One by one, Cayuga County health care and human services officials told the horror stories of the lack of health care.
Mark Genito / The Citizen
Terri Wasilenko, co-founder of the National Alliance on Mental Illness-Cayuga County chapter, reacts to hearing recent heath care related statistics from one of her fellow panel speakers at a local meeting on health care reform.
Terri Wasilenko, co-founder of the National Alliance on Mental Illness-Cayuga County chapter, reacts to hearing recent heath care related statistics from one of her fellow panel speakers at a local meeting on health care reform.
A crowd packed a basement room of the Cayuga-Seneca Action Agency's Clark Street office two weeks ago for a discussion initiated by Tompkins County activists about a national health care plan. The Cayuga County attendees did not make a decision about what public policy remedy might be best to improve access to health care.
But they did agree that for the uninsured, the working poor and those on government-funded health insurance, there are leaps and bounds still needed to be taken to ensure health care for every resident.
Cayuga-Seneca Community Action Agency executive director Gloria Griffin said three people had been to their offices that day seeking help with prescriptions written by Auburn Memorial Hospital staff that they couldn't afford to fill. Her agency sees children whose teeth are rotting because earlier preventive care wasn't affordable for their families.
The agency regularly transports children to get dental care in Geneva and Rochester because Auburn's East Hill Family Medical Inc., a rare county provider still accepting new Medicaid primary care and dental patients, is swamped, Griffin said.
The agency's cohort of families resort to care for the mildest problems at Auburn Memorial Hospital's emergency room, where by law, they cannot be denied health care.
Terri Wasilenko, a cofounder of a local chapter of the National Alliance for the Mentally Ill, became an activist for mental health care because of the hurdles she found in getting a family member needed mental health care.
Wasilenko worries that there are only 4,400 mental health beds available in the central New York region, which means seriously ill mental health patients face shortened hospital stays that don't last long enough to stabilize them. Patients also face waiting lists and the possibility of getting bumped before their treatment course is completed, she said.
Port Byron nurse practitioner Chris Grey's fatigue was palpable and her emotions charged as she described the $40,000 paycut she took to open her practice when Port Byron leaders couldn't attract a doctor to their village. She is owed $10,000 in reimbursement by Medicaid. Besides a full-time secretary, she is a one-person shop handling 1,000 patients, and she is taking even more patients following the closing of some local practices.
She faces a dirge of calls because most other practices are not accepting new Medicaid patients. Because she is a nurse practitioner, many specialists won't take her referrals.
Despite some of Grey's limitations, “they're coming to me because there's no one else in the area,” she said.
Out of those heartfelt testimonials, Jim Kennedy, the executive director of the Cayuga Community Health Network, a federally-funded not-for-profit that connects health-care providers, offered to initiate a task force that would examine reform. He hopes the task force will be a means to address the “root causes that we lump together as access to care issues.”
Access to health care
For the privately insured, Auburn, and its neighboring towns Owasco, Fleming and Sennett, have sufficient health-care options. But for other residents, access to a primary care physician is limited because in a county almost 65 miles long, many of the doctors' offices are located in the center.
In Cayuga County alone, Cato, Conquest, Genoa, Ledyard, Ira, Scipio, Springport and Venice are considered part of primary care federal heath professional shortage areas (HPSA). An area is determined to be short of providers when there are at least 3,500 patients for every physician. Several other towns are low-income federal medically underserved areas. The Moravia-Locke area is part of a dental HPSA, and the entire county is a HPSA for psychiatry.
“We have some service. Location is often a barrier (and) the number of providers who are available,” said Kathleen Cuddy, deputy director for the Cayuga County Health Department's Health Services division.
The number of uninsured in the county numbers one out of six. Most are working, Kennedy said, but are not covered by their employers or cannot avoid a private policy.
The number of providers who take new Medicaid patients, including families and children enrolled in the Health Plus program, is minute, but the demand is growing.
