NEW YORK NURSE: January/February 2010
by Erin Silk
Governor David Paterson’s 2010-11 Executive State Budget, announced on Jan. 19, includes nearly $1 billion in cuts to health care. “These are cuts so large, the impact to facilities will be devastating,” said Shaun Flynn, NYSNA’s director of Governmental Affairs.
The state’s current budget deficit stands at $7.4 billion, and everything from education to the environment is on the chopping block, with funds for healthcare slated to be slashed by $1.9 billion. In the past, healthcare facilities have mitigated budget shortfalls by reducing vital direct care staff, primarily nurses. However, endangering patient care is not the answer and NYSNA will fight budget cuts that ultimately equal short-staffed facilities.
The Governor’s proposed “gap closing plan” for healthcare’s share of the budget consists of $1 billion in provider cuts and more than $240 million in increased assessments and surcharges that tax hospital revenues. Another $650 million would be added by imposing an excise tax on cigarettes and a so-called “syrup tax” on soft drinks and other unhealthy beverages.
As usual, cuts to Medicaid seem like the obvious answer. However, even the proposed plan designed to curtail services still increases spending by 1.8% to $51.5 billion.
Personal and home care services, the fastest growing sector of Medicaid, have increased by 27% since 2007, while the number of people served has declined by 6.3%. The Governor’s budget recommends a redirection of services for this division, including a cap of 12 hours per day for fee-for-service payments, with utilization of alternative community-based settings for individuals exceeding the cap. This initiative still has the potential to endanger patient safety by leaving our most vulnerable population, the indigent, at risk.
Under the current proposal, hospitals would see a $244.6 million reduction in payments for services. Provisions include modifying indigent care to reflect the cost of services delivered rather than hospital bad debt; limiting payments for preventable conditions by setting benchmarks to reduce levels of unnecessary treatments; a redirection of indirect medical education (IME) payments; and an increased assessment of inpatient services from 0.35% to 0.75%. As was proposed in previous budgets, the remaining share of 1.7% of the hospital “trend factor” for the calendar year would be eliminated.
The Governor is recommending a regional pricing system to encourage efficiencies in management and to better reflect the costs of hard-to-serve patients. But nursing homes will also be penalized with fewer payments for holding beds vacant in an effort to discourage unnecessary placements.
While the overall budget for nursing education fared better than expected, SUNY nursing programs are targeted to be cut by $143,100. The Senator Patricia McGee Nursing Faculty Scholarship Program was extended for another year and private nursing education dollars are still intact.
Although the SUNY program is just one part of the nursing education system, it is integral to the larger effort of meeting the long-term needs of the nursing shortage. “NYSNA applauds the Governor’s extension of the Senator Patricia McGee Nursing Faculty Scholarship Program and continued funding of private nursing education, but we cannot ignore the need for funding at our SUNY institutions,” said Tina Gerardi, NYSNA CEO. “Without sufficient nursing programs, the nursing shortage will worsen and patient care will be severely compromised,” she said.