City’s primary care infrastructure, especially by the Health and Hospitals Corporation and our organization, shortages still exist in parts of the City, “ said Ronda Kotelchuck, Executive Director of the Primary Care Development Corporation. “With the vast resources now marshaled to restructure the health care system, the State must seize this opportunity to create a comprehensive primary care strategy.”

Since 1993, PCDC has invested in 58 capital projects, valued at $172 million, which have developed approximately 490,000 feet of previously dilapidated or vacant space. The facilities PCDC invests in provide care for some 380,000 low-income New Yorkers and 1,800 permanent jobs in their communities. PCDC is working with another nine projects, valued at over $22 million, which are in development across the state. PCDC also has assisted over 230 primary care center teams at over 50 sites to implement changes that revolutionize how centers organize and deliver healthcare—reducing wait times and other barriers to care; increasing productivity, revenue, and patient and staff satisfaction; and providing patient-focused care. For more information about PCDC, visit www.pcdcny.org.

The Health and Hospitals Corporation (HHC), the largest municipal hospital and health care system in the country, is a $4.5 billion public benefit corporation that serves 1.3 million New Yorkers and nearly 450,000 who are uninsured. HHC provides medical, mental health, and substance abuse services through its 11 acute care hospitals, four skilled nursing facilities, six large diagnostic and treatment centers, and nearly 100 community based clinics. For more information about HHC, visit www.nyc.gov/hhc.