A new report found New York hospitals are in a precarious financial state.

The New York State Hospitals Fiscal Survey Report showed statewide hospitals are projecting an operating budget margin of 0.0% percent. While it is a slight improvement, hospital administrators said it is still insufficient for hospitals to handle patient care.

Bea Grause, president of the Healthcare Association of New York State, said government reimbursements do not cover the costs of administering health care.

"Those reimbursements are fixed and do not change," Grause pointed out. "They grow a little bit year over year but they're not keeping up with the expense growth that all hospitals are experiencing."

She noted hospitals cannot raise their commercial expenses with the expectation it will make up the difference, arguing the best way to help hospitals is to close the gap on Medicare and Medicaid payments so they keep up with expense growth. Prescription drugs are the largest continuously increasing expense hospitals face since such prices run 83% above the rate of inflation.

Staffing issues are being exacerbated by New York hospital's fiscal challenges. The report found labor expenses have grown more than 36% since 2019. While it is the second year of declining contract labor expenditures, they are double what they were in 2019.

Grause emphasized not having sufficient staff can affect the services hospitals offer.

"If a hospital is going to have a dialysis unit, you need a nephrologist. You'd probably need more than one nephrologist," Grause observed. "But you also need specially trained nurses, you need the right equipment, you need all the medication, you need the IV solution and the peritoneal solution."

Another factor in hospitals' declining operating margins is insurer demands. The report showed some surveyed hospitals project insurers' actions will cut their 2024 operating revenues by 5% or more. Estimates showed it would result in $1.3 billion or more in lost revenue for the hospitals.


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In the aftermath of Hurricane Helene, many dentists in Western North Carolina faced devastating losses, from damaged practices to destroyed homes. The North Carolina Dental Society Foundation is stepping in to help them. The group launched an emergency relief grant program to help dentists get back on their feet.

Dr. Ruma Simhan, former president of the North Carolina Dental Society Foundation, said the recovery efforts are about more than rebuilding practices; they're about restoring vital oral health services to communities that need them most.

"A lot of dentists we hear from, their practice is damaged or lost altogether, and they're trying to find a way to go back to their community and serve their patients," she explained. "And so they just really need help getting back on their feet."

She added that the goal is to make sure that critical health care gets back to communities where access was already limited.

Simhan said the foundation isn't stopping at grant funding. Through partnerships with local organizations, it launched an oral hygiene supply drive, collecting more than 25,000 items such as toothbrushes, toothpaste and floss for impacted residents. Collaborations with Valley Strong Disaster Relief and Blue Ridge Tae Kwon Do helped transform community spaces into relief centers, while dental associations across the country sent donations to expand support efforts. Simhan said these initiatives are helping ensure oral health remains a priority.

"Oral health is truly important to one's overall health. And it cannot be stated enough that if one part of the state struggles for access, has dentists that cannot work in the area then that really affects that community to obtain its optimal health," she continued.

The foundation is still accepting grant applications and donations to support recovery efforts. Simhan said with rural communities in Western North Carolina already facing limited access to dental care, getting these practices back up and running is critical. More information is available on the foundation's website.

The Community Health Provider Alliance improved health care quality and saved $17.3 million in taxpayer money that would have been paid out by Medicare in 2023.

Brandi Apodaca, chief operating officer with Community Health Provider Alliance, said nearly half of the money saved will go to support community health centers that treat all patients regardless of their ability to pay. That's good news for clinics struggling with a steep increase in uncompensated care after more than half a million Coloradans were dropped from health insurance rolls.

"As Medicaid dollars have decreased to the community health centers due to the Medicaid unwind, these dollars are coming at a critical time to really support the integrated work that community health centers are doing," she said.

Medicaid coverage was automatically maintained during the COVID public health emergency, but that ended in the spring of 2023. Nearly half of enrolled Coloradans, including thousands who still qualified for coverage, lost their health insurance.

Over the past five years, the alliance has helped save $70 million for the Centers for Medicare and Medicaid Services. Apodaca said improving the quality of care - for example, by bringing more people in for their annual wellness visits - creates better health outcomes for patients, and keeps costs down by reducing expensive emergency room visits and hospitalizations.

"By doing things like managing chronic conditions and getting engaged into primary care - which should be your number one source of health care - we're going to control costs," she continued.

Nationally, the Medicare Shared Savings Program saved a record $5.2 billion in 2023. Program participants get to keep a portion of those savings. Apodaca says in Colorado, the money will help ensure that community health centers can continue to deliver high-quality coordinated health care.

"They not only provide physical health, they are also integrated with dental and behavioral health. So when you show up at a community health center, we're going to be able to provide services for all of your health care needs," she concluded.


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Some anesthesiologists hope this is the year Tennessee passes legislation to allow Certified Anesthesiologist Assistants to practice in the state.

Assistants are authorized to work in 20 states but not in Tennessee.

Sasi Duggirala, certified anesthesiologist assistant and managing partner at Harmony Anesthesia in Atlanta, a former Tennessean, said the state's shortage of anesthesiologists as well as Certified Registered Nurse Anesthetists delays surgeries. He is advocating for licensure of certified assistants to increase the number of anesthesia providers, saying it would ultimately improve patient care.

"After coming out of COVID, there's been just a huge backlog on necessary procedures and surgeries that need to be done," Duggirala pointed out. "The mid-level anesthetist coming only from CRNA pool is just not enough to fill that gap."

Last year, Senate Bill 453 would have allowed certified assistants to practice in Tennessee but the bill stalled in the House. Some Tennessee Certified Registered Nurse Anesthetists opposed it, claiming the assistants lack the comprehensive training of nurse anesthetists. Backers want to see the bill reintroduced.

David Ryan Diehl, certified anesthesiologist assistant at Diehl Anesthesia in Atlanta, explained his son was born with a congenital disorder requiring prosthetics. The family receives support from the Jordan Thomas Foundation in Nashville. Diehl said new legislation would allow him to practice anesthesiology in Tennessee.

"Legislation needs to be passed that allows us to practice there, to bill insurance, Medicare, Medicaid, all those types of things, and for the groups to be reimbursed," Diehl outlined. "Also for us to be insured there as well, to practice."

Dr. Richard Duncan, orthopedic surgeon and medical director of the Center for Advanced Bone and Joint Surgery at Watauga Orthopedics in Johnson City, Tennessee, pointed out both Certified Registered Nurse Anesthetists and Certified Anesthesiologist Assistants can administer anesthesia during surgeries. He highlighted their extensive training, and suggested Tennessee institutions could offer such training as an additional educational benefit.

"A Certified Anesthesia Assistant is a person that has a bachelor's degree with some prerequisites that they have to have, and testing that they do," Duncan explained. "Once they're admitted into their training, it's 24 to 28 months of didactic training, and then clinical training."

Duncan added the critical shortage of anesthesia providers affects hospitals, surgery centers and patient care across the board.


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