The county has experienced a 36-percent increase in the number of Medicaid eligible patients, from 5,000 individuals in 1999 to 6,877 individuals in 2003, according to a study done for the Cayuga Community Health Network. The study also concludes the rise in the Medicaid population is due to the increasing enrollment in the Child Health Care Plus and Family Health Care Plus programs.
The county also has experienced a 37-percent increase in the number of Medicare eligible patients, an increase of 7,648 in 1999 to 10,473 in 2003.
Doctors often turn away new Medicaid patients because the capped reimbursement rate of $30 per visit does not cover the costs of a practice's overhead costs per patient visit, said Dr. Phillip Gioia, who has a 5,000-patient pediatrics practice with two other pediatricians and is a part-time medical consultant with the county health department.
Gioia is one of the few physicians - including Dr. Farraukh Anwer and Dr. Chakrapani Irri- that will take newborn patients born to parents with Medicaid coverage. Otherwise, patients must seek care outside of the community. Now 70 percent of newborns born at AMH are Medicaid patients, Gioia said.
Doctors cannot manage a 100-percent Medicaid patient base “because you've got overhead, malpractice insurance, staff,” said Kathleen Dymna, the executive vice president of the 65-member Cayuga County Medical Society. “Their costs are rising just like every other business, but their fees are going down.
“It costs more than ($30) to take care of the patient. It's not that physicians don't want to take care of everybody. It's just not feasible to take care of everybody, when there's just so many expenses.”
Area doctors also consider the high level of “no show” rate among Medicaid clients - some of it being caused because of transportation issues - in not taking on a large number of Medicaid patients, according to the 2005 Community Health Assessment completed by the county Health Department.
AMH becomes the default health-care provider for many residents.
Three-and-a-half percent of the hospital's budget is written off because of unreimbursed payments from patients who have no insurance, patients who can't meet the deductibles, or patients on Medicaid, which reimburses less than 100 percent of the cost of caring for a patient, said Brendan McGrath, AMH's administrator. In particular, the hospital has seen elderly patients who can't afford the rising copayments and deductibles with Medicare, McGrath said.
The hospital has $2 million outstanding in unpaid medical bills for the first three fiscal quarters of 2005, McGrath said.
AMH would like to keep patients in the county, because as they head to Syracuse or Rochester, it weakens the market for health-care provided in this county. Twenty-five percent of primary care Cayuga County recipients leave the county for their care. Patients at the northern end of the county go to Oswego, Rochester and Syracuse for their care. Patients at the southern end often travel to Cortland, Ithaca and Lansing.
Recently, the county primary care system has been stretched with the death of Dr. Robert Kalet in early October to be able to absorb his patients, Kennedy said. AMH's Scipio primary care clinic and Port Byron's Grey, among others, have all been inundated with calls from Kalet's former clients.
Access to mental health care
Unlike in the primary care field, it's private insurance companies that are a bane for Cayuga Counseling Services, said Ray Bizzari, executive director of the Office of Mental Health-licensed agencies staffed with a psychiatrist, psychologist and 15 therapists.
Medicaid reimburses at a reasonable $63.50 per mental health visit, he said, but it's private insurers who stipulate only one staff member can be the provider for a client. That means therapists can't share the load if a patient needs to see the psychiatrist, or the patients can't see the psychiatrist as well as a therapist for the agency to be paid. Insurers also limit the number of mental health visits allowed for a patient.
“Sometimes insurance companies don't recognize mental health needs the same way they recognize physical health needs,” said Bizzari, who has worked for the agency close to 20 years.
With patients needing to receive care longer than covered by insurance policies, the agency has written off $370,000 through September. Of the $100,000 that the United Way gives to the agency, $60,000 is used to underwrite losses.
Providers also point to the acute needs of children's and adolescents' mental health, said David Blair, director of the Cayuga County Mental Health Center.
Blair thinks the prevention network in the county is excellent, but “even so, the number of children with serious mental illnesses is growing. The number of children with serious behavior disorders is growing so much, teachers are unable to control elementary students in their classrooms.”
