Kendall Hicks Campaign Event

I received the following release from the Kendall Hicks Campaign

Please join us this Friday Night, 3/22 at the Frederick Allen Lodge at 69 Beekman Street as we kick off Kendall Hicks Campaign for Commissioner Of Public Safety.  Have a chance to speak with the candidate, enjoy good community, live music and refreshments.  Event begins at 7PM.  Here is link to the Facebook Event.  Share with your groups and bring your friends.  Thanks for your support.

https://www.facebook.com/events/252658398955717/?active_tab=about

 

City Center Parking Structure Development On The Move

On March 21st at 5:30 at the City Recreation Center (15 Vanderbilt Avenue) the City’s Design Review Commission and the City’s Planning Board will meet to hear a presentation by the LA Group regarding the plans to develop the Flat Rock Centre Parking Structure.  Saratoga Today has an informative article about the latest iteration of the project.

Link To Story

 

 

Third Parties Endorse Saratoga Springs Candidates For City Council and Supervisor

New York State is one of the few states in the country that allows candidates to appear on multiple ballot lines in a practice called “fusion voting” or “cross-endorsements”.  Candidates will often seek multiple party endorsements to attract voters who might not vote for them on say the Republican line but might cast a vote for them on say the Independence Party line. Votes on all the party lines are tallied to determine the winner of a race.

While there has been some talk in Albany about ending fusion voting, so far the NY State Legislature has not included this in their changes to the voting system.

I have not yet been able to obtain the endorsements, if any, made by the Green Party.  The Republican chair, Matt Hogan, tells me it is his understanding that the local Conservative Party has endorsed the four candidates on the Republican slate and no Democrats.  I will report on any additional endorsements as I learn of them.

Here is a list of the candidates endorsed by the Working Families Party and the Independence Party.

The Working Families Party has endorsed:

Meg Kelly for Mayor

Michele Madigan for Commissioner of Finance

John Franck for Commissioner of Accounts

Tara Gaston for Supervisor

 

The Independence Party has endorsed:

Meg Kelly for Mayor

Michele Madigan for Commissioner of Finance

John Franck for Commissioner of Accounts

Robin Dalton for Commissioner of Public Safety

Skip Scirocco for Commissioner of Public Works

Matt Veitch for Supervisor

Steve Mittler for Supervisor

The Saratoga County Chair of the Independence Party, Eddy Miller, expressed enthusiasm for their candidates: “We have endorsed five  excellent incumbents who have been doing a great job for Saratoga Springs and are confident that the newcomers we have endorsed will work well with those currently serving as Saratoga races into a new decade, the 100th year anniversary of the Roaring 20’s!”

Members of all the parties are currently circulating petitions to get endorsed candidates on the ballot. Petitions are due to be filed April 1-4.

 

 

 

 

 

No Good Deed By An Elected Official Goes Unpunished: Michele Madigan’s Insurance Savings

Last week I posted a release from Finance Commissioner Michele Madigan’s office announcing that the city would be changing its health insurance contract and would be saving $300,000.00 this year and more in coming years.

An anonymous commenter who goes under the name “Bartelby” attacked Commissioner Madigan for failing to do this earlier.  This is not the first time this person has tried to post a comment containing misinformation that was meant to damage the credibility of Commissioner Madigan.  In the past I have just put the comment in the trash rather than post it, but in this case I am publishing the text in order to make a point.  I expect this person has taken their name from the great Herman Melville short story “Bartleby, The Scrivener” but in a wonderful example of irony, the person misspelled the name.  In other words, he/she cannot get his/her own name straight.

Here is Bartelby’s (sic) comment:

“So the taxpayers have been missing out on a $300,000 savings because Madigan was holding out for a promise to, if cheaper, convert back to a community-rated plan? This was completely unnecessary, as a proper competitive bid would have allowed for both options because there would have been more than one insurer competing.”

This comment is so inaccurate and misleading in so many ways that it is hard to  know whether Bartelby is just  ill informed or consciously malicious.

The following is a an account of how this policy change evolved.  I think it is worthwhile going into the weeds on this.  Most people are appropriately cynical about their elected officials and not without reason, but it is a mistake to assume that all are self serving, incompetent, and lazy.  The effort that went into this project is very much worth understanding and acknowledging.

The History:

There are two general methods used to determine the cost of health insurance to employers. In “Experience Based” plans premiums are based on the actual costs incurred by the insured group compared to what was expected.  For instance, if you were a modest size firm and you had more employees undergo expensive procedures than expected, you were at risk of a major hike in your insurance.  The other method used is referred to as “Community rated.”  In this case the insurer identifies a pool of companies and sets the premium rate based on their overall utilization.  By expanding the pool theoretically one minimizes the potential for hikes.

