Oct 13, 2022

Plus: Charles B. Wang opens $75M Flushing health center Lenox Hill Hospital unveils 8,000-square-foot neuroscience ICU Montefiore Health System’s plan to consolidate three of its Bronx health centers at two locations beginning next week could run afoul of federal and state requirements, providers and community activists who are protesting the impending changes  say. Under the reorganization, Montefiore will close its Grand Concourse health center and move that location’s providers and patients to the health system’s Family Health Center at 1 Fordham Plaza. To accommodate the consolidation, some of the Family Health Center’s family medicine providers and residents are being relocated to a Montefiore family medicine practice in Williamsbridge, more than 2 miles away from their current facility. The Family Health Center and Williamsbridge clinic are both federally qualified health centers, a formal classification for federally funded facilities that serve a medically underserved area or population and offer a sliding-fee scale to certain low-income patients. The centers are required to provide comprehensive primary and preventive care, including pediatrics, OB/GYN care and family planning services. In return, they enjoy enhanced Medicaid and Medicare reimbursement rates. Montefiore’s plan to consolidate services at the Family Health Center and Williamsbridge practice should therefore be subject to the rules that govern federally qualified health centers, said Dr. Steve Auerbach, a former public health analyst at the New York regional office of the Health Resources and Services Administration, the federal agency that oversees and funds federally qualified health centers. Auerbach, who is working with current and former Montefiore providers to get the Health Resources and Services Administration to intervene, said Montefiore should have to file a request to change the scope of its federally qualified health centers, because the consolidation would reduce capacity for services that the Family Health Center and Williamsbridge clinic are required to provide. After the rearrangement starts Monday, seven of the Family Health Center’s family medicine doctors and 10 residents will relocate to Williamsbridge, which will eventually house all Montefiore’s family medicine residents. The Family Health Center’s 12 remaining family medicine doctors and five remaining residents will have 12 rooms to see patients, down from 45. Former Grand Concourse providers and their more than 17,000 patients will use the remaining rooms. Auerbach said such changes to federally qualified health centers also require prior approval from the centers’ governing board—in this case, a not-for-profit organization called the Bronx Community Health Network that oversees 21 health centers. Montefiore may also need the approval of the state Health Department, he said. “Montefiore as the self-interested party does not get to unilaterally make the decision as to whether it is OK,” he said. “It should be fully reviewed by the governing authorities, and that review [should] come before—and not after—the changes.” Jeffrey Hammond, a Health Department spokesman, said Montefiore does not need the state’s approval because its Grand Concourse facility is a private medical practice and the Family Health Center’s services and operating certificate are not changing. Lara Markenson, a Montefiore spokeswoman, said state approval is not required because no services will be added or removed from the Family Health Center’s operating certificate. Approval from the Bronx Community Health Network isn’t required, either, she said, but Montefiore has been in touch with the nonprofit since July about the transition. It appears that Montefiore put together the reorganization plan before then; one Family Health Center provider, who asked to remain anonymous, said Montefiore officials held an emergency meeting right after the Fourth of July holiday to inform physicians of the forthcoming changes. A Health Resources and Services Administration spokesman said the agency has been in touch with the Bronx Community Health Network about the proposal but did not specifically address allegations that Montefiore must first get approval. “Our goal is to ensure individuals maintain access to critical primary care services and that HRSA-funded entities remain in compliance with all Health Center Program requirements,” the spokesman said in a statement. Legal nuts and bolts aside, stakeholders say they are concerned the reshuffling will squeeze primary care access for low-income, marginalized communities that have long received services at the Family Health Center and Williamsbridge practice. Family medicine doctors often serve as the primary care provider for multiple generations of the same family. “The short timeframe and inadequate communication with the community left little to no room for Montefiore to develop a complete understanding of how the consolidation could negatively impact reasonable access to care in my district and across the Bronx,” Rep. Jamaal Bowman, who represents the Bronx, wrote last week to Health Resources and Services Administration officials. Rep. Alexandria Ocasio-Cortez, who represents a portion of the Bronx, said she shares stakeholders’ concern that