Process begins to reshape NNY health care landscape

By Ted Booker

ALBANY — The process that will shape the health care landscape in the north country over the next five years began in Albany on Wednesday.

An 18-member oversight panel approved “performing provider system” applications for Central New York, which includes Lewis County General Hospital of Lowville and the Adirondack Health Institute, which includes Canton-Potsdam Hospital of Potsdam and Massena Memorial Hospital. 

Over a three-day period ending Friday, the panel is assigning scores for 25 Performing Provider System applications statewide in the state’s new Delivery System Reform Incentive Payment program.

The review process will determine how much hospital funding each PPS will be tentatively awarded over a five-year period — but they’ll need to achieve annual milestones to earn it.

In March, each PPS will be awarded funding from a $6.42 billion pool for the program. The state Department of Health has set a goal of preventing avoidable hospital visits by 25 percent over the period, urging hospitals to consolidate services and team up with primary-care providers and other agencies.

The panel — whose members were hand-picked by the DOH — is set to review the Samaritan Medical Center PPS application Friday morning. In addition to Samaritan, hospitals in the PPS are Carthage Area Hospital, River Hospital of Alexandria Bay, Clifton-Fine Hospital of Star Lake, Claxton-Hepburn Medical Center of Ogdensburg and Massena Memorial Hospital, which is also affiliated with the Adirondack PPS.

A schedule of the hour-long PPS reviews through Friday, which are webcast live, is available at wdt.me/pSup8E.

PAID BY PERFORMANCE

Panelist William L. Owens, former representative of the 21st Congressional District, told the Times on Wednesday that while some PPS applicants tentatively will be awarded more funding than others, they won’t earn it all unless they achieve milestones established by their plans. He said the scores for applications — decided on by a group of independent assessors — have ranged from the low 80s to mid-90s.

“The dollar amount actually received by the applicant will be determined by their performance against the proposal,” Mr. Owens said.

If a PPS received a score of 95, for example, it would not receive the entire amount of awarded funding if the applicant doesn’t meet milestones to perform at that level, Mr. Owens said. If a PPS received a score of 85 and exceeds expectations in its plan, it would then receive more than the funding initially awarded.

Awarded funding “will be what you can possibly secure over the five-year period,” Mr. Owens said.

Wednesday, the panel had the chance to disagree with scores for each PPS by voting to increase or decrease them, affecting how much funding would be awarded. Scores were already established before the panel review by a group of six independent assessors from Public Consulting Group of Buffalo.

Each PPS was allowed to pursue five to 11 projects, which received a score out of 100 points. If a PPS proposed 11 projects, for example, their overall score would be based on 1,100 points. The panel changed the score established for the Central New York PPS, but it slightly increased the score for the AHI PPS by adding two points to one project. Total scores were not disclosed Wednesday by the panel.

Mr. Owens said changes made to scores by the panel will only have a marginal impact on their overall score.

“As long as the evaluation has not made a change in a gross area and the scoring is within a narrow band, I don’t believe there’s going to be a significant impact,” he said.

Mr. Owens said he recused himself from voting on the PPS application for Adirondack because the hospital is a client of his law firm, McKenna, Long & Aldridge of Washington, D.C.

CHANGES IN LEWIS COUNTY

Mr. Owens said Lewis County General Hospital’s decision to be affiliated with the Central New York PPS makes sense because it will benefit from being served by larger hospitals in the Syracuse area.

“If you’re going to have to transport a patient either to Samaritan or Syracuse, they may have made the decision that they believe their patients would be better off in the Syracuse area because you have larger institutions,” he said. “They may have a greater number of specialty providers, and it could be the population was saying they prefer to go to Syracuse rather than Watertown for their care.”

The lead agents of the PPS are Upstate University Hospital of Syracuse, St. Joseph’s Hospital Health Center, Auburn Community Hospital and Faxton St. Luke’s Health Care. The four hospitals originally planned to establish their own PPS applications, but they reversed course last year and decided to form one PPS. The PPS — called the CNY Care Collaborative — will be governed by a 22-member board of directors. The board will include 11 representatives from hospitals and 11 from community groups, and all decisions will require a two-thirds majority vote, according to Shawna Craigmile, project manager for the collaborative.

“We were challenged by our rural communities saying, ‘We don’t want this to be Syracuse-centric or hospital-centric,” Ms. Craigmile said during a presentation Wednesday morning. “The experience of our Medicaid population varies in regard to access of quality care between an urban and rural setting. Someone in Syracuse may choose to go to an ER for a non-acute condition, but someone in Oswego County or Lewis County might not do that and wait until their condition becomes worse. We want to make sure the diversity across urban and rural populations is very well represented.”

Major challenges health care providers face in the PPS include providing sufficient prenatal care services and transportation for low-income residents, according to Michael Kelleher, an independent assessor. He pointed out that the PPS covers 9,700 square miles — roughly the size of Vermont.

“It goes from a dense, urban population in Syracuse and Utica to rural areas. Lewis County has 27,000 people,” Mr. Kelleher said, adding that Upstate serves a population of about 1.8 million in Syracuse. “It’s a broad area and transportation is a significant problem for access to care ... About 32 percent of the population is low-income, about double the regional rate. So lack of employment and transportation are issues.”

After the presentation, Mr. Owens asked how the PPS plans to solve transportation problems in the regions that have restricted access to care.

“If they need the transportation system to bring people for care and return them home, will they get funding in advance to create the transportation system, or is that funding a result of achieving a goal?” he said.

In response, Jason Helgerson, New York state Medicaid director, said that transportation services are already covered by Medicaid and would not be aided by DSRIP funding. But “I think the issue is that in some rural communities there is a lack of providers,” he said, “so I think the issue is to better connect them to that manager so they have better access to transportation.”

Mr. Owens told the Times that transportation issues are especially a concern in rural Lewis and Oswego counties, because people will need to travel long distances to receive care.

“It’s a significant issue in those two counties, just like it would be for large sections of Jefferson County,” he said. “In more urban settings they may well have access to public transportation, and that may mean providing a voucher to someone. But in rural areas you have limited options, and in many cases you don’t have cabs or buses. You have to come up with some form of rural transportation system that delivers people to health care providers.”

TEAMWORK IN ADIRONDACKS

During the panel’s review of the AHI PPS application, Mr. Helgerson praised the region for having already established a strong collaborative network. Based in the eastern half of Northern New York, the 14-hospital region’s management structure includes Adirondack Medical Center in Saranac Lake, Hudson Headwaters Health Network and Glens Falls Hospital. The 11,000-square-mile region runs from Malone to Gloversville and it is geographically one of the largest proposed networks in the state.

“They have been actively involved in one of the nation’s most successful patient medical-home pilots that brought together a whole array of providers who have actively participated in the Medicaid program,” he said. “That positions them well, because they have already been collaborating. I would say that Adirondack is one of the furthest and most advanced from an implementation standpoint.”

Mr. Owens said that Massena Memorial’s choice to be affiliated with both the AHI and Samaritan PPS proposals is not uncommon. He said the hospital will be awarded funding based on the number of patients it serves within the boundaries of both districts.

“Massena has people who come to it from the east and the west, so I believe people are going to want to go to Samaritan and the Adirondack Health Institute for care,” he said. “So we want to make sure we have access to both of those areas.”

Of Canton-Potsdam’s decision to affiliate with the AHI PPS, Mr. Owens said, “I think that’s a geographic decision. They’re physically closer to the eastern side of the district and they have a relationship with Fletcher Allen hospital (Fletcher Allen Health Care, now the University of Vermont Medical Center, Burlington, Vt.).” 

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