NYHealth submitted the following public comments in support of a proposed NYSDOH rule that would include a Health Equity Impact Assessment as part of the Certificate of Need process to ensure that people affected by health system transactions in their communities have a voice in the decision-making process.
June 8, 2023
Katherine Ceroalo
Bureau of Program Counsel, Regulatory Affairs Unit
New York State Department of Health
Room 2438, Empire State Plaza Tower Building
Albany, NY 12237
RE: HLT-15-23-00008-P Health Equity Impact Assessment proposed rules
Dear Ms. Ceroalo:
The New York Health Foundation (NYHealth) appreciates the opportunity to provide comments in response to the New York State Department of Health’s (NYSDOH) proposed rulemaking regarding the inclusion of a Health Equity Impact Assessment (HEIA) as part of the Certificate of Need (CON) process.
As the first state in the nation to institute a CON process, New York State has been a pioneer in promoting oversight of health system transactions. New York should continue its legacy of transparency by ensuring that the people affected by health system transactions in their communities have a meaningful voice in the decision-making process.
NYHealth is a private, independent, statewide foundation dedicated to improving the health of all New Yorkers, especially people of color and others who have been historically marginalized. For the past six years, the Foundation’s Empowering Health Care Consumers program focused on ensuring that patients and consumers, who are too often marginalized by the health care system, are placed at its center and treated as its most important stakeholders. At the policy level, we have supported efforts to give patients and consumers a seat at the table to help drive and inform decisions that affect health care access, quality, costs, and equity in New York State.
Hospitals are consolidating at a rapid pace. Consolidations can provide many important benefits. They can also reduce competition and consumer choice, exacerbate barriers to care and other inequities, and result in higher prices. The stakes are high; affected patients and communities must have a robust say in New York State’s regulation of health facilities, including the CON process.
NYHealth has supported efforts to make the CON process more consumer-friendly and transparent for New Yorkers. With NYHealth support, MergerWatch produced a report, “Empowering New York Consumers in an Era of Hospital Consolidation,” to identify potential reforms to facilitate increased consumer engagement in New York’s CON process. Two of its key recommendations closely align with the State’s proposed regulations, including:
- Ensuring that consumers affected by hospital closures or elimination of key hospital services are notified and engaged. Recommendations include providing advance notice to community members of proposed reductions in services; engaging affected residents and seeking their feedback; and charging the Public Health and Health Planning Council with reviewing transactions with an eye toward the impact on medically underserved populations.
- Ensuring CON-approved projects preserve access to timely, affordable care and advance local and State health-planning goals. Recommendations include that CON applications incorporate an analysis of how transactions advance health equity by preserving or improving access to care for medically underserved populations, as well as how they affect the price of health care services and align with State and local health planning goals, such as the Prevention Agenda.
NYHealth-supported partners have tested channels to solicit community input and to assess access, equity, quality, and cost implications of health system changes. In the Bronx, for example, trusted community-based organizations and faith leaders surveyed local residents affected by a health system’s consolidation of clinics; the results showed that patients struggled to get in contact with their providers and were largely unsatisfied with the care provided. In Schenectady, a survey of more than 400 residents demonstrated that patients from marginalized communities—including people of color and those with low incomes—had higher rates of negative care experiences with the health system involved in the proposed merger.
Based on these experiences and lessons, NYHealth affirms NYSDOH’s proposed regulations.
We support its provisions that:
- Independent assessors have “demonstrated expertise and experience in the study of health equity, anti-racism, and community and stakeholder engagement,” as well as other preferred qualifications including expertise studying health care access and delivery and a lack of conflict of interest with the health system applicant.
- Assessors conduct “meaningful engagement” of medically underserved people and other key stakeholders through mechanisms that are accessible and culturally competent, including those specified in the proposed regulations, like phone calls, surveys, community forums, and online methods.
We encourage the State to ensure that the final regulations fully realize the spirit of the HEIA law.
Thank you for the opportunity to provide these comments. We look forward to continuing to partner with NYSDOH and work toward our shared goal of elevating patient, consumer, and community voices in health care decision-making.
Sincerely,
David Sandman, Ph.D.
President and CEO
New York Health Foundation
