Ending Segregated Care in New York Hospitals

Presentation to the NYS Assembly/Senate Puerto Rican and Hispanic Task Force

February 29, 2012

Separate & Unequal

About Us:

Bronx Health REACH is a coalition of over 70 community-based organizations, health care providers and faith-based institutions, led by the Institute for Family Health. It is dedicated to eliminating racial and ethnic disparities in health outcomes in African American and Latino communities in NYC.

New York Lawyers for the Public Interest is a nonprofit civil rights law firm committed to advancing health justice, disability rights and environmental justice through community lawyering and partnerships with the private bar.

The Institute for Family Health is a federally-qualified community health center (FQHC) network that provides primary health services to medically underserved populations and trains primary care providers.

Partners:

Bronx Health REACH Coalition

Community Based Organizations

Faith-Based Organizations

Lawyers & Advocates

Elected Officials

Health Professionals & Advocates

Patients

General Teaching Hospital

Privately Insured Medicaid & Uninsured

ClinicFaculty Practice

Segregation by Insurance: Inequalities in Care

FACULTY PRACTICE CLINIC

Who gets seen there Privately insured patients Uninsured and Medicaid patients

Providers Board-certified faculty physicians

Students, residents and fellows

Continuity Each patient has their own private doctor

Rotating group of doctors in training

Coordination of Care Good reports – doctors want referrals

No coordination or communication

Night Coverage Doctors are on call for their practice

Go to the Emergency Room

If the person needs hospital care

Doctors take care of their own patients

Another group of doctors takes over who don’t know the patient

Separate and Unequal Care:• Separate Care:

– Patients seeking care at NY hospitals, particularly those attached to medical schools, are segregated into a two-tiered system of care based on their insurance.

– Patients with private insurance are seen in private offices known as “Faculty Practices,” while patients who are on public insurance or are uninsured are seen in the “Clinic” system.

• Unequal Quality of Care:– Patients in the clinics are usually seen by students and residents who rotate in and out

of the clinic every few weeks. In contrast, patients seen in the faculty practices are generally seen by board-certified physicians.

– Patients in the clinics rarely have access to their doctors during emergencies, while patients seen in the faculty practices usually have 24/7 access by telephone.

These differences affect quality, coordination andcontinuity of care, and contribute to different health outcomes for patients seen in different settings.

Effect of Inequalities of Care on Patient Health and Healthcare Costs:

• The current system does not promote continuity of care, which has been linked to:– increased preventive care– earlier identification of chronic illness– reduced hospitalization– fewer complications– better follow-up – greater patient satisfaction– COST SAVINGS

• In addition, clinic patients rely on the emergency room for after-hours care since they cannot access their physicians, which results in costlier care

Correlation between Race & Insurance:

White Black Hispanic0

10

20

30

40

50

60

70

13.9

33.4 37.98.8

14.4

23.3

UninsuredMedicaid

% o

f pop

ulati

on o

n M

edic

aid

or U

nins

ured

Health Insurance in New York, United Hospital Fund, 2009

New York State

Coalition Voices:

• Bronx Health REACH educates community members about health disparities and provides them with resources to advocate for their rights

• We have collected testimony from numerous patients who have received unequal treatment based on their insurance status:– Ms. Emma Torres– Mr. Antonio Torres

• The coalition also works with health care providers to learn about their experiences in this system, and to identify examples of integrated models of care:– Dr. Bert Petersen – Director, Breast Surgery Clinic

at St. Barnabas Hospital and Associate Professor, Dept of Surgery at NYU School of Medicine

Health Equity Bill: S5785/A07699

The Health Equity Bill ensures that all Patients receive affordable, quality health care regardless of their type of insurance.

The bill: • Prohibits steering patients into separate

facilities and requires patients seen in hospital-based clinics be treated by integrated care teams

• Requires improved notification of financial assistance services through the hospital’s website and its physician referral line

• Requires hospitals to make best efforts to negotiate with Medicaid managed care plans

Legal Issues: What is this bill based on?

In 2008, Bronx Health REACH and New York Lawyers for the Public Interest filed a complaint with the NYS Attorney General alleging that hospital steering practices violated civil rights laws, including: • Title VI of the Civil Rights Act of 1964• Hill-Burton Act• New York City Human Rights Law

Title VI of the Civil Rights of 1964:

“No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”

Title VI Prohibits:

• Intentionally discriminating on the basis of race, color or national origin

•Engaging in conduct that has a disparate impact on the basis of race, color or national origin

Hill-Burton Act “Community Service Obligation”:

• Requires hospitals to make their services available to people living in the hospital’s service area without discrimination on any ground – including race, color or national origin – unrelated to the need for or availability of that service

• Explicitly prohibits discrimination against Medicaid beneficiaries

14

State and City Regulations:

New York State Patients’ Bill of Rights • prohibits discrimination on the basis of source of payment and

race/national origin

The New York City Human Rights Law • similar to Title VI – prohibits disparate impact discrimination

For more information, please contact:

212-633-0800 ext. 1232 212-244-4664 bronxhealthreach.org nylpi.org