consolidating Montefiore’s prestigious family medicine residency program at the Williamsbridge facility “may put the program managers at odds with standards for residency and fellowship programs.” Those standards include certain ratios for the number of exam rooms per faculty member and resident. The residency program, which pioneered the inclusion of abortion care in family medicine, has long placed half its residents at the Family Health Center for specialized training in such areas as abortion care, addiction medicine and primary care for patients with HIV/AIDS. Eliminating those placements will have a ripple effect on other underserved areas across the U.S. where graduating residents move to practice, including states that have dismantled abortion rights since the Supreme Court struck down Roe v. Wade, current providers said. Current family medicine providers said the changes would more immediately affect residents of the Bronx, which has a shortage of primary care providers, according to federal data. They said Montefiore’s plan assumes that about 6,000 Family Health Center patients will follow their doctors to the Williamsbridge practice. But one doctor who is being relocated to Williamsbridge said about a quarter of the patients reported that the move would be impossible for them, and the remaining Family Health Center providers are all at capacity. Montefiore has not shared any plans to ensure such patients do not lose access to primary care services, the current providers said. The health system has characterized the reorganization as an “inconvenience.” “While we understand the inconvenience this move might have on a small group of practitioners, ultimately, we know they share our paramount obligation, as the leading medical provider addressing health care equity and access, to improve the care of all the patients in this neighborhood,” Dr. Andrew Racine, senior vice president and chief medical officer for Montefiore Health System, said in a statement to Crain’s. “We firmly believe this relocation achieves this shared goal.” Current providers and other critics of the plan said Montefiore’s decision is financially motivated, not related to quality of care. Providers briefed on the decision by management said the reorganization was based on a recommendation from consulting firm McKinsey & Co., which the health system retained to improve its finances. Montefiore has said it partnered with a national consulting firm on a financial improvement program to achieve $500 million in annual savings , Crain’s previously reported, but officials have declined to publicly name McKinsey as that firm. “They’re going against their own mission,” another Family Health Center provider said, referring to Montefiore’s history as a safety-net provider for underserved communities in the Bronx. “It’s just really disheartening that they get away with it.” —Maya Kaufman Lenox Hill Hospital unveils 8,000-square-foot neuroscience ICU Lenox Hill Hospital on the Upper East Side has opened an 8,000-square-foot neuroscience intensive care unit for complex neurological patients, including those recovering from surgery, the hospital has announced. The unit will care for people with aneurysms, strokes, tumors, complex spinal disease and arteriovenous malformations, which are tangles in the blood vessels connecting arteries and veins that interrupt oxygen flow. Up until now, the neuro intensive care unit had been in a shared space with Lenox Hill’s surgical intensive care unit, said Dr. David Langer, the chair of neurosurgery at the hospital. Now the space is just for neurological patients, which is a reflection of Lenox Hill’s commitment to the field since starting a neurological intensive care program in 2013, he added. Lenox Hill did a makeover of the space for the unit. The cost of the new space is mostly an investment in employees, Langer said. Staff on the unit will include five neurological intensivists—specialists trained to do this kind of work—neurological intensive care nurses and neurosurgery residents. The staff will be able to use a new app to keep families updated on their loved ones’ progress. The space will have 12 beds. Langer said Lenox Hill performs 500 craniotomies, or procedures to open a patient’s head, annually, and all of those patients will recover in the intensive care unit. Langer projected the space would see at least 50 stroke patients and 50 other patients with various diagnoses each year. Lenox Hill is part of the Northwell Health system, the state’s largest health care system, which operates 21 hospitals. In addition to the neuroscience intensive care unit, Lenox Hill has one of the only neuroplastics programs in the city. —J.N. Charles B. Wang opens $75M Flushing health center  The Charles B. Wang Community Health Center, a federally qualified health center that caters to underserved Asian American communities, has opened a new site in Flushing to the tune of $75 million, it announced Wednesday. The new center, called Healthview, is the Charles B. Wang Community Health Center’s third location in Flushing. The 80,000-square-foot facility will have 54 exam rooms and 17 dental treatment rooms. It is expected to serve more than 25,000 patients a year, increasing the nonprofit’s total yearly number of patients by about 