Prior to the Obama Affordable Care Act (ACA), heath care companies were under no obligation to allow employers who had changed from a “Community” plan to an “Experience”  plan to change back to a “Community “ plan.  In 2018 the State of New York issued a directive requiring providers allow both options as required under ACA.

Still, the issue remained complicated.

  1. There are only a handful of providers in the area, limiting the city’s ability to make such jumps.
  2. Not every community-rated plan is the same, and a new provider would almost certainly include different doctors.  Any change could expose the City to grievances from employees based on the union contracts.

So the new found flexibility to change plans provided the city with the potential for greater savings but actually determining what changes would be best both in terms of cost and consistency with union contracts was not simple.

Like most individuals and families the City uses brokers to get insurance and to assist in claims and general support.  You may have an insurance agent who you buy your house insurance through, for example.  They provide you with support in selecting the actual insurance company and in addressing any claims you may have.

So the City first issued an RFP requesting brokers to submit proposals for a package that included their support to the city for its insurance issues, claims, etc. along with an actual health provider who would deliver the service.

Eleven brokers submitted proposals.  A committee to review the proposals was established and they whittled the potential brokers down to four.  In the end, Amsure which is operated by Adirondack Trust was selected.   As part of that decision, Amsure was directed to pursue creative solutions to address the City’s increasing healthcare burden. Moving to an “Experience Based” plan was one option presented by Amsure, at which point the City asked them to approach medical providers in the area. MVP ultimately came up with the lowest price.

Interestingly, MVP had been the existing health provider for the city.  Since MVP had been servicing the city, it was a good sign that their low bid reflected a realistic understanding of the city’s employees and usage.

One of the benefits of the change was that MVP Experience Based plan included out of network benefits to employees which would not have been allowed under the “Community” pool model.

The City then sought out agreements from its unions.  The city has seven different bargaining units.  The City met with all seven groups.  The range of services in the new contract would be the same as the old with the one added benefit of additional out of network coverage.

One union offered to accept the plan but only if the existing contract (which includes an annual 2% raise) was extended for an additional year.  The City had already reached agreements with a number of units but it then went back to the all of them, whether they had agreed already or not, with the one year extension proposal.  As of this writing five had signed.  The bargaining unit for the police needed more time because a number of its union officers were away.  The Department of Public Works bargaining unit rejected the deal.

It is important to note that Commissioner Madigan’s office involved the unions early in the process.  While the city can unilaterally change health plans, the unions can grieve the actions if they believe the changes violate their agreements with the city.  In the past, administrations had unilaterally made these kinds of changes and in so doing generated bad feelings on the part of the unions.  Since the health care change represented no loss of benefits, it appears likely that the change will survive a challenge by the DPW bargaining unit.

On February 27 the City Council convened a special meeting to authorize the Mayor to sign the updated healthcare rate renewal forms with MVP Health Care.

A Lesson

If you waded through this narrative regarding what it took to save  money on the City’s health insurance it should be clear that Commissioner Madigan and her deputy Mike Sharp deserve praise and acknowledgement for their initiative.  People in general forget that in the commission form of government, elected officials need to work hard as administrators.  The public is usually acutely aware when their leaves are not picked up when they think they should be or when their taxes go up, but they are often unaware of other work or lack thereof of their elected city officials.   It is fully understandable. Who but geeks like me spend time sorting through this stuff?   Still, I wish efforts like this were better understood and acknowledged.

It is unfortunate that misleading and inaccurate  comments such as “Bartelby’s” often resonate with the public and  that it has become common for comments such as this to be  uncritically circulated and amplified on social media.   I would not have posted his/her comment normally.  Comments that are as inaccurate as this do not contribute to a constructive dialog about issues and are trashed.

 

 

 

 

 

 

A Conversation With Hospital CEO, Angelo Calbone, Re the Controversial Plans For A Medical Office Building

I met with Angelo Calbone at his invitation to discuss the Saratoga Hospital’s plans to build an office facility and parking lot on land currently owned by D.A. Collins but under option to the hospital.

An earlier proposal by the hospital to expand was the source of considerable controversy several years ago with strong opposition from the neighbors in the area.

At present, the land the hospital wants to build on is undeveloped and quite charming.  While this land is subject to development now under current zoning, the hospital proposal would involve a much more intensive use of the land than is currently allowed and raises concerns about the impact it would have on traffic in the affected neighborhoods.

