In the first year of Governor Andrew Cuomo’s tenure in 2011, he successfully established a Medicaid Task Force whose job was to figure out ways to curtail the program’s increasing costs.  The idea was to bring together Medicaid “stakeholders” and design programs to limit Medicaid spending.  That effort became known as the Medicaid Global Spending Cap program and was a component of the then-governor’s plans to keep the overall state budget at no more than a 2 percent annual increase.

One of the major components of the Medicaid Global Cap was a new program to limit the financial exposure of hospitals where a baby was born with catastrophic neurological damage due to medical malpractice.  The Medical Indemnity Fund offset the medical malpractice by shifting those payments from the hospitals’ insurance to the taxpayer.  Under the program, the future medical costs of treating a neurologically-impaired baby would be covered by the state.  In that way, the financial exposure of hospitals was limited and, at least theoretically, the lifetime medical needs of the injured baby would be covered – the money would never run out.

Unfortunately, it didn’t work out that way.  Earlier this Spring, the program ran out of money.  The Department of Health announced that it had run out of money and could not take new enrollees.  In this year’s budget, no new money was allocated so the families in the process of enrolling were now unsure if they would have the coverage needed for their neurologically impaired children.  This is devastating news for those families and threatens the precarious health of their children.

This past weekend, The New York Times reported that the state would add revenues in order to keep the program running for at least another year.  However, the Hochul Administration commented about the mushrooming costs that could put the program’s survival in jeopardy.

The overall financial health of the program only is sustainable if the state is doing all it can to reduce the number of injuries – thus keeping costs down as well as reducing the number of families caring for seriously injured children.  And in fact, New York pledged to do just that by instituting new safety protocols, such as increased staffing and training, to reduce the number of birth injuries.  Again according to the Times, no such reduction in cases has occurred: “Where actuaries predicted that roughly one in 10,000 children would be eligible for the fund as a result of a brain or spinal cord injury in 2011, by 2014 they were expecting nearly three times that number.”

In retrospect, that outcome is not surprising.  When it comes to patient safety, New York’s track record is not good.

The U.S. Department of Health and Human Services annually publishes Medicare.gov/Compare, which reports the quality of the nation’s hospitals and other providers to the public.  Researchers use that information to compare states.  One national organization, the “Leapfrog Group” (established by the nation’s large employers in 2000 in order to measure “hospital performance, empowering purchasers to find the highest-value care and giving consumers the lifesaving information they need to make informed decisions”) has issued annual reports on the quality of American hospital care for over 20 years.  Over those two decades New York has been consistently ranked poorly.

Earlier this month, in its latest annual report Leapfrog Group’s analysis found that New York State ranked 39^th nationwide in terms of quality, well behind large diverse states like California (ranked 19^th), Florida (12^th), Massachusetts (30^th), Pennsylvania (7^th), and Texas (23^rd).  Of New York’s 144 hospitals, only 17 received an “A” grade.

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.” 

The Leapfrog Group data relies on Medicare information, so these rankings do not directly explain what’s going on in the Medical Indemnity Fund (MIF).  But in a state that doesn’t “seem to have emphasized safety,” it isn’t much of a jump to conclude that in too many New York hospitals, the overall quality of care is below the national standard, Leapfrog says.  And when it comes to the MIF, that takes a bite out of the state’s revenues – putting taxpayers on the hook for the substantial costs of caring for children injured by the poor quality of hospital care.

When we go to the hospital, we should expect that all is being done to make us better, not worse.  It seems too often that isn’t happening in New York.  As state lawmakers deal with the MIF problem, they should look to the broader issue of weak patient safety.  When it comes to patient safety, New York policymakers should follow the Hippocratic Oath to “first do no harm.”