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PostPosted: Mon Jan 04, 2010 6:22 pm    Post subject: SCHUMER, MCMAHON FIGHT TO PRESERVE HEALTH CARE ACCESS ON SI
From Mon Jan 04, 2010 3:00 am to Thu Jan 07, 2010 2:59 am (included)
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Monday, January 04, 2010


Julie Halpin (Schumer): 212-486 4489

Lauren Amendolara (McMahon): 202-215-9605



Richmond University Medical Center could lose millions of dollars from a decrease in

their residency slots; Slots are Key to Both Quality Medical Care and RUMC’s Bottom Line

Schumer, McMahon Press Centers for Medicare and Medicaid

Services to Reverse Decision Cutting Back on Residency Slots at RUMC

Staten Island, NY - Today, Sen. Charles E. Schumer and Rep. Michael E. McMahon sent a letter to the Centers for Medicare and Medicaid Services (CMS) expressing their concern over a recent decision that could severely impact Richmond University Medical Center’s (RUMC) medical residency program. Schumer and McMahon noted that RUMC is one of only two hospitals that serve the large and rapidly growing Staten Island community, and that Staten Island is the only borough that does not have a New York City Health and Hospitals Corporation hospital to serve its residents.

RUMC is home to a fully accredited medical residency program, wherein medical residents are able to provide patient care under the supervision of a teaching physician. It is one of only 300 teaching hospitals in the nation to offer a full residency program, which offers residency programs in all areas of medicine. These residents, and the teaching faculty they work with, provide critical support and care to the hospital, specifically its clinics that treat uninsured or underinsured patients. They are an integral part of the medical center’s efforts to provide ambulatory care to disadvantaged populations.

CMS has recently proposed a residency cap adjustment that would reduce RUMC's medical resident reimbursement caps for 2007, 2008, and in all future years. At the present time, RUMC has 143 residents in its program in various disciplines. CMS’s proposed adjustment, however, would retroactively impose a reduced resident allocation to the hospital even though these slots were previously eliminated in 2005 as part of a national redistribution of residency slots undertaken by CMS at that time. RUMC is reimbursed for its residency program through Medicare, as are many other teaching hospitals. This reduction in residency slots could result in an estimated $6 million hit to the hospital for the period 2007-2009 and more than $2 million for all future years.

“Centers for Medicare and Medicaid Services needs to rethink the decision to reduce these vital residency slots because it will cost Richmond University Medical Center millions and impeded our ability to get the best care available for Staten Islanders," Schumer said. "RUMC is an outstanding medical center that treats countless Staten Islanders each year, and their residency program plays a crucial role in ensuring that RUMC can ably care for its patients. During these tough economic times, RUMC can ill afford a financial hit as like this, and, along with Congressman McMahon, we will do everything in our power to work with CMS to find a solution that does not damage Staten Island residents’ access to care.”

“Staten Island has no public city hospitals, and no matter how much our private hospitals continue to provide for the residents of this Island, they are constantly plagued by fighting for additional funding which should rightfully go to them,” said Rep. McMahon. “CMS’ proposed reduction of RUMC’s residency cap is totally unreasonable. The residents and teaching faculty are a necessary component of the hospital’s ability to function efficiently and effectively. It would also place unnecessary burdens on RUMC, which has experienced a significant financial turnaround in the past few years. This hospital, where many of my friends’ children and grandchildren are born each year, expected to see a surplus for the first time in several years and now CMS plans to jeopardize its fundamental training program. Sen. Schumer and I are exploring all available options so that RUMC can continue to effectively serve the families of Staten Island.”

“It is of the utmost importance that healthcare is accessible to all Staten Islanders,” said Assemblyman Michael Cusick. “Maintaining a full residency program at Richmond University Medical Center is essential towards this goal, especially for the under- and un-insured. I sincerely thank Senator Charles Schumer and Representative Michael McMahon for their action on this matter, and will continue to work with them on this important issue.”

A copy of the body of the letter sent by Sen. Schumer and Rep. McMahon follows:

January 4, 2010

Ms. Charlene Frizzera

Acting Administrator

Centers for Medicare & Medicaid Services

Department of Health & Human Services

P.O. Box 8016

Baltimore, MD 21244-8016

Dear Ms. Frizzera:

We write to express our concern regarding a recent decision by the Centers for Medicare & Medicaid Services (CMS) that adversely affects Richmond University Medical Center (RUMC), Medicare provider number 33-0028, and to request that CMS work with RUMC to further examine this decision. We are particularly concerned that this CMS decision will add to the hospital’s already precarious financial situation and inhibit access to patient care for the Staten Island, New York community.

Based on the information that has been shared with us, it appears that CMS has decided to reduce RUMC’s Medicare resident “cap” for both 2007 and 2008 to a level that would leave RUMC with a significant number of residents-in-training without support from the Medicare program. We understand that this reduction is being made by CMS for those time periods immediately, but would also be expected to continue in the future.

We understand that one of the reasons for CMS’s decision is that RUMC did not formally extend beyond the end date of July 2005 a written agreement it had with another hospital establishing a Medicare affiliated group. The written agreement had the effect of aggregating Medicare resident cap positions otherwise assigned to individual hospitals. According to CMS, one reason that the cap reduction must occur is that the date on the written agreement was not changed and the agreement was not extended as per Medicare regulations.

We further understand that another reason for this decision is CMS’s determination that most, but perhaps not all, of the residency slots that would have been available for the extension of that written agreement were no longer available to be shared with RUMC by another hospital. According to CMS, under the resident redistribution program authorized within Section 422 of the Medicare Modernization Act, 75 percent of “unused” residency slots were redistributed to other hospitals as of July 2005. Thus, according to CMS, available cap slots were redistributed to other hospitals, but this redistribution may not have accounted for all of the available “unused” positions.

But in reviewing CMS’s decision, we urge you to consider RUMC’s unique status as the primary provider to the underserved population of Staten Island. Staten Island has a very large population and is one of the fastest growing regions in New York State. Furthermore, it has fewer health care options than other similarly sized urban areas and is the only one of New York City’s five boroughs does not have a public Health and Hospitals Corporation facility to serve its population. As one of only two hospitals in the area, it serves approximately 500,000 residents. Over the last several years, RUMC has been working diligently to pull itself out of a severely difficult financial situation since separating from the Saint Vincent Catholic Medical Center health system, which filed a Chapter 11 bankruptcy petition in July 2005. During this time, RUMC has been working under the assumption that it would continue to receive this Medicare funding. If this decision by CMS stands, there will be a material and adverse impact on RUMC’s finances totaling approximately $6.3 million for the three year period of 2007 through 2009, and approximately $2 million a year prospectively. This loss of funding would dramatically impair the efforts of the hospital to turn around its financial performance.

We are greatly concerned that any kind of sudden take-back in Medicare funding will leave RUMC unable to meet its financial obligations and will force the hospital to eliminate staff positions and discontinue services, jeopardizing access to care for its community. We believe RUMC’s crucial status as one of only two hospitals on Staten Island, as well as the unique series of events that led to the present finding, warrant a creative and workable solution on the part of CMS, and urge you to consider all available options to rectify this situation.


Senator Charles E. Schumer and Representative Michael E. McMahon
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