Expansion 3

The Comp Plan that was in effect before the adoption of the current 2015 Comp Plan designated the area to the north of Morgan Street and the west of Seward Street (includes all Birch Run, the apartments on Morgan Street and the two vacant parcels the hospital intends to purchase from D.A. Collins – see map above) as HDR-2.  HDR-2 stands for High Density Residential which allows for 10-15 units/acre.  The condos at Birch Run and apartments in that area are examples of what is  allowed under HDR-2.  The two vacant parcels along Morgan Street where the hospital intends to build were never rezoned as called for in the pre-2015 Comp Plan. Arguably, the zoning for these two parcels was more or less compliant with the old comprehensive plan because the UR-1 zone (four units per acre) is less dense than the directive in the old comprehensive plan that called for zoning that would allow residential units with 10-15 units per acre.  In any case, that all changed with the adoption of the 2015 Comprehensive Plan that now designates this area to be INST which stands for Institutional.  This designation contemplates the re-zoning of this property  for, among other things, health related facilities like a medical office building. The Institutional designation does not contemplate zoning for single family or multi family units. The actual language from the Comprehensive Plan that describes the INST designation is “the Institutional designation includes areas that provide services such as religious, educational, health, cultural and tourism”.  The change in designation for these parcels came at the behest of Saratoga Hospital’s request of the Comprehensive Plan Committee in November 2014 when Hospital Vice President Kevin Ronayne described the hospital’s need for more medical office space in close proximity to the main hospital building. He urged the committee to re-designate this area in a manner that would accommodate zoning to allow for medical offices. The committee agreed and the Council ultimately adopted this designation as part of the overall Comprehensive Plan when it voted in June 2015.

In February 0f 2016 things got very messy when the city council addressed the actual rezoning.  Both Mayor Joanne Yepsen and Commissioner Franck recused themselves from voting on the rezoning asserting that they had conflicts of interest.  The vote to rezone required a super majority and without Yepsen’s and Franck’s participation a super majority was not possible.

Now with a different Mayor and a different Public Safety Commissioner, the zoning change vote is slated to come before the Council again, once the Council has reviewed the zoning map and comprehensive plan alignment recommendation, currently scheduled for March 12. This recommendation will presumably affect many city parcels, not just the land of interest to the hospital. If the zoning map is amended, the hospital will be able to make a site plan application to the Planning Board.

Mr. Calbone, Saratoga Hospital CEO, and I had a very thoughtful conversation which I found helpful in understanding better the hospital’s rationale for their proposal.

First of all I had thought that the proposed office facility was a kind of medical building simply providing space to interested doctors.  In fact, the medical offices that would be located there are offices of the hospital’s medical group, all employees of the hospital. It is beyond the range of this post to address the trend but essentially independent medical practices are becoming increasingly rare.  The full gamut of the medical profession from family practitioners to surgeons are opting to work directly for hospitals.  The hospital already has a very large employed medical group and given the national trends it is reasonable to expect the staffing of the hospital to continue to grow.

As explained to me by Mr. Calbone, the medical group’s offices are now scattered about the area in a variety of locations.  In order to be eligible for certain reimbursement streams, medical facilities in New York State must adhere to standards set under Article 28 of the New York State Public Health Law.  The process to certify these facilities is apparently extensive and rigorous.  Given that these facilities are meant to address health needs of a vulnerable  population, it is not surprising the requirements in areas such as safety, ventilation, and sanitation are extensive..

As explained by Mr. Calbone, the cost of retrofitting these off site offices to meet these standards is high as, I expect, is the cost of maintaining them.  My impression is that most of these facilities are leased.  He made a compelling argument as to the value of having a centralized medical facility in the city which would be owned by the hospital and designed specifically to meet these requirements

He also raised an oddity in the Medicare reimbursement formula.  For some reason, Medicare has a higher reimbursement rate for services provided at the hospital than at other offices.  Apparently their definition of what is “at a hospital” is that the operation must be within 250 yards of the main building.  He provided links to the Medicare regulations in support of this.  I will admit to the readers of this blog that I found the arcane nature of these links beyond my ability to decipher.  In correspondence from Mr. Calbone, he asserted that the savings would be in the order of $1.5 million dollars a year if the offices were situated adjacent to the hospital.  I am in no position to verify this number but it seems reasonable that whatever the figure is it would be significant given the magnitude of Medicare.  If there is someone out there that challenges Mr. Calbone on the Medicare regulations, I would welcome it but barring that I am willing to give Mr. Calbone the benefit of the doubt on this. A consistent theme in Mr. Calbone’s commentary is that increased revenue or money saved through any hospital initiative is money that can be redirected to patient care.

