Remarks by Alan D. Aviles
President, NYC Health and Hospitals Corporation

Press conference to Announce Report About Primary Care Capacity Shortage in New York City and The Potential Impact of Hospital Closures

I’m Alan Aviles, President of the New York City Health and Hospitals Corporation. I’m joined by Ronda Kotelchuck, Executive Director of the Primary Care Development Corporation, and we are here to release a new report that warns how hospital closures could widen the gap in primary care capacity for the poor in New York City.

Yesterday, the federal government approved for the State of New York a much needed $1.5 billion dollars in funding to help restructure and make more efficient the state’s healthcare system, especially its hospital and nursing home industry.

How wisely that money is spent greatly depends on the work of the Commission on Health Care Facilities in the 21st Century which is chaired by Stephen Berger. There is an opportunity for the Commission to strongly endorse using a portion of these newly available federal funds to expand primary care services capacity which is inadequate in many communities in New York City.

The Commission has the enormous task of re-shaping the state-wide healthcare landscape through a strategic rightsizing of hospitals and nursing homes. The stated goal is to make our healthcare system more cost-efficient and, at the same time, strengthen its ability to meet the long term healthcare needs of New Yorkers.

It is our hope that the Commission and State policymakers ensure that efficiencies or savings gained by downsizing hospitals do not exacerbate disparities in primary care availability. The report we are releasing today is an important first step in helping to identify areas of greatest need and opportunity to improve care for all New Yorkers and especially those with low income.

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 patients and communities stay healthy.

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.

The failure to effectively treat chronic disease like hypertension, diabetes, asthma and depression on the front end of our health care system – through accessible primary and preventive care – results not only in needless suffering but needless expense. Again, too much attention on “sick” care and not enough attention on proactive “health” care simply contributes to more inpatient admissions, burgeoning intensive care units, and overcrowded emergency rooms. In fact, a disproportionate share of our Medicaid costs are driven by patients suffering the ravages of untreated or poorly treated chronic disease who end up in an intensive care unit or a skilled nursing home.

Our report makes clear that not only is there too little primary care available to meet the needs of low-income New Yorkers now; but that nearly a third of the available primary care capacity is provided in hospital-based clinics – and not just in public hospitals, but in most voluntary hospitals. Unfortunately, it appears that much of the deliberations regarding hospital restructuring in NYC has focused on reducing hospital beds and closing down facilities without extensive analysis as to how such reductions and closures may impact this critical source of the primary and preventive health services.

There also has been too little focus on a misaligned Medicaid reimbursement system. New York City’s public hospitals have invested heavily in building primary care capacity over the years and now provide nearly 2 million primary care visits each year. We do so even though the reimbursement under Medicaid for primary care visits has not been increased in the last 14 years and now covers less than one-third of the actual cost of the average comprehensive primary care visit at an HHC hospital.

This failure to adequately reimburse primary care – either in institutional settings or private physician offices -- creates powerful disincentives for the development of additional primary care capacity. The newly available $1.5 billion in federal healthcare restructuring funds presents a golden opportunity to realign healthcare reimbursement in favor of an expanded and more robust primary care system… to support the development of more primary care capacity as well as support more effective chronic disease management.

I will conclude by highlighting two key recommendations in our report.

One recommendation is that the Commission for Healthcare Facilities in the 21st Century should endorse, and the State should undertake, a primary care expansion strategy that includes reform of the current reimbursement scheme to support, rather than impede, robust and effective outpatient services that can improve the health of all New Yorkers.

The second is that the Commission should ensure that any hospital restructuring or closing does not diminish existing primary care services – and that primary care capacity, at a minimum, be preserved or replaced.

Now I’ll ask Ronda Kotelchuck to speak on behalf of the Primary Care Development Corporation and to share more specifics about the report we are releasing today.