Understanding Health Care Rankings Is Not Easy

By Thomas M. Biancaniello MD

Rating Health Care Providers – CMS Hospital Compare ranks NY hospitals lowest in US

Rating providers of health care, individuals, institutions and countries is a difficult task.  As a colleague of mine once commented, “there are five hundred 100 best hospital in the US.”  He was referring, of course, to the numerous published lists that would allow one to tout their hospital as one of the hundred best by quoting a particular ranking list. 

The World Health Organization’s (WHO) last international ranking was in 2000 (the US ranked 37^th) but WHO now considers the ranking to be too complicated to continue. However, WHO still ranks countries in outcome categories such as preventable deaths (US 14^th), life expectancy (US 24^th).  The Centers for Disease Control (CDC) also ranks and has designated the US 28^th in infant mortality.  

Despite the highest cost health care system in the world (17% of GDP), the US consistently does poorly on ratings such as The Common Wealth Fund which in 2014 ranked the US dead last amongst a group of 11 wealthy countries.  The Commonwealth Fund is a private foundation that promotes high performing health care systems by supporting research and grants to improve health care.  Their ratings are based on quality, access, efficiency and equity.

It is no surprise that US rankings are so poor since we do not have universal coverage.  Faced with the most expensive health care system, those who are not covered often do not access the system as frequently as they should, utilize the emergency room instead of receiving continuity of care, will not get recommended treatment or follow-up care because they cannot afford it, and will not get the medicines they need because of the cost. 

Of course in a medical crisis the US system delivers high quality care because of advanced training and technology that can be utilized by the providers.  Patients will more likely require this crisis care if the condition is poorly treated because they do not have the resources to get the care they need.

It is difficult to say why NY hospitals did so poorly in the CMS Hospital Compare report (7-27-2016).  The ratings employed a 5 star system (1 lowest to 5 highest) and NY averaged 2.26, lowest of any state. A frequent challenge to ratings and scoring are what is referred to risk adjustment factors.  The patient being admitted to a small hospital with pneumonia may not be as sick as one being admitted to a tertiary care center.  And in fact, those patients may be transferred when it is clear they require a level of care not available in the smaller hospital.  CMS does make allowance for this to some degree in that it does not compare the more complex procedures that are not universally available in all hospitals.  Another criticism is that many of the better performing hospitals are not the “safety net” hospital where those patients who are poor are treated.

NY’s publicly supported hospitals did poorly especially the NY City Health and Hospitals (eight one star and three two star) and the State University Hospitals (Stony Brook 2, Syracuse and Brooklyn 1).  These hospitals are all safety net and take care of those with limited means.  Teaching hospitals and tertiary care centers tend to receive some of the sickest patients.

The question really is how should patients utilize this data? First, I would say the best source to help meet the individual needs is the patient’s own physician.  Ideally, the patient has chosen a physician they trust and will get the recommendation based on the patient’s best interest.  Second, in making the recommendation the physician should heed the advice we all received as medical students – go to the places that have the sickest patients and most experienced doctors to best learn how to take care of patients.  Finally, in choosing a physician, seek out the “doctor’s doctor”, those physicians we as physicians chose to take care of our loved ones and ourselves.

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Thomas Biancaniello, MD is a Professor of Pediatrics (Cardiology) Columbia University Medical Center, Former Chief Medical Officer, Stony Brook University Hospital, Emeritus Professor of Pediatrics and Medicine, Stony Brook University

