LI teaching hospitals fear Medicare cuts

Proposed cuts in Medicare funding now part of the federal budget debate would severely impact teaching hospitals, critics say, potentially shrinking doctor-training programs on Long Island and around the country.

A proposal by the Bowles-Simpson Commission, which has advised the Obama administration on budget-reduction strategies, would carve billions out of medical education programs nationwide over several years.

The proposal is being floated in negotiations to raise the federal debt ceiling and its fate remains uncertain. Another proposal calls for lesser reductions in Medicare subsidies -- $1.4 billion over 10 years.

If the deeper cuts are realized, Long Island teaching hospitals would lose, on average, $154 million a year -- more than half their $257-million allocation, according to data from the Greater New York Hospital Association. New York State would lose $1.25 billion a year out of its $2.19-billion allocation.

The Medicare system pays salaries for medical residents at the nation's 400 major teaching hospitals through subsidies to the institutions. The hospitals can use the money for faculty salaries, high-tech teaching equipment and classroom maintenance.

Patients also benefit: The subsidies finance specialized medical services like burn units, trauma centers and community care programs, such as mammography vans and aid for the elderly.

Opponents of the payments say New York teaching hospitals receive a disproportionate share of federal funding -- and need to scale back.

Hospital officials, however, view the proposed cuts as a threat to the foundation of American medical training, long viewed as the best in the world.

"It is not hyperbole to say the cuts they are talking about would have catastrophic implications for teaching hospitals," said Dr. Steven Walerstein, medical director and executive vice president for medical affairs at Nassau University Medical Center in East Meadow.

Federal funding has not only allowed NUMC to develop strong teaching programs, Walerstein said, but to also attract top-tier faculty.

More than 2,500 doctors are serving as residents at major local hospitals. About 600 residents are in training at Stony Brook University Medical Center; 1,400 are in North Shore University-LIJ Health Care System hospitals; nearly 300 are at NUMC; and 200 are at Winthrop University Hospital in Mineola.

Walerstein said NUMC, like other teaching institutions, would have to seriously consider discontinuing an array of patient-care services if the subsidies are slashed because residency training programs would have to be scaled down or eliminated. Filling the patient-care gap with doctors from the community or nurse practitioners would be prohibitively expensive, he said.

Residents, on average, earn about $54,000 a year in New York, providing highly skilled medical services at a low cost. Nurse practitioners, by comparison, earn about $85,000.

Kenneth Raske, president of the hospital association, met with the New York congressional delegation this week, urging lawmakers "to just say no to the cuts."

The association also launched a newspaper advertising campaign to draw attention to what Raske calls a crisis that will effectively undo health care reform and lead to hospital closures.

"In terms of losses for graduate medical education, the numbers are staggering," Raske said. "When we scored this out over 10 years, there is a loss of more than $1 billion for Long Island alone."

New York trains more physicians than any other state, with an estimated 16,000 residents in graduate medical programs.

While acknowledging that New York gets more Medicare subsidies than most states, Raske said scientifically innovative doctors here often offer therapies that can't be found elsewhere.

The New York subsidies have been strongly protected in the Senate for decades. But the Bowles-Simpson Commission, created in 2010 by Obama to help achieve long-term "fiscal sustainability," described teaching-hospital subsidies as "excessive."

Sen. Charles Schumer (D-N.Y.) said he is vigorously fighting the proposed cuts. "We need more doctors than ever, so cutting support to our world-class teaching hospitals makes absolutely no sense," he said.