Opinion: It’s Well Past Time for New York City to Get the Right Stuff Done

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“The city is becoming increasingly harsh for the very constituency the mayor claims to care about: the underserved in the forgotten outreaches of the city’s neighborhoods.”

Michael Appleton/Mayoral Photography Office

Mayor Eric Adams at a press conference in January 2022.

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Eric Adams has made “get stuff done” his mayoral mantra. And he’s right, there’s so much to do. But it’s not just a matter of getting stuff done—it’s a matter of who it’s getting done for.

In this regard Adams is much like his mayoral predecessors, following a multi-decade legacy of getting stuff done that mostly prioritizes the wants and perspectives of New York’s elites, from finance and real estate to the big, purportedly nonprofit universities and hospital systems and deep-pocketed Manhattan museums. Some of the city’s major philanthropies and municipal unions are culpable too. It’s a legacy that far too often leaves behind the needs of everyday New Yorkers and their neighborhoods.

In the absence of strong mayoral leadership committed to the interests of the many, we have a civic agenda frequently set by campaign cash, political expediency and, oftentimes, bureaucratic inertia. I’ve seen this from the inside, for a decade in city government, including as director of the Mayor’s Office of Operations under David Dinkins. The time to reset the civic balance of power is long overdue. 

To start, we need to re-examine our culture, our city’s governing belief system. The current culture is based on impunity where economic exploitation by the powerful few goes unpunished. Under Mayor Adams, and to a large degree much like his predecessors, the predators and exploiters run rampant while most New Yorkers are left with shredded services. A tattered semblance of regulatory guardrails exists, with a light touch on enforcement. While Mayor Adams has cracked down on street vendors, Starbucks is allowed to flaunt the Fair Workweek law and exploit its modestly paid staff.

The need for structural change can no longer be ignored. This begins with burden sharing and a renewed conversation about who pays what and who subsidizes whom. We know that during the COVID pandemic the financial and other elites amassed even greater wealth, while much of the rest of us gained little economic ground. Data shows that the wealthy pocketed most of the rewards and shouldered none of the burdens. The number of city tax filers with incomes of $10 million or more grew by more than 50 percent from 2019 to 2021.

As the mayor’s record low approval ratings underscore, we need to call out the absence of civic and political leadership at this moment in our city’s history. It’s hard to name executives not only in government, but in our private institutions and in the philanthropic community that would step beyond their current roles and offer solutions to structural issues that have hampered our city for decades.

The list of challenges the city faces is considerable. Topping the list is significant affordable housing. While Adams has made some concrete proposals to help spur housing construction, a key question remains about how much of it will be affordable to New Yorkers of modest means. For decades, the city’s affordable housing programs have largely left the lowest-income New Yorkers behind. And much of the lowest-cost housing that’s been created is studios and one-bedrooms, not suitable for families. The mayor’s refusal to expand the availability of city-funded housing vouchers—as mandated by the City Council—underscores a lack of emphasis on the housing needs of lower income New Yorkers.

Likewise, the mayor’s continued commitment to the long-dominant civic philosophy of austerity budgeting has further frayed the city’s safety net. For the mayor’s first two years, the city processed barely 40 percent of the applicants for the federally funded food stamp program in a timely fashion. While the mayor has recently hired 1,000 people to deal with the backlog, for two years he allowed timely processing to tumble even as the need grew.

And as The City reported in January, the number of apartments sitting vacant in the city’s public housing developments had increased by almost 50 percent over the past year—despite a waiting list of 240,000 households.

Some of the decline in services can be linked to cutbacks in city staffing through attrition and a hiring freeze. But the problems with the mayor’s management of the city’s workforce run deeper than staff shortages—he’s pushed aside some of the very people who have the knowledge and experience that can help meet the challenges the city faces now and in the future. As a result, city agencies have lost institutional knowledge, planning capacity and, to borrow one of the mayor’s favorite phrases, the expertise for getting stuff done.