Oak Wilt Found On LI Report Sudden Loss Of Oak Tree Leaves

Residents Encouraged to Report Any Sudden Loss of Oak Tree Leaves during the Month of August New York State’s Department of Environmental Conservation (DEC) and Department of Agriculture and Markets (DAM) today announced that the oak tree disease, oak wilt, has been detected in the Central Islip area of the town of Islip, Suffolk County. The disease was identified by the Cornell Plant Disease Diagnostic Clinic after samples from a symptomatic oak tree were submitted by a concerned tree care professional. This is the second location in New York that oak wilt has been confirmed, the first being in Schenectady County in 2008 and 2013. After the provided oak samples tested positive for the fungus that causes the disease, the tree care professional removed and destroyed four trees that exhibited signs of being infected. There is no known treatment to contain and kill the oak wilt fungus other than to remove the infected trees as well as any surrounding host oak trees. “The infestation is small and isolated making an aggressive eradication response warranted and feasible to address this serious disease.” said DEC Commissioner Basil Seggos. “Additional oak trees will need to be removed in the immediate infected area to stop oak wilt in its tracks.” DEC will utilize the eradication protocols from the Schenectady County occurrence to control the Islip infestation. An emergency order has been issued establishing a protective zone that prohibits the removal of any living, dead, standing, cut or fallen oak trees or any portion thereof, including branches, logs, stumps or roots, green oak lumber and firewood (of any species) out of the immediate area unless it has been chipped to less than one inch in two dimensions. The order also creates a 150 foot “red oak free zone” around the specific location where the infected trees were discovered. All red oak located in these zones will be removed by DEC and destroyed in order to protect the remaining oak trees in the area. State Agriculture Commissioner Richard A. Ball said, “Acting now, while the incident is isolated, is a critical step toward preventing the spread of oak wilt and saving our trees. This aggressive plan will protect additional trees from infection and help eradicate the infestation quickly.” Impacted property owners will be contacted to inform them about oak wilt and provide information about how to help protect their remaining oak trees. DEC will schedule a public meeting to address questions and concerns regarding the planned activities to eradicate the disease. Aerial surveys, as well as ground surveys, will be conducted through the coming weeks to determine the number of trees that need to be removed from the red oak free zone and tree removal is expected to take place within the next six months. Additional oak samples are being collected from surrounding areas to determine if further action is necessary to control the spread. Oak wilt is a very serious tree disease in the eastern United States, killing thousands of oaks each year in forests, woodlots and home landscapes. It is caused by a fungus, Ceratocystis fagacearum. The fungus grows in the water conducting vessels of host trees causing the vessels to produce gummy plugs that prevent water transport. As water movement within the tree is slowed, the leaves wilt and drop off, and eventually the tree dies. Members of the public are encouraged to report any occurrences where an oak tree suddenly loses its leaves during the month of August to the Forest Health Information Line toll-free at 1-866-640-0652. For more information about oak wilt or the emergency order, visit DEC’s website.

September 11 Victim Compensation Fund Begins Accepting New Claims

September 11th Victim Compensation Fund Begins Accepting New Claims 

Payment on All Group A Claims Has Been Authorized

September 11th Victim Compensation Fund (VCF) Special Master Rupa Bhattacharyya announced today that the VCF is once again accepting new claims using a new claim form that was redesigned following the Dec. 18, 2015, reauthorization of the VCF.  The new claim form was made available earlier today along with a significantly revamped and improved online claims system.  Claimants who do not have consistent access to the Internet will still be able to file a hard copy claim using the new form.

The 9/11 VCF staff  learned a great deal over the past five years about which claim form questions were truly necessary and as a result, the Fund was able to reduce the number of overall questions and combine the four versions of the old claim form into one, simplified form.  Additionally, VCF staff solicited input from many law firms that represent VCF claimants and incorporated their feedback into the new form and the redesigned online claims system. 

“We appreciate the 9/11 community’s support as the Fund’s staff worked over the past six months to finalize the new claim form and believe claimants will agree it was worth the wait,” said Special Master Bhattacharyya.  “There is much work yet to be done and I stand ready to help the VCF build upon its successes and move into the next phase of the program with a renewed sense of purpose and commitment to the 9/11 community to provide the deserved compensation to those who have suffered as a result of the terrorist attacks of Sept. 11, 2001.”

The new form results in the need for fewer documents to be submitted in support of a claim and the multiple attestations, certifications and exhibits used with the old claim forms have been replaced with a single signature page.  The online system guides claimants to answer only those questions that are applicable to their individual circumstances and also includes a new “smart” document checklist that identifies the documents the claimant will need to submit based on answers to specific claim form questions.  Overall, the new online system and claim form are much easier to navigate and more user-friendly – two key goals the VCF set at the start of this effort. 

With the launch of the new claim form, the online claims system has returned to full functionality, including the ability to file online amendments to previously submitted claims.

