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GUEST VIEW By Joseph A. Ruffolo

Gov. Andrew M. Cuomo's Medicaid Redesign Team has been given a March 1 deadline to submit initial findings and recommendations for genuine reforms that improve the quality of care while lowering Medicaid costs.

One of its first objectives, a commendable one, is to hear the concerns and recommendations of Medicaid stakeholders -- including patients, care providers, local governments and taxpayers. To do so, the team is holding a series of seven public hearings all across the state. The first such hearing took place Jan. 19 in Buffalo.

The Buffalo hearing gave Niagara Falls Memorial Medical Center an opportunity to publicly state our readiness to assist Gov. Cuomo and his hand-picked Redesign Team in this important work.

However, we also made it clear that another round of "one-size-fits-all" across-the-board Medicaid cuts would sound the death knell for many of the state's most vulnerable hospitals. Essential safety-net hospitals such as Niagara Falls Memorial must be identified and preserved despite the state's budget crisis. Like other hospitals in New York, Niagara Falls Memorial has endured nine consecutive rounds of state budget cuts.

But since such a large share of Memorial's revenues derives from serving at-risk Medicaid patients, Medicaid cuts have hit us harder than most hospitals.

In addition, the new Medicaid rate-setting method, or rebasing, implemented by the state in December 2009 hit Memorial and seven other urban and rural hospitals in the state exceptionally hard, cutting our Medicaid revenues by $2.35 million, or 54 percent annually, the eighth highest percentage in the state.

To put that in perspective, the average loss for all New York hospitals was a 7.8 percent reduction in Medicaid revenue. Although transition funding has helped ease the pain, that funding will be phased out in 2013.

We believe the state should stabilize the most at-risk essential hospitals -- those that serve the highest proportion of economically distressed, vulnerable patients -- through across-the-board or service-specific funding restorations.

Consideration also should be given to:

Let me make clear that Memorial is not asking to be exempt from measures that truly reform how we deliver Medicaid services. We know our responsibilities and have already voluntarily acted to reform healthcare in the Niagara community.

Memorial is voluntarily implementing innovative, quantifiable, cost-saving measures to reduce inappropriate readmissions and emergency room usage in both the medical/surgical and behavioral health areas.

Over the past year, for example, Memorial achieved a reduction of 218 ambulatory care-sensitive hospital admissions involving chronic conditions that could be treated on an outpatient basis. This saved the healthcare system $1.35 million in one year alone. Hospitals throughout New York should be incentivized to produce similar results.

Additionally, Memorial is one of 147 hospitals in the nation selected by the Robert Wood Johnson Foundation to participate in a collaborative effort to reduce the rate of hospital readmissions for patients with heart failure.

The state can significantly reduce Medicaid spending by incentivizing hospitals to find meaningful alternatives to readmission -- not just for heart failure patients but for patients with pneumonia and other chronic conditions such as diabetes. These are the kinds of real reforms that are sustainable and can save the healthcare systems millions of dollars per year.

Joseph A. Ruffolo is president and CEO of NFMMC.

Niagara Falls Reporter www.niagarafallsreporter.com Feb. 8, 2011