Redesigning the Regulatory Framework for Ambulatory Care Services in New York

• Published in: The Milbank quarterly 2014-12, Vol.92 (4), p.776-795
• Main Authors: CHOKSHI, DAVE A., RUGGE, JOHN, SHAH, NIRAV R.
• Format: Article
• Language: English
• Subjects: 21st century; Ambulatory care; Ambulatory Care - legislation & jurisprudence; Ambulatory Care - organization & administration; Ambulatory Care - standards; Certificates of need; Clinics; Commercial regulation; Consumers; Continuity of Patient Care - legislation & jurisprudence; Continuity of Patient Care - organization & administration; Continuity of Patient Care - standards; Cost; Government Regulation; Health care; Health care costs; Health care delivery; Health care policy; Health planning; Health policy; Health services; Hospitals; Humans; Information technology; Insurance regulation; Medicaid; Medical service; New York; Patients; Physicians; primary care; Primary health care; Public health; Public interest; Quality of Health Care - legislation & jurisprudence; Quality of Health Care - standards; Recommendations; Regional planning; Regulation; Review; Review Article; Review articles; State Government; Surveillance; U.S.A
• ISSN: 0887-378X; 1468-0009
• DOI: 10.1111/1468-0009.12092

Context: While hospitals remain important centers of gravity in the health system, services are increasingly being delivered through ambulatory care. This shift to ambulatory care is giving rise to new delivery structures, such as retail clinics and urgent care centers, as well as reinventing existing ambulatory care capacity, as seen with the patient-centered medical home model and the movement toward team-based care. To protect the public's interests, oversight of ambulatory care services must keep pace with these rapid changes. With this purpose, in January 2013 the New York Public Health and Health Planning Council undertook a redesign of the regulatory framework for the state's ambulatory care services. This article describes the principles undergirding the framework as well as the regulatory recommendations themselves. Methods: We explored and analyzed the regulation of ambulatory care services in New York in accordance with the available gray and peer-reviewed literature and legislative documents. The deliberations of the Public Health and Health Planning Council informed our review. Findings: The vision of high-performing ambulatory care should be rooted in the Triple