Mr. Calbone emphasized to me that the hospital is a not-for-profit institution.  The moneys saved by the success of the proposed facility do not go to share holders. They are invested in the improvement and expansion of patient care.

We also discussed the option of building the offices above the existing hospital structure.  He offered that the hospital will in the future expand space by building up but that he felt strongly that this future space needed to be reserved for anticipated patient care.  He noted that his own administrative offices are under consideration to be moved to provide additional space for patient care.

I asked him about the possibility of expanding the parking facility at the hospital.  The following was his description of the problems with this option.

A combined parking garage/office building structure on the hill

Regarding your question about a combined parking garage/office building structure, as reference, I’ve included below the excerpts from the letter we sent to our neighbors.

To specifically address the idea of a combined parking garage/office building structure, there are additional constraints and considerations we have explored:

  • Traffic concerns would not be mitigated, in fact, would still be compounded if we were to build “on the hill”
  • Current employee and visitor parking would still be displaced for upwards of two years during construction
  • A combined building structure would likely conflict with the current PUD and city building height restrictions, requiring additional zoning modifications
  • Our current office building on the hill is a two-story structure, in part, due to these considerations
  • A combined building structure would interfere with the medical transport helicopter flight pattern to and from the helipad located on the west corner of the property
  • Placing a helipad on top of any building is cost prohibitive, from a construction as well as, more significantly, an insurance perspective
  • We maintain that all costs committed to building any parking structure, upwards of a projected $10 million, is money wasted, money better committed to patient care

From the letter [JK: A letter sent to the hospitals neighbors]

…If the hospital does not move forward with this project on this parcel of land, we may revisit the concept of building adjacent to the hospital’s main campus, on the hill on the west side of Myrtle Street where our current employee and visitor parking is located. If this concept were to move forward, we would still be bringing staff and patients to the main campus. If another developer purchases the land at the top of Myrtle Street and expands the neighborhood, that will increase traffic and compound the traffic concerns.

Building “on the hill” was fully explored and determined to be the less viable solution on many levels. Building on the hill would require constructing an 800-space, multilevel parking garage to accommodate the employee and visitor parking displaced by the new office building and parking garage, as well as for the additional parking needed for the new building.

In this scenario, all of the current parking demands would be dispersed throughout the surrounding neighborhood for upwards of two years during construction. This redistributed parking would account for hospital staffing and shift changes, 24 hours a day, seven days a week.

Constructing a parking garage is estimated at $10 million dollars above the cost of the office building. We believe that would be an irresponsible use of the community’s resources, money that should be directed to patient care and patient safety….

The major vexing issue remains how to address the increased traffic that would result from the Hospital’s expansion.  To his credit, Mr. Calbone did not try to minimize the traffic concerns nor did he offer glib solutions.  In the end, if this project goes forward, finding a solution will rest with the cooperation between the city and the hospital.  During the last few years the makeup of the city’s Planning Board has improved in terms of its independence in critically assessing projects.  I have great respect for Mark Torpey, its chair.  The citizens of this city will have to rely upon the Planning Board to protect the neighborhoods affected by this project by insisting on a workable traffic plan.

Assessing this project has not been easy for me.  I have friends who live in the affected neighborhood who adamantly oppose the hospital’s plans.  It is a beautiful piece of undeveloped land and in the best of all possible worlds I would greatly prefer that the city bought it and turned it into a park.  The reality is that this is not going to happen.

During my conversation with Mr. Calbone I noticed aerial photos on the walls of his office that serve as a documentary history of Saratoga Hospital.  Similar to many other hospitals, it has experienced enormous physical expansion over the years.  The fact is that if I were Mr. Calbone thinking strategically, I would be coveting the D.A. Collins land as probably the last major property to use for future growth.  If this land were sold and developed as residential property, the cost for acquiring it from multiple homeowners in the future would probably be both financially and logistically problematic.  I can only assume that this is probably an important element in his pursuit of his project.

Hospital Ratings

The Medicare website periodically issues a report card evaluating the nation’s hospitals.  They recently issued a report that showed a decline in the ratings for New York hospitals.  Disturbingly, New York State’s hospitals rated 50th out of 50.  Bucking that trend has been Saratoga Hospital [https://www.medicare.gov/hospitalcompare/results.html#dist=50&loc=12866&lat=43.0964412&lng=-73.7242486].  Saratoga Hospital increased its rating from a 3 to a 4 (ratings range from 1 to 5).

