United Hospital Fund has a long history of bringing together diverse perspectives to address critical challenges in health care in New York. In the current crisis, it’s more important than ever to hear from all parts of the health care system. Today’s commentary from Bob Hayes provides an important point of view from a leader of community health centers, which are an important part of our health care system, particularly for the underserved – UHF President Tony Shih
Disclaimer: The views presented here are of the authors and do not necessarily reflect the views of United Hospital Fund, its staff, or its board of directors.
The human casualties from COVID-19 are staggering. Now, this pandemic is also threatening the survival of one of the most critical elements of New York’s health care infrastructure: community health centers. At this moment of need, it is essential that our federal and state governments become aware of the looming bankruptcy of community health.
For a half century, community health centers in New York have stood out as the most patient-centered and cost-effective way to deliver primary care. Before holistic, integrated health care became a talking point for academics and consultants, community health centers were doing it.
At Community Healthcare Network, a nonprofit organization operating 14 health centers in New York City’s poorest neighborhoods, medical care is one element in our delivery system. We treat the needs of our patients in their entirety. Though medical providers are at the core of our mission, a team effort makes it all work.
Each center integrates behavioral health care—both psychiatrists and therapists—along with social workers, nutritionists, health educators, family planning counselors, and care coordinators. Health outcomes for our complex patients are good primarily for one reason: we are able to connect the health care dots. Before anyone knew the term “social determinants,” community health centers were a bridge to patients’ basic needs: housing, food, and employment.
The work is cost-effective. National estimates say that health centers save the U.S. $24 billion annually by helping patients avoid more expensive, unnecessary care. In New York, health centers save the state Medicaid program $1,000 for each averted emergency department visit and $13,000 for each avoidable hospitalization.
But suddenly, just weeks into the COVID-19 pandemic, each of New York City’s community health centers is on the brink of insolvency.
Heroic frontline staff are putting their lives on the line. We are doing all the right things. Centers remain open for patients who must be seen in person. When the City’s Department of Health and Mental Hygiene (DOHMH) told us to test for COVID-19, we tested. When DOHMH told us to stop testing, we stopped. In a matter of days, for the safety of our patients, we turned the bulk of our care to telemedicine.
Now, we need additional support from New York State’s Department of Health (DOH).
Governor Andrew Cuomo has been magnificent in communicating the reality of the pandemic to the people of New York. But after transitioning to telehealth, our health center payment rates are now 31 cents on the dollar for Medicaid tele-visits (which often include nutrition, social work, and therapy, along with medical care), when compared to in-person rates.
Further, we are not being reimbursed for mental health therapy conducted by phone—at a time when more New Yorkers than ever are decompensating from relentless stress and uncertainty.
Federal stimulus funding for community health has been meager. Although the U.S. Senate Minority Leader is a New Yorker, Congress is allowing the Trump Administration to hand out these grants without regard to where COVID-19 is spreading, and without regard to which cities are being decimated. Yes, small Kansas health centers receive this federal money through the same per-patient formula as the health centers in the epicenter of the pandemic.
My volunteer board of directors is facing cruel decisions. Should we shut down during the pandemic so we can survive in the years ahead? Should we fight the pandemic until we are broke? Should we abandon staff to layoffs, as other community health centers are doing? How do we comfort staff risking their own lives each day, if neither Albany nor Washington will offer them security?
We health workers are shaken. One of our most beloved colleagues, who worked for years with HIV patients, died of COVID-19 complications last week. Yet we carry on, perplexed at this official abandonment by New York State.
At the request of the New York City Fire Department, Community Healthcare Network agreed this week to take calls from 911 that can be handled by telemedicine. Our role is to divert patients who do not need hospital care away from emergency departments—to keep the hospitals functioning for people who must arrive by ambulance.
When asked how the City would pay for these visits, a Fire Department official joked, “We will give you one-day vouchers for Disneyland.” It was a funny way to say, “We will pay nothing,” and it was OK because we need laughs—even gallows humor.
The survival of community health centers is on the brink. The state and federal governments must step up and move funding now, before it is too late.
Robert M. Hayes is the President and CEO of Community Healthcare Network (CHN).