State lawmakers continue to review Governor Hochul’s $252 billion proposed budget. This week’s big hearing focuses on health care – by far the largest chunk of state spending. According to the governor, New York is expected to spend over $100 billion of the $252 billion proposed budget on health care.
That’s a lot of money and it dwarfs all other spending. With that much of the state budget focused on health care, a good question to ask is how well does the system work?
Of course, defining how well a system works depends on how you look at it. New York State has one of the highest rates of health coverage in the nation, with about 95 percent of the public covered.
But when it comes to the quality of hospital care, New York lags.
Why does this matter? First off, no one wants to go to the hospital and get hurt. In November 1999 the Institute of Medicine report, To Err is Human: Building a Safer Health System, was released. It documented a veritable epidemic of tens of thousands of preventable deaths in United States hospitals. Then in 2013, a widely-covered study published in the Journal of Patient Safety reported that nearly 400,000 U.S. hospital patient deaths each year were preventable.
Those numbers are staggering. And experts now consider deaths due to medical mistakes as the third leading cause of death in America, behind heart disease and cancer.
Second, poor quality care is a waste of money. According to experts, higher quality care is less expensive care. Thus, developing recommendations to improve the quality of care will not only lessen unnecessary patient injuries and deaths, but will also make the system more efficient in its use of public dollars.
A key way to improve patient safety is making the quality of health care delivery transparent.
Perhaps the most comprehensive safety guide is the hospital ranking issued by The Leapfrog Group (http://www.leapfroggroup.org/). Leapfrog was created over 20 years ago by large businesses that were frustrated by the lack of quality health data. The businesses usually negotiated coverage for their employees yet lacked the data to comparison shop. The Group issues its ranking twice a year.
In its most recent report, Leapfrog Group found that New York State ranked 34th nationwide in terms of quality, with only one fifth of hospitals receiving an “A” grade. In addition, according to Leapfrog, New York’s hospitals ranked seventh nationwide in terms of having the highest percentage of poor-quality grades – and has the most hospitals in that category overall.
Why do New York hospitals perform comparatively so much worse? In July 2019 the director of Leapfrog Group, explained what she knew about New York’s hospital safety:
“The system as a whole didn’t seem to have emphasized safety. We’ve seen other states work together and look at what’s working well at other states and implement it. It just doesn’t seem to be happening in New York. It has to be front of mind every single day in a hospital.”
New York State is the single biggest non-federal “purchaser” of health care through its Medicaid program and Essential Plan (projected to be approximately $124 billion combined) alone and its funding of the state employee health insurance programs, Empire Plan and NYSHIP. Yet, as seen in the Leapfrog Safety Grades, the state simply does little to ensure that the quality and value of the health care services paid for with taxpayer money meets the highest standards.
New York has a fiduciary responsibility to the taxpayers to leverage its buying power in ways that reward safety, quality and efficiency, and penalize those who fail to meet standards of high-value, high-quality health care. It is time for New York policymakers to ensure that the state is doing all it can to embrace “prudent purchaser” programs that drive patient safety.
These analyses raise serious questions for New York’s lawmakers considering the health budget. Questions should be asked of the Health Department, such as why did New York State hospitals rank so poorly? What has the Health Department done to respond to the national rankings that have consistently found poor quality in state hospitals?
Failing to get answers to those questions not only costs taxpayers money but puts too many New Yorkers’ health at risk.