40%. Lynn D. Sherman, executive vice president of finance, IT, capital projects and HR for the Charles B. Wang Community Health Center, said the facility will address an overwhelming need for dental services, which the nonprofit previously only offered at one location in Manhattan’s Chinatown. Healthview is opening with six dentists on staff. “It can take months to get an appointment,” she said. “Our waiting list is extraordinary.” Healthview will also expand capacity for mental health services, which Sherman said are in high demand. Other available services include primary care, health education and social work. Available languages will include Mandarin and Cantonese. The project was financed with a $30 million Build NYC tax-exempt bond purchased by Flushing Bank, a $10 million donation from the Chinatown Health Clinic Foundation, $7 million from the federal New Markets Tax Credit Program and support from the Queens Borough President’s Office and City Council, among other funding vehicles. “The players were all really committed to Queens,” Sherman said. The organization also received a grant from the city Office of Environmental Remediation to clean up the site at College Point Boulevard and 40th Road, which it purchased for $15 million. The Charles B. Wang Community Health Center was founded in 1971 and serves about 62,000 patients annually. It has five other locations. —M.K. Hochul earmarks $13M for 37 additional abortion providers throughout the state Gov. Kathy Hochul announced on Wednesday that her office has awarded $13.4 million to 37 abortion providers around the state in the second round of funding through the Abortion Provider Support Fund. The organizations that will receive money include family planning providers that were not included in the first round of funding because they were ineligible or did not apply. According to the governor's office, just under 30 of the 37 organizations are in high-priority regions where New Yorkers are expected to seek  abortion care , such as the city and western New York. The organizations operate 64 clinic sites. Groups getting funds include one clinic at Maimonides Medical Center, several clinics at different New York City Health + Hospital sites, four clinics at NYU Langone hospitals, nine clinics at Weill Cornell Medical College of Cornell and one clinic at Stony Brook University Hospital. Round one of funding , which Hochul announced in July, gave $10 million to 13 providers operating 63 sites. Recipients included two clinics at the Long Island Jewish Medical Center, 23 clinics of Planned Parenthood of Greater New York, seven clinics at Planned Parenthood of North Country New York and one clinic at the Nassau Health Care Corporation. "New York state is committed to protecting reproductive rights, and as other states wage a war on abortion access, we will continue to be a safe harbor," Hochul said Wednesday. “I will not stand by and allow women to be subjected to government-mandated pregnancies." City policymakers have also created initiatives to make the city a continued safe haven for patients who need abortions, including people coming from out of state. In July, the women-majority City Council passed a package of bills to expand access to abortion and reproductive health care. —Jacqueline Neber Loading… AT A GLANCE WORKER COMPLAINT: Several labor groups representing home health aides have filed a federal discrimination complaint against the state departments of health and labor for how they are handling the 24-hour shift issue . The complaint argues that the departments’ policies, which typically only pay workers for 13 hours of what are often 24-hour shifts without adequate rest, subject aides to wage theft and makes them susceptible to injuries on the job that can lead to disability. The complaint is filed with the U.S. Departments of Justice, Labor and Health and Human Services. RESEARCH GRANT: Columbia Nursing professor Ruth Masterson Creber has been awarded a $2.5 million grant from the National Heart, Lung and Blood Institute to study outcomes in patients with heart issues over four years. Dr. Creber will study patients with coronary heart disease recovering from coronary artery bypass grafting, patients with heart failure who are recovering after being in the hospital, and patients with a specific type of heart failure whose care is managed by ambulatory centers. TRIAL RECRUITING: Walmart is going to begin helping pharmaceutical companies and research firms recruit clinical trial participants to compete with CVS and Walgreens, Modern Healthcare reports . The Walmart Healthcare Research Institute will focus on attracting older adults, people who live in rural areas and people who are part of underrepresented groups. Nearly 4,000 Walmart stores are located in underserved parts of the country. WHO'S NEWS: The "Who's News" portion of "At a Glance" is available online at  this link  and in the Health Pulse newsletter. "Who's News" is a daily update of career transitions in the local health care industry. For more information on submitting a listing, reach out to Debora Stein:  [email protected] . CONTACT US: Have a tip about news happening in the local health care industry? Want to provide feedback about our coverage? Contact the Health Pulse team at [email protected]