The mental health illness incident rate in children and teenagers has grown from 2 to 4 percent of the population to 22 percent. The mental health incident rate has risen from 4 to about 8 percent for the middle aged and elderly in the county.
Between the county's mental health center and Cayuga Counseling Services, the county has the capacity to treat about 4,200 patients, but there are 6,560 patients in need of treatment in the county. The waiting list for the agency's 32-patient day hospital program is “elongating,” Blair said.
“While we have a broad array of services and these services don't exist everywhere, the system is just not adequate for the numbers we're trying to serve,” Blair said.
There are few and far-between hospital beds for mentally ill children. The beds are available only in scattered spots throughout the state, the closest being in Rochester.
The hospital beds that are available for children don't work because they are too far away. Families are reluctant to institute their children at far-away facilities, and families must be involved in treatment if the treatment is going to have benefit. And insurance money often runs out before a patient is ready to be discharged.
Reasons for hope
Local officials still say there are some silver linings in this area's access to health care.
In comparison to other small cities in the United States, Auburn has plentiful doctors, dentists and specialists per capita, said Cynthia Aikman, the program manager for the city's Planning and Economic Development office.
“Right now, as I field calls from people interested in moving to the area, they're very impressed and want to know why we have such an excellent selection. They see our health care infrastructure as very comprehensive and they're very impressed by it,” Aikman said.
The Medical Society's Dymna said Cayuga County has “such dedicated physicians in a small community” who take more calls and work longer hours than physicians in larger cities.
Cuddy is pleased with the county's immunization rates, cancer screenings, lead poison prevention, water quality and rabies control.
There are also excellent programs working on the preventive measures related to alcohol, smoking and obesity, Cuddy said.
On the mental health front, Blair says the wave of the future includes new programs like play therapists going to six local day care centers to identify children with developmental problems and intervene before further neurological damage occurs.
Gioia is hopes more efficient health information systems will eliminate administrative redundancies and make health care more cost-effective.
Terri Bridenbecker, the executive director of the 450-member Cayuga County Chamber of Commerce, said the last survey of chamber members found health-care costs were the number one issue.
“Employers were opting out of providing health care for employees because they couldn't afford the double-digit premium increases,” Bridenbecker said. “We need to make sure employers have the tools they need to attract quality employees and be able to provide them a benefit like health insurance that is cost effective.”
Staff writer Amaris Elliott-Engel can be reached at 253-5311 ext. 282 or at amaris.elliot-engel@lee.net
But they did agree that for the uninsured, the working poor and those on government-funded health insurance, there are leaps and bounds still needed to be taken to ensure health care for every resident.
Cayuga-Seneca Community Action Agency executive director Gloria Griffin said three people had been to their offices that day seeking help with prescriptions written by Auburn Memorial Hospital staff that they couldn't afford to fill. Her agency sees children whose teeth are rotting because earlier preventive care wasn't affordable for their families.
The agency regularly transports children to get dental care in Geneva and Rochester because Auburn's East Hill Family Medical Inc., a rare county provider still accepting new Medicaid primary care and dental patients, is swamped, Griffin said.
The agency's cohort of families resort to care for the mildest problems at Auburn Memorial Hospital's emergency room, where by law, they cannot be denied health care.
Terri Wasilenko, a cofounder of a local chapter of the National Alliance for the Mentally Ill, became an activist for mental health care because of the hurdles she found in getting a family member needed mental health care.
Wasilenko worries that there are only 4,400 mental health beds available in the central New York region, which means seriously ill mental health patients face shortened hospital stays that don't last long enough to stabilize them. Patients also face waiting lists and the possibility of getting bumped before their treatment course is completed, she said.
Port Byron nurse practitioner Chris Grey's fatigue was palpable and her emotions charged as she described the $40,000 paycut she took to open her practice when Port Byron leaders couldn't attract a doctor to their village. She is owed $10,000 in reimbursement by Medicaid. Besides a full-time secretary, she is a one-person shop handling 1,000 patients, and she is taking even more patients following the closing of some local practices.
