Consumers need a say when health care changes
Another shift in the health care landscape of the Capital Region is likely this year, as Ellis Medicine has announced it is pursuing a partnership with a larger health system. The move by Ellis Medicine — itself the product of Ellis Hospital’s merger with the former St. Clare’s Hospital and Bellevue Women’s Hospital — is the latest example of a wave of consolidation among hospitals nationwide, and here in New York.
Almost every other hospital in the region is already in such a system. St. Peter’s Hospital and Memorial Hospital in Albany and Troy’s Samaritan and
St. Mary’s hospitals are all part of St. Peter’s Health Partners, a regional system that is itself part of a large national Catholic health system, Trinity. Albany Medical Center has recently created affiliations with both Saratoga Hospital and Columbia Memorial Hospital. St. Mary’s Hospital in Amsterdam is part of Ascension Health, the nation’s largest Catholic health system. Only Glens Falls Hospital and Nathan Littauer Hospital in Gloversville remain unaffiliated.
Why is all this hospital consolidation happening and what does it mean for consumers? One cause is the movement of medical care into outpatient settings, leaving unneeded hospital beds. Another factor is the rise of complicated reimbursement schemes that require the sophistication of a large hospital system. Hospitals joining systems also argue that the quality of care will be improved.
But hospital consolidation can also have negative consequences for affected
consumers. Local hospitals that join large systems are sometimes downsized, closed or transformed into outpatient facilities. Patients needing advanced care may be referred to academic medical centers located an hour or more away. Decision-making often shifts to out-of-town system executives who don’t know the community. Consolidation can also cause the price of health care to go up.
With such significant consequences for patients, it’s important that consumers have a say when their local hospitals are proposing mergers or other types of consolidation. But all too often, that doesn’t happen, according to a year-long study we recently completed with the support of the New York State Health Foundation. Our report, “Empowering New York Consumers in an Era of Hospital Consolidation,” concluded that New York’s 54-year-old Certificate of Need system of state hospital oversight needs to be updated to ensure that consumers are notified and engaged when their local hospitals propose to join health systems or plan to downsize, close or transform the way they deliver health services.
Our recommendations include requiring public hearings in affected communities prior to hospital closings or elimination of key services, such as maternity care or the emergency department. We urge that when health systems are taking over local hospitals, they be required to disclose whether services might be downsized or transferred elsewhere in the system, and predict whether the transaction might cause the price of health care to go up. We recommend changes to the state Department of Health website to make it easier for consumers to find information about proposed hospital consolidations and submit comments.
We also urge a stronger voice for consumers in the state decision-making through increased consumer representation on the state Public Health and Health Planning Council (PHHPC), which considers the most important hospital transactions. The PPHPC has only one consumer seat, and it has been vacant since 2016, while the majority of council members (including the chair) are employed by hospitals and other health providers. By contrast, in New Jersey and Maryland, the majority of hospital review board members are consumers, and in Delaware, the chair of the review board must be drawn from the “public at large.”
As hospital consolidation continues in the Capital Region and around the state, we hope to see an improved and more transparent state review process that informs, engages and carefully considers comments from the consumers whose health care will be dramatically affected.