For additional information about the new claim form, the online system and how to file a claim, please visit the “How to File a Claim” page on the VCF’s website at www.vcf.gov.  If you have any questions about the claim form, the website, or the VCF process, please contact the VCF’s toll-free Helpline at 1-855-885-1555.

SUFFOLK CLOSEUP - Mixed Happenings For Green Energy

SUFFOLK CLOSEUP

By Karl Grossman

There were mixed happenings last week for green energy in—and off—Suffolk County. 

The expected approval by the Long Island Power Authority of what would be the nation’s largest offshore wind energy project—to rise in the Atlantic Ocean 30 miles southeast of Montauk—was suddenly postponed. Why? Did Governor Andrew Cuomo, who has been micro-managing energy policy in New York State—and been all over the power map in doing so—have a hand in it? In an editorial, the Sag Harbor Express pointed to this. 

Mr. Cuomo has been demanding the Indian Point nuclear power plants 26 miles north of New York City—46 miles from Smithtown—be closed. He declared a ban on fracking in the state. But, at the same time, he has been aggressively promoting the continued operation of nuclear plants upstate. His proposed state “Clean Energy Standard” would designate those nuclear plants as providing “clean and renewable” energy. As an article two weeks ago about this on the Alternet news service was headlined: “New York’s Governor Would Rather Prop Up the Nuclear Industry Than Invest in Renewable Energy.” And Mr. Cuomo was responsible for bringing the New Jersey-based PSEG to Long Island to be its main electric utility.

Meanwhile, also last week, the push to allow a solar power system to be built on 25 acres of the historic Suffolk County Farm and Education Center in Yaphank ended. This occurred after a Suffolk Legislature committee received a highly critical statement on it from a farmer long involved in seeking to save agricultural land in Suffolk, and the head of the Long Island Farm Bureau scored the plan, too. The committee then voted to table action on a bill that facilitated it, and Legislator Kate Browning of Shirley thereafter withdrew her measure. 

The statement from environmental organizations on LIPA’s putting off its scheduled vote on Deepwater Wind placing 15 wind turbines off Montauk came from groups that included the Sierra Club, National Wildlife Federation and Renewable Energy Long Island. Its heading declared their “Deep Disappointment.” It noted that just a week earlier Mr. Cuomo said “I strongly encourage the [LIPA] trustees to once again demonstrate New York’s leadership on climate change and help achieve the state’s ambitious goal of supplying 50 percent of our electricity from renewable energy by 2030.” 

The organizations said “we are calling on Governor Cuomo to follow through on this commitment to support offshore wind and work with LIPA to expeditiously reschedule this historic vote…When opportunity knocks, we must open the door. We need Governor Cuomo to ensure this vote happens quickly so that offshore wind power becomes a reality for New York.”

The claimed reason for the abrupt postponement was a last-minute request by the New York State Energy Research and Development Authority “for a brief delay of the LIPA board vote so the project can be examined in the broader context of the Offshore Wind Master Plan, the development of which NYSERDA is heading for the state,” NYSERDA’s announcement said..  According to NYSERDA’s website, it is “governed by a 13-member board appointed by the governor with advice and consent of the New York State Senate.”

In the days before the LIPA postponement, there were numerous media reports anticipating a favorable LIPA vote including an Associated Press article quoting Thomas Falcone, LIPA chief executive officer, saying the offshore wind farm would be “the largest to date” and “a tremendous offshore wind resource…and it’s not the last…I think this is a very big step…for New York, but also for the United States.”

Deepwater Wind, headquartered in Rhode Island, is now completing the placement of five wind turbines off Block Island, Rhode Island. They are to go online producing 30 megawatts later this year. The 15-turbine wind farm off Montauk would generate 90 megawatts and, according to Mr. Falcone, power could be reaching Long Island from it by 2022.

Deepwater Wind has mastered the building of wind turbines to go far out to sea, eliminating complaints about earlier proposed U.S. offshore wind projects being close to the coastline and, for some people, aesthetically disturbing. It hopes to eventually have 200 wind turbines off Montauk and another 200 off New Jersey.