She faces a dirge of calls because most other practices are not accepting new Medicaid patients. Because she is a nurse practitioner, many specialists won't take her referrals.
Despite some of Grey's limitations, “they're coming to me because there's no one else in the area,” she said.
Out of those heartfelt testimonials, Jim Kennedy, the executive director of the Cayuga Community Health Network, a federally-funded not-for-profit that connects health-care providers, offered to initiate a task force that would examine reform. He hopes the task force will be a means to address the “root causes that we lump together as access to care issues.”
Access to health care
For the privately insured, Auburn, and its neighboring towns Owasco, Fleming and Sennett, have sufficient health-care options. But for other residents, access to a primary care physician is limited because in a county almost 65 miles long, many of the doctors' offices are located in the center.
In Cayuga County alone, Cato, Conquest, Genoa, Ledyard, Ira, Scipio, Springport and Venice are considered part of primary care federal heath professional shortage areas (HPSA). An area is determined to be short of providers when there are at least 3,500 patients for every physician. Several other towns are low-income federal medically underserved areas. The Moravia-Locke area is part of a dental HPSA, and the entire county is a HPSA for psychiatry.
“We have some service. Location is often a barrier (and) the number of providers who are available,” said Kathleen Cuddy, deputy director for the Cayuga County Health Department's Health Services division.
The number of uninsured in the county numbers one out of six. Most are working, Kennedy said, but are not covered by their employers or cannot avoid a private policy.
The number of providers who take new Medicaid patients, including families and children enrolled in the Health Plus program, is minute, but the demand is growing.
The county has experienced a 36-percent increase in the number of Medicaid eligible patients, from 5,000 individuals in 1999 to 6,877 individuals in 2003, according to a study done for the Cayuga Community Health Network. The study also concludes the rise in the Medicaid population is due to the increasing enrollment in the Child Health Care Plus and Family Health Care Plus programs.
The county also has experienced a 37-percent increase in the number of Medicare eligible patients, an increase of 7,648 in 1999 to 10,473 in 2003.
Doctors often turn away new Medicaid patients because the capped reimbursement rate of $30 per visit does not cover the costs of a practice's overhead costs per patient visit, said Dr. Phillip Gioia, who has a 5,000-patient pediatrics practice with two other pediatricians and is a part-time medical consultant with the county health department.
Gioia is one of the few physicians - including Dr. Farraukh Anwer and Dr. Chakrapani Irri- that will take newborn patients born to parents with Medicaid coverage. Otherwise, patients must seek care outside of the community. Now 70 percent of newborns born at AMH are Medicaid patients, Gioia said.
Doctors cannot manage a 100-percent Medicaid patient base “because you've got overhead, malpractice insurance, staff,” said Kathleen Dymna, the executive vice president of the 65-member Cayuga County Medical Society. “Their costs are rising just like every other business, but their fees are going down.
“It costs more than ($30) to take care of the patient. It's not that physicians don't want to take care of everybody. It's just not feasible to take care of everybody, when there's just so many expenses.”
Area doctors also consider the high level of “no show” rate among Medicaid clients - some of it being caused because of transportation issues - in not taking on a large number of Medicaid patients, according to the 2005 Community Health Assessment completed by the county Health Department.
AMH becomes the default health-care provider for many residents.
Three-and-a-half percent of the hospital's budget is written off because of unreimbursed payments from patients who have no insurance, patients who can't meet the deductibles, or patients on Medicaid, which reimburses less than 100 percent of the cost of caring for a patient, said Brendan McGrath, AMH's administrator. In particular, the hospital has seen elderly patients who can't afford the rising copayments and deductibles with Medicare, McGrath said.
The hospital has $2 million outstanding in unpaid medical bills for the first three fiscal quarters of 2005, McGrath said.
AMH would like to keep patients in the county, because as they head to Syracuse or Rochester, it weakens the market for health-care provided in this county. Twenty-five percent of primary care Cayuga County recipients leave the county for their care. Patients at the northern end of the county go to Oswego, Rochester and Syracuse for their care. Patients at the southern end often travel to Cortland, Ithaca and Lansing.