A Cautionary Tale

This is a story that was published in the Glens Falls Post Star Newspaper in its March 3rd edition.  It is headlined “Glens Falls Hospital CEO Describes Dire Financial Situation To Local Leaders.”  It is a sobering story and it reinforces the poverty of what passes for our health care “system” and how critical the role money plays in the survival of our most essential institutions.

 

 

A Neighbor Responds To Saratoga Hospital’s Expansion Plans

[JK: I invited Alice Smith to be a guest writer on my blog to respond to my piece on Saratoga Hospital’s planned Medical Office Building.  Alice lives in a neighborhood that will be impacted by the project.  She is a person of high integrity with a strong sense of social justice]

John

Thank you for reaching out to me.

A couple of years ago, when the expansion plan was defeated, the neighbors were not only upset about the plan itself, but also about the fact that the hospital never communicated with the neighbors, despite telling the public and the press that they “were working closely with the neighborhood”.   The whole project was kept very quiet.  Then we learned about the plan and there was an uproar.  The attitude of the hospital was “we’re going to build, no matter what yout think or how you are affected”.

This time around they realized that was a mistake and they are doing a tremendous public relations campaign to gain support.

The facts are still the same, except that they are being more professional in dealing with the neighbors and the public.

Beginning with the Comprehensive Plan, Chris Mathiesen is right.  The part referring to this re-zoning was passed at the end of the day, after a long tedious discussion about many changes in the city, and the impact of this change was (conveniently) not even noted.  Yes, it should be revised.

Second,  the proposed building is for doctor’s offices, as noted above.  I have no doubt it is more practical for the hospital to have them all in one building where they can collect the rent and have a much higher profit.

The fact that it costs money to meet certain standards to certify facilities for Medicaid and Medicare reimbursement is just one of the expenses that the medical business has to deal with, and I’m sure they would have to reach similar standards for patients with private insurance as well.  With that said, they still have to  figure out how to make the highest profits.  I’m sure their financial experts consideredl those calculations when they chose the site on Morgan St for their expansion .

The hospital is a big corporation that needs to make money, whether it is for profit or not-for-profit,   which is fine,  – who doesn’t?

However, there are other options, such as building on the hill, which might not be as cost effective, but this does not entitle them to break rules and violate the rights of neighborhood residents.   The biggest assett a person has is his/her home.  Some homeowners are paying high mortgages to live in a nice neighborhood and their rights should be respected.

You mention the probability that D.A.Collins could sell the land for residential development.  We are not opposed to this.  The area is residential and we have no problem with anyone building residences.  If the purchase from multiple owners would be logistically and financially too complicated   -there are financial advisers who can handle those matters.

There are many other negative issues that were previously raised by neighbors, such as the need to add sidewalks,  street lighting, traffic, and flooding in the lower areas, but I won’t go into those details here.

There is a purpose for Zoning laws, and these laws should be respected  -even if  a big corporation such as the hospital thinks that the only way it can be more profitable is by rezoning.  Other options should be considered more seriously, such as building on the hill, but they have not been willing to even consider it and are telling the public there is no other way this can be done.  They will turn down possible every alternative.

John, the fact that the hospital is now reaching out to the community makes their proposal more appealing, but this does not change the reality that they are stepping on the rights of residents who don’t have the money or the political power to fight this, and I do hope that our elected officials can see clearly.   By the way, patients will not be saving money, they will be paying the same price for medical care.

Lastly, regardless of whether any corporation wants to build a  mall, or a roller coaster, a condo, or a hospital (profit or non-profit)-  this does not change the fact that certain rights should still be protected.

Although there has been a big change in their public relations approach, it is appreciated, but  civility does not mean “meet in the middle”.

Will end here for now.  I’m sure there will be a lot more about this in the near future, and I appreciate that you look at both sides of the issue.

Times Union Watch

[JK: this is a new, on-going feature I am initiating.  The coverage by the Times Union newspaper of Saratoga Springs is discouragingly bad.  This feature is meant to shed light on this problem and to correct the record.  Readers are welcome to advise me of problem stories in the future.]

In a February 25 article by Wendy Liberatore on the Saratoga Springs Democratic Committee endorsements she wrote:

“We are fortunate to have such excellent people who want to continue serving this city,” said DeLeonardis, whose husband and city attorney Vincent DeLeonardis saw a doubling of his salary under the incumbents. 

 This is the kind of cheap shot that the Times Union frequently  indulges in.  Mr. DeLeonardis’ salary went up because he went from part time to full time.  Apparently to juice the story up, Ms. Liberatore has dropped this into her report to imply some improper influence was exerted by Ms. DeLenonardis who is chairperson of the city Democratic Committee.