Meanwhile, also last week, Lee Foster who with her husband Cliff are farmers in Sagaponack and early and leading supporters of the Suffolk County Farmland Preservation Program, said in a statement to the Suffolk Legislature’s Environment, Planning and Agriculture Committee: “Why is it that farmland is so quickly identified as something else?  As to the County Farm at Yaphank and this recent issue of transformation into something solar, there is an underlying misconception that farmland is in excess, unimportant and won’t be missed.  Actually, farmland is irreplaceable…and worse, this particular resource is vested by soil, sweat, easements and history that can’t be replaced or reincarnated.” 

Robert Carpenter, executive director of the Long Island Farm Bureau, testified that the placement of solar arrays on 25 acres at the County Farm would set a bad “precedent” for farmland designated for preservation by Suffolk County. 

Theater Review - 'Mamma Mia!'

THEATER REVIEW - ‘Mamma Mia!’ - Produced by: John W. Engeman Theater - Northport  - Reviewed by: Jeb Ladouceur  

Granted, many fans of the feel-good ‘Mamma Mia!’ featuring songs like “Dancing Queen,” … “The Winner Takes It All,” … and of course the title track … probably identify the play with the so-so motion picture adaptation starring the great Meryl Streep and Colin Firth. But the fact is, the movie was greeted with mixed reviews at best. It made $600 million with an investment of $50 million. In Hollywood parlance … hardly a blockbuster!

The stage show that opened in London’s West End in 1999, on the other hand, has been attended by 60 million theatergoers over the years, and it’s grossed a whopping two billion bucks! In fact, the musical played almost 6000 performances on Broadway alone, making ‘Mamma Mia!’ the longest running ‘Jukebox’ show in the Great White Way’s history!

But as The Bard has written in ‘The Tempest’ … “What is past is prologue.” In other words, historical events merely set the stage for what is about to take place today. And what’s currently going on at Northport’s snazzy Engeman Theatre is really quite a marvelous piece of show business indeed.

First, let’s get that silly definition disposed of: The term ‘Jukebox Musical,’ I hasten to point out, is not a pejorative; it merely defines a stage or film musical that uses previously released popular songs as its score. And it should be further noted that ‘Mamma Mia’s’ unquestioned success has contributed greatly to the acceptance of the genre throughout the world.

I frankly prefer not to use the ‘Jukebox’ idiom because a number of the people I know in this critiquing business tend to equate the expression with artificiality … but if there’s anything synthetic about Music Director James Olmstead’s appealing numbers at the heart of this show, I’ll eat my hat. The plain fact of the matter is that once any musical is revived, and new life is breathed into its familiar score, the show has essentially become the equivalent of what the theater industry foolishly (in this critic’s view) chooses to call a ‘Jukebox Musical.’

Be that as it may, the lovely Michelle Dawson (Donna Sheridan) wastes no time in assuming center stage with poise and élan in this story that takes place on a Greek island. You see … ‘Donna’s’ little girl (Sophie), played by Hannah Slabaugh, is getting married in the morning, but before she walks down the aisle, she’s determined to find the answer to something that obsesses her—which of three potential candidates (each of whom obviously has a 20-year-old history with Mamma)—is her daddy? 

The potential for grown-up farce in this situation is evident. And the audience at the sold-out Engeman press opening responded to the rib-tickling challenge predictably.

Ms. Dawson has played ‘Mamma Mia!’ in the Big Town, as have performers Sean Hayden, and Jacob Dickey … and their experience shows. But the rest of the featured cast, though they’re new to this Tony-nominated play, are equally at home. They include Robin Loonsbury, Heather Patterson King, Jeff Williams, and Frank Vlastnik (a standout as Harry Bright) and they owe a lot to veteran Director-Choreographer Antoinette Dipietropolo and her creative team. These seasoned experts make the players look great!

There are a dozen more cast members who appear for our edification in this summertime toe-tapping delight, and unless I miss my guess, most of them are on their way to feature status … and even stardom.

After so many years of constantly producing Broadway quality shows, and individual virtuoso performances, there’s no reason to believe that appearance on the Engeman stage won’t ultimately lead these kids all the way to the top.

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Award-winning writer, Jeb Ladouceur is the author of eleven novels, and his theater and book reviews appear in several major L.I. publications. His newest book, THE GHOSTWRITERS, explores the bizarre relationship between the late Harper Lee and Truman Capote. It maintains that each actually wrote the other’s most acclaimed work. Ladouceur’s revealing website is www.JebsBooks.com