Recently, the county primary care system has been stretched with the death of Dr. Robert Kalet in early October to be able to absorb his patients, Kennedy said. AMH's Scipio primary care clinic and Port Byron's Grey, among others, have all been inundated with calls from Kalet's former clients.
Access to mental health care
Unlike in the primary care field, it's private insurance companies that are a bane for Cayuga Counseling Services, said Ray Bizzari, executive director of the Office of Mental Health-licensed agencies staffed with a psychiatrist, psychologist and 15 therapists.
Medicaid reimburses at a reasonable $63.50 per mental health visit, he said, but it's private insurers who stipulate only one staff member can be the provider for a client. That means therapists can't share the load if a patient needs to see the psychiatrist, or the patients can't see the psychiatrist as well as a therapist for the agency to be paid. Insurers also limit the number of mental health visits allowed for a patient.
“Sometimes insurance companies don't recognize mental health needs the same way they recognize physical health needs,” said Bizzari, who has worked for the agency close to 20 years.
With patients needing to receive care longer than covered by insurance policies, the agency has written off $370,000 through September. Of the $100,000 that the United Way gives to the agency, $60,000 is used to underwrite losses.
Providers also point to the acute needs of children's and adolescents' mental health, said David Blair, director of the Cayuga County Mental Health Center.
Blair thinks the prevention network in the county is excellent, but “even so, the number of children with serious mental illnesses is growing. The number of children with serious behavior disorders is growing so much, teachers are unable to control elementary students in their classrooms.”
The mental health illness incident rate in children and teenagers has grown from 2 to 4 percent of the population to 22 percent. The mental health incident rate has risen from 4 to about 8 percent for the middle aged and elderly in the county.
Between the county's mental health center and Cayuga Counseling Services, the county has the capacity to treat about 4,200 patients, but there are 6,560 patients in need of treatment in the county. The waiting list for the agency's 32-patient day hospital program is “elongating,” Blair said.
“While we have a broad array of services and these services don't exist everywhere, the system is just not adequate for the numbers we're trying to serve,” Blair said.
There are few and far-between hospital beds for mentally ill children. The beds are available only in scattered spots throughout the state, the closest being in Rochester.
The hospital beds that are available for children don't work because they are too far away. Families are reluctant to institute their children at far-away facilities, and families must be involved in treatment if the treatment is going to have benefit. And insurance money often runs out before a patient is ready to be discharged.
Reasons for hope
Local officials still say there are some silver linings in this area's access to health care.
In comparison to other small cities in the United States, Auburn has plentiful doctors, dentists and specialists per capita, said Cynthia Aikman, the program manager for the city's Planning and Economic Development office.
“Right now, as I field calls from people interested in moving to the area, they're very impressed and want to know why we have such an excellent selection. They see our health care infrastructure as very comprehensive and they're very impressed by it,” Aikman said.
The Medical Society's Dymna said Cayuga County has “such dedicated physicians in a small community” who take more calls and work longer hours than physicians in larger cities.
Cuddy is pleased with the county's immunization rates, cancer screenings, lead poison prevention, water quality and rabies control.
There are also excellent programs working on the preventive measures related to alcohol, smoking and obesity, Cuddy said.
On the mental health front, Blair says the wave of the future includes new programs like play therapists going to six local day care centers to identify children with developmental problems and intervene before further neurological damage occurs.
Gioia is hopes more efficient health information systems will eliminate administrative redundancies and make health care more cost-effective.
Terri Bridenbecker, the executive director of the 450-member Cayuga County Chamber of Commerce, said the last survey of chamber members found health-care costs were the number one issue.
“Employers were opting out of providing health care for employees because they couldn't afford the double-digit premium increases,” Bridenbecker said. “We need to make sure employers have the tools they need to attract quality employees and be able to provide them a benefit like health insurance that is cost effective.”
Staff writer Amaris Elliott-Engel can be reached at 253-5311 ext. 282 or at amaris.elliot-engel@lee.net