The city is becoming increasingly harsh for the very constituency the mayor claims to care about: the underserved in the forgotten outreaches of the city’s neighborhoods. Library hours have been cut, pre-K slots dropped and funding for our parks, contrary to the mayor’s campaign pledge, is decreasing to a proposed $584 million in the upcoming fiscal year.

It would not be an overstatement to say that the city has become the intersection between private wealth and public squalor. While hedge fund billionaire Steve Cohen makes a play for building a casino on parkland, his baseball team, the Mets, pays no property tax for its stadium—much as the Yankees, Knicks, Nets and Rangers get a free pass on property taxes for their facilities collectively worth more than $300 million a year.

New Yorkers should also be asking why the city continues to put billions of taxpayer dollars in banks that fail to prioritize the interests of our communities. Too many of the banks that hold the city’s deposits maintain lending and other practices that foster racial and economic disparities: namely, redlining neighborhoods of color and investing in predatory landlords. The city doesn’t regulate the banks, but we can decide where we want to put our money if they’re not meeting our needs.

With so much to do, here are some ideas about taking another road forward, one that maps out structural and systemic changes. It’s a call for leadership that sets a new direction for a vastly different set of governing choices:

Shift resources to public infrastructure and public space. We need to turn away from the stale practice of awarding sizeable public tax abatements to private sector entities, with questionable benefits to the city. The recent deal to exempt property taxes and charge a reduced rent for Vornado Realty Trust’s Pier 94 project, which the local community board chair called an economic development “giveaway,” is a clear example. So, too, are the tax breaks provided to luxury housing developments like One57, where a penthouse sold for $100 million.

These giveaways should be in the city’s rear-view mirror (yet the mayor and governor pushed to recently revive the break that went to One57 and many other buildings). Instead, we need to redirect the use of subsidies from private entities to enhancing public physical space: to our libraries, early childhood and day care centers, our senior centers, New York City Housing Authority community centers and playgrounds, public-school yards and our outer borough cultural institutions. It is also critical that such efforts involve substantial community input, as is finally occurring with the Kingsbridge Armory. “[F]or for nearly 30 years, the Kingsbridge Armory has languished despite grand plans by mega-developers, billionaire investors and celebrities to repurpose the 570,000-square foot landmark,” wrote Stefanos Chen and Winnie Hu in The New York Times, highlighting the unusual redirection of planning for the armory to a community-led approach.

Ensure that safety net programs are efficient and effective. As Kim Phillips-Fein wrote in The New York Review of Books, “Mayor Adams’ skepticism about raising taxes and his insistence on belt tightening and the need to cut social service programs reflect a sense of who matters in the city, and who the city is for.”

At a time of increased need, accelerated access to basic social services like food stamps and cash advances, as well as other services such as child care, are critically important and cannot be relegated to crimped budget outlays and bureaucratic inertia. The city’s poverty rate has soared to 23 percent, from 18 percent in 2021. According to a February New York Times article by Stefanos Chen, ‘The number of New Yorkers living in poverty, nearly two million in all, included one in four children.” The article continues, “The steep rise in the number of New Yorkers living in poverty which grew by 500,000 residents in 2022, underscores wide and longstanding disparities.” And a December article in Gothamist by Arya Sundaram cited James Parrott, who characterized the city’s prosperity as lopsided. “People in the bottom half are losing ground,” Parrott said, “income inequality in the city is now the greatest among major cities across the country.”

Forge a new relationship with municipal labor. For too long, the city’s workforce has functioned under antiquated work rules and bureaucratic inertia. As Dana Rubinstein and Emma G. Fitzsimmons wrote in The New York Times, the Adams administration “…created a work environment where independent thought was discouraged and obedience to directives was valued.” Staff dissatisfaction, coupled with substantial staff cuts, is a recipe for agency dysfunction—and it’s the city’s everyday residents who suffer the consequences. In tandem with the municipal labor unions, the city should craft a partnership that gives a greater voice to frontline employees, reforms rigid work rules that constrain job responsibilities and modernizes work hours—from a four-day workweek to more work from home opportunities. At the same time, the municipal unions need to step back from their parochial focus on the interest of just their members and embrace actions that benefit all workers. 

Create—and enforce—robust guardrails that protect working families from predatory abuse. While the Adams administration has vigorously enforced regulations against street vendors, seizing their goods and levying hefty fines, white collar abuses of tenants and workers remain largely unchecked. Property owners who fail to make repairs and violate rent and other regulatory rules can repeatedly wind up on worst landlord lists but rarely face consequences—even as millions of dollars in fines go unpaid. Similarly, too many private sector employers engage in wage theft, particularly among hourly paid workers in the hospitality and construction sectors. Migrants are especially targeted for wage and benefit abuses. And another aspect of wage theft that employers use is to squeeze hourly work week schedules, that result in lost pay and unpredictable work week conditions, and wreaks havoc on individual’s home lives. Lost wages total an estimated $1 billion annually. 

Divest from Wall Street banks and create a public bank. Currently, the city deposits billions of dollars in Wall Street banks, entities notorious for exploiting and draining wealth from low-income neighborhoods, perpetuating racial and economic disparities. In fact, the bulk of the city’s funds sit in just three big banks—Bank of America, Citibank, and JPMorgan Chase—which collectively poured over $1 trillion into fossil fuel corporations over the past decade.

The city should establish a public bank to leverage this dormant potential toward investments in long-ignored public needs. A broad coalition led by New Economy Project has been leading the charge for such a bank to hold city deposits and reinvest in the public good. It would invigorate local economies by providing responsible loans, often in partnership with neighborhood financial institutions, to small businesses and individuals—directly fueling job creation, affordable housing initiatives, and the development of sustainable infrastructure.

This initiative will require collaboration between the state and key city stakeholders, including the mayor, city comptroller, and City Council. Fierce lobbying by the big banks has all but ensured Wall Street maintains its monopolistic grip on New York’s financial ecosystem. In the meantime, in the spirit of embracing the common good and equitable burden-sharing, wealthy institutions—such as private hospitals, universities, foundations and well-endowed museums—should begin to divest from Wall Street banks and redirect their account holdings to community-based credit unions and other financial institutions that responsibly serve the city’s neighborhoods. Municipal labor also should join in this effort. 

For decades, conversations about the city’s policies and priorities have been framed and directed by the elite. For too long, we have as a city accepted their views, their facts, their preferences. In a series of wrong turns mapped by the leadership of blinkered institutions, they’ve taken us down a path of harsh economic conditions and starved city services, while wealth accumulation for the few has been protected.

It’s time for a reset on the city’s priorities, one that emphasizes the needs and interests of everyday New Yorkers.  It’s time for leadership that listens to all voices.  It’s time to get stuff done, especially when there’s so much to do. 

For over 40 years, Harvey Robins, has worked in various positions in city government, non-profits and foundations, including the NYC Human Resources Administration as first deputy administrator, the Board of Education as deputy chancellor for finance and administration, the director of the Mayor’s Office of Operations, the Children’s Aid Society as director of strategic planning and the Edna McConnell Clark Foundation as director of strategic planning and operations.

Amgen plows ahead with costly, highly toxic cancer dosing despite FDA challenge

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Arthur Allen | (TNS) KFF Health News

When doctors began using the drug sotorasib in 2021 with high expectations for its innovative approach to attacking lung cancer, retired medical technician Don Crosslin was an early beneficiary. Crosslin started the drug that July. His tumors shrank, then stabilized.

But while the drug has helped keep him alive, its side effects have gradually narrowed the confines of his life, said Crosslin, 76, who lives in Ocala, Florida: “My appetite has been minimal. I’m very weak. I walk my dogs and get around a bit, but I haven’t been able to golf since last July.”

He wonders whether he’d do better on a lower dose, “but I do what my oncologist tells me to do,” Crosslin said. Every day, he takes eight of the 120-milligram pills, sold under Amgen’s brand name Lumakras.

Crosslin’s concern lies at the heart of an FDA effort to make cancer drugs less toxic and more effective. Cancer drug trials are structured to promote high doses, which then become routine patient care. In the face of evidence that thousands of patients become so ill that they skip doses or stop taking the drugs — thereby risking resurgence of their cancers — the FDA has begun requiring companies to pinpoint the right dosage before they reach patients.

The initiative, Project Optimus, launched in 2021 just as Amgen was seeking to market sotorasib. At the time, the FDA’s leading cancer drug regulator, Richard Pazdur, co-authored an editorial in the New England Journal of Medicine that said Amgen’s trials of the $20,000-a-month drug were “hampered by a lack of robust dose exploration.”

The FDA conditionally approved sotorasib but required Amgen to conduct a study comparing the labeled dosage of 960 mg with a dosage of 240 mg. The trial, published in November, showed that the 960-mg dose may have given patients a month more of life, on average, but caused more severe side effects than the lower dose.

Amgen is keeping the 960-mg dosage as it conducts further tests to get final approval for the drug, spokesperson Elissa Snook said, adding that the dose showed superiority in one study. Whether medically justified or not, the heavier dosage allows the company to protect 75% of its revenue from the drug, which brought in nearly $200 million in the United States last year.

And there appears to be nothing the FDA can do about it.

“There’s a gap in FDA’s authority that results in patients getting excess doses of a drug at excess costs,” said Mark Ratain, a University of Chicago oncologist who has pushed for more accurate cancer drug dosing. “We should do something about this.”

Deciding on Dosage

It may be too late for the FDA to change the sotorasib dosage, although in principle it could demand a new regimen before granting final approval, perhaps in 2028. Under Project Optimus, however, the agency is doing something about dosage guidelines for future drugs. It is stressing dose optimization in its meetings with companies, particularly as they prepare to test drugs on patients for the first time, spokesperson Lauren-Jei McCarthy said.

“When you go in front of FDA with a plan to approve your drug now, they are going to address dosing studies,” said Julie Gralow, chief medical officer of the American Society of Clinical Oncology. “A lot of companies are struggling with this.”

That’s largely because the new requirements add six months to a year and millions in drug development costs, said Julie Bullock, a former FDA drug reviewer who advocated for more extensive dosing studies and is now senior vice president at Certara, a drug development consultancy.

In part, Project Optimus represents an effort to manage the faults of the FDA’s accelerated approval process, begun in 1992. While the process gets innovative drugs to patients more quickly, some medicines have proved lackluster or had unacceptable side effects.

That’s especially true of the newer pills to treat cancer, said Donald Harvey, an Emory University pharmacology professor, who has led or contributed to more than 100 early-phase cancer trials.

A study released last month in the Journal of the American Medical Association showed that 41% of the cancer drugs granted accelerated approval from 2013 to 2017 did not improve overall survival or quality of life after five years.

Many of these drugs flop because they must be given at toxic dosages to have any effect, Harvey said, adding that sotorasib might work better if the company had found an appropriate dosage earlier on.

“Sotorasib is a poster child for incredibly bad development,” Harvey said. The drug was the first to target the KRAS G12C mutation, which drives about 15% of lung cancers and was considered “undruggable” until University of California-San Francisco chemist Kevan Shokat figured out how to attack it in 2012.

Given the specificity of sotorasib’s target, Harvey said, Amgen could have found a lower dosage. “Instead, they followed the old model and said, ‘We’re going to push the dose up until we see a major side effect.’ They didn’t need to do that. They just needed more experience with a lower dose.”

The 960-mg dose “is really tough on patients,” said Yale University oncologist and assistant professor Michael Grant. “They get a lot of nausea and other GI side effects that are not pleasant. It hurts their quality of life.”

The FDA noted in its review of sotorasib that in phase 1 studies tumors shrank when exposed to as little as a fifth of the 960-mg daily dose Amgen selected. At all doses tested in that early trial, the drug reached roughly the same concentrations in the blood, which suggested that at higher doses the drug was mostly just intensifying side effects like diarrhea, vomiting, and mouth sores.

For most classes of drugs, companies spend considerable time in phases 1 and 2 of development, homing in on the right dosage. “No one would think of dosing a statin or antibiotic at the highest tolerable dose,” Ratain said.

Things are different in cancer drug creation, whose approach originated with chemotherapy, which damages as many cancer cells as possible, wrecking plenty of healthy tissue in the bargain. Typically, a company’s first series of cancer drug trials involve escalating doses in small groups of patients until something like a quarter of them get seriously ill. That “maximum tolerated dose” is then employed in more advanced clinical trials, and goes on the drug’s label. Once a drug is approved, a doctor can “go off-label” and alter the dosage, but most are leery of doing so.

Patients can find the experience rougher than advertised. During clinical trials, the side effects of the cancer drug osimertinib (Tagrisso) were listed as tolerable and manageable, said Jill Feldman, a lung cancer patient and advocate. “That killed me. After two months on that drug, I had lost 15 pounds, had sores in my mouth and down my throat, stomach stuff. It was horrible.”

Some practitioners, at least, have responded to the FDA’s cues on sotorasib. In the Kaiser Permanente health system, lung cancer specialists start with a lower dose of the drug, spokesperson Stephen Shivinsky said.

Smaller Doses — And Revenue

Amgen was clearly aware of the advantages of the 240-mg dosage before it sought FDA approval: It filed a provisional patent application on that dosage before the agency gave breakthrough approval for the drug at 960 mg. The company doesn’t appear to have disclosed the patent filing to investors or the FDA. McCarthy said the FDA was prohibited by law from discussing the particulars of its sotorasib regulation plans.

Switching to a 240-mg dosage could register a huge hit to Amgen’s revenue. The company markets the drug at more than $20,000 for a month of 960-mg daily doses. Each patient who could get by with a quarter of that would trim the company’s revenue by roughly $180,000 a year.

Amgen declined to comment on the patent issue or to make an official available to discuss the dosage and pricing issues.

Crosslin, who depends on Social Security for his income, couldn’t afford the $3,000 a month that Medicare required him to pay for sotorasib, but he has received assistance from Amgen and a charity that covers costs for patients below a certain income.

While the drug has worked well for Crosslin and other patients, its overall modest impact on lung cancer suggests that $5,000, rather than $20,000, might be a more appropriate price, Ratain said.

In the company’s phase 3 clinical trial for advanced lung cancer patients, sotorasib kept patients alive for about a month longer than docetaxel, the current, highly toxic standard of care. Docetaxel is a generic drug for which Medicare pays about $1 per injection. The trial was so unconvincing that the FDA sent Amgen back to do another.

Ratain, a staunch critic of Amgen’s handling of sotorasib, told Centers for Medicare & Medicaid Services officials at a recent meeting that they should pay for sotorasib on a basis of 240 mg per day. But CMS would do that only “if there is a change in the drug’s FDA-approved dosage,” spokesperson Aaron Smith said.

Drug companies generally don’t want to spend money on trials like the one the FDA ordered on sotorasib. In 2018, Ratain and other researchers used their institutions’ funding to conduct a dosing trial on the prostate cancer drug abiraterone, marketed under the brand name Zytiga by Johnson & Johnson. They found that taking one 250-mg pill with food was just as effective as taking four on an empty stomach, as the label called for.

Although J&J hasn’t changed the Zytiga label, the evidence generated in that trial was strong enough for the standards-setting National Comprehensive Cancer Network to change its recommendations.

Post-marketing studies like that one are hard to conduct, Emory’s Harvey said. Patients are reluctant to join a trial in which they may have to take a lower dosage, since most people tend to believe “the more the better,” he said.

“It’s better for everyone to find the right dose before a drug is out on the market,” Harvey said. “Better for the patient, and better for the company, which can sell more of a good drug if the patients aren’t getting sick and no longer taking it.”

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(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Stormy Daniels unfavorably compares Trump to ‘real men’ after hush-money trial testimony

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David Matthews | New York Daily News

Stormy Daniels blasted Donald Trump on social media Thursday night, just a few hours after she finished testifying against the former president in his Manhattan hush-money trial.

“Real men respond to testimony by being sworn in and taking the stand in court. Oh…wait. Nevermind,” she wrote in a post on X — a taunting reference to Trump not testifying in the case and using his own social media accounts to rail against the proceedings.

The zinger came after Trump’s lawyers unsuccessfully requested a mistrial based on Daniels’ testimony.

If Trump were to testify, he would open himself up to cross-examination by prosecutors.

Earlier in the day, Daniels pushed back during a tense, hour-long cross-examination by Trump’s attorney Susan Necheles.

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Daniels, whose real name is Stephanie Clifford, said she had sex with Trump in a Lake Tahoe hotel room in 2006. Trump has denied the two had any such encounter. The alleged tryst is at the center of Manhattan District Attorney Alvin Bragg’s case alleging Trump covered up a $130,000 reimbursement to fixer Cohen for paying Daniels into silence days before the 2016 election.

The presumed Republican presidential nominee scowled and crossed his arms during her testimony.

Trump was charged with 34 felony counts of falsifying business records for purportedly buying Daniels’ silence.

After Daniels’ testimony, Trump lawyer Todd Blanche argued unsuccessfully for a mistrial, claiming Daniels’ comments were “a dog whistle for rape” and went far beyond the scope of the charges Trump’s facing.

“He’s a corrupt judge, and he’s totally conflicted,” Trump told reporters outside the courtroom.

‘Birthing friendly’ label requires little effort by hospitals

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Jessie Hellmann | (TNS) CQ-Roll Call

WASHINGTON — Six months after the launch of the Biden administration’s “birthing friendly” designation for hospitals, advocates are questioning the next steps for the tool aimed at incentivizing better care for patients.

Beginning last fall, hospitals that achieved the designation received an icon on Care Compare, a federal website aimed at helping consumers pick health care providers.

But it’s not difficult for hospitals to receive the designation, with 2,225 — that is, most eligible hospitals — having received it as of April.

Of the nearly 1,000 acute care hospitals that didn’t get the designation, more than 800 said they didn’t provide delivery or labor care.

And only 135 didn’t get the designation because they didn’t meet the requirements of participating in a statewide or national perinatal quality improvement collaborative program.

What’s more, many of the hospitals that have received the designation perform cesarean sections above the recommended levels, which could indicate overuse of the procedure. C-sections are considered riskier than vaginal birth, with a longer recovery time.

“Right now, it falls short in terms of what pregnant people would need,” said Sinsi Hernández-Cancio, vice president of health justice at the National Partnership for Women and Families.

While many people typically don’t have much of a choice on where they give birth because of insurance limitations or living in areas with few providers, for those with choices, the designation currently is of little use, she said.

“Given that the majority of hospitals have gotten the designation because the requirements for it are a pretty low bar, it’s not really a useful distinction even for those consumers that do have a choice,” Hernández-Cancio said. “Because if the majority of the hospitals have it, and all the ones in your area do, it doesn’t make a difference.”

The designation is part of the Biden administration’s efforts to improve maternal health amid concerns about persistent inequities in health outcomes.

It was rolled out last November with much fanfare, touted by Vice President Kamala Harris as an important step to increasing “high-quality maternity care.”

But all a hospital has to do to receive the designation is attest to participating in a statewide or national perinatal quality improvement collaborative program and implementing evidence-based interventions to improve maternal health, sometimes called bundles.

While the Centers for Medicare and Medicaid Services has said it will work toward including other factors in the designation, when that will happen is unclear. The designation was not mentioned in the 2025 proposed hospital inpatient payment rule, which would typically be the vehicle for such changes.

While there is evidence that participating in high-quality collaboratives and implementing evidence-based practices can improve birth outcomes, the designation currently doesn’t probe into how meaningful those efforts are.

“It is kind of a low bar for hospitals to self-describe that they have implemented it without defining what implementation of a bundle is,” said Elliott Main, former medical director of the California Maternal Quality Care Collaborative, a stakeholder organization that aims to improve maternal health outcomes in the state.

Main, who advised CMS on the designation, said it is typical for designations to begin with a soft launch to get hospitals involved in the process.

“What does it mean to be engaged, to become a member (of a collaborative)— those kinds of terms are still being defined, but it gets hospitals to sit up and pay attention,” he said.

For example, The Joint Commission, which accredits health care organizations, has a checklist for evidence-based safety practices that should be implemented in maternity units to reduce the risk of harm from hemorrhage and hypertension.

“I think that’s likely a direction CMS may go,” Main said.

Improving care

While hospital designations may have little utility for patients, they have evolved to become powerful ways to get hospitals to improve patient care, experts say.

For example, California’s Cal Hospital Compare awards the “maternity care honor roll” to hospitals that have C-section rates below 23.6%, a goal that aligns with the Department of Health and Human Services’ “Healthy People 2030” initiative to reduce C-section births among low-risk, first-time mothers.

“It’s really a great carrot for hospitals and other facilities to improve,” said Alex Stack, director of programs and strategic initiatives at Cal Healthcare Compare.

Cal Healthcare Compare is working on revamping the model to include data on severe complications, access to doula care and breastfeeding.

“The great thing about an honor roll is it gives additional emphasis and helps facilities to prioritize further what the collective state or region is trying to work towards together,” Stack said.

The honor roll in California is part of a multifaceted effort to reduce C-section rates. According to provisional data from the Centers for Disease Control and Prevention, California’s rate of C-sections in low-risk mothers was 25.9%, below the national average of 26.6%.

Throughout the country, there is extreme variability between different hospitals and different regions that can’t be explained solely by patient characteristics, Main said. The culture of a hospital and the training of the people who work there likely have more of an impact.

Better data collection could be part of the solution.

This is the first year CMS will require acute care hospitals report rates of severe obstetric complications and C-sections, which will give a fuller picture of the issue at individual hospitals. Currently, that data is not collected in a widespread manner.

“We intend to propose a more robust set of criteria for awarding the designation in future notice-and-comment rulemaking,” a CMS spokesperson said in a statement. “CMS is considering how to build upon the Maternal Morbidity Structural measure through the future inclusion of clinical outcome and patient experience measures.”

As CMS puts more requirements on the measure, hospitals could lose the designation if their care does not improve.

Of more than 1,300 birthing-friendly hospitals surveyed by the Leapfrog Group, a nonprofit focused on health care transparency, 58% — 782 hospitals —did not meet the Healthy People 2030 goal of a C-section rate of 23.6%, according to a CQ Roll Call analysis.

While there are still six years to meet that goal, 56% of those hospitals are also not meeting the Healthy People 2020 goal of 23.9%.

And nearly 21% of the birthing-friendly hospitals — 279 hospitals — had C-section rates of 30% or higher.

Main said adding disqualifiers to the designation could be an option.

“One thing that’s been discussed… is to be an awarded hospital you can’t have a high C-section rate. A C-section rate over 30, that would disqualify you,” he said. “There’s no reason for hospitals to have over 30% C-section rate.”

For example, Harrison Memorial Hospital in Kentucky had the highest rate of all of the “birthing friendly” hospitals at 58% of births done through C-section. The hospital did not respond to a request for comment.

Still, that doesn’t stop hospitals from touting their designation on social media without explaining to patients what that really means.

While Hernández-Cancio said she understands the intent behind making it simple for hospitals to initially achieve the designation, she said nothing is stopping a hospital from advertising the award in the future even if it loses that award as standards ramp up.

“If it’s being used for marketing and PR, that’s a bit problematic,” she said.

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©2024 CQ-Roll Call, Inc., All Rights Reserved. Visit cqrollcall.com. Distributed by Tribune Content Agency, LLC.