healthsignals new york

Pataki's Budget, Part 3: Making decisions

The Governor's Budget differs from past ones in a subtle, but very important way. Rather than spreading the pain, he clearly made some decisions that favor one approach over another.

Prime example:

The big Medicaid cuts were targeted at hospitals and nursing homes. With a couple of minor exceptions, home health care was mostly left alone.

It comes down to this: people would rather be at home. Medicine and healthcare have advanced so that more can be. It's that simple, but that important. The Governor recognized that and acted on it. Kudos!

Full disclosure: I've mentioned this before, but some of you may be new here. My wife is President of the Home Care Association of New York State. We share many (but God knows not all) of the same biases.

Home visits are a financial challenge

Though the number of physician housecalls is growing, it's still tough to make it work financially. A local group, Homedical sees about 500 patients with four MDs and one NP. All of its patients are homebound.

But Homedical is having a tough time financially. Last week, they sent out an e-mail asking for donations and they followed it up with this story in the Albany Times-Union. They're looking for $300,000 ($600 per average patient) which I suspect is going to be tough unless they find an angel. 

One of Homedical's physicians, Dr. Roberta Miller, ran what I'm told was a quite innovative home care program through the Albany VA hospital. But she left the VA after an internal struggle that I still don't completely understand.

Comparative costs of post-acute care

The focus of this report (PDF) issued last February was long-term care hospitals, which don't have much presence in New York, but some of the other stats regarding costs of post-acute care were revealing. Democratic members of Congress's Joint Economic Committee released the study showing substantial differences in costs based on where care is received. Care provided through home health agencies cost $4,000; but $8,300 through skilled nursing facilities, $12,500 through inpatient rehab facilities; and $35,700 through long-term care hospitals.

We should keep these in mind when we talk about "swing-beds" which, to my mind, have always been more about finding new revenue sources for hospitals than about providing better care for patients.

Lots of new healthcare jobs in NYC

Jobs report from mid-November showed that New York City unemployment dropped to a three-year low (6.1% in October from 6.9% in September). One-quarter of the gain was in healthcare. From the New York Daily News:

The city's private sector added 36,700 jobs in October from a year ago, slightly above September's pace. Professional services and health care led the hiring surge, largely mirroring national trends. Accounting, computer consulting and company management added 17,300 new positions during the month. Over 9,000 were hired in health care, about half of those in home health services. (Emphasis added.)

One-quarter of the increase in jobs ... but, I'll bet that the vast majority of the home health jobs pay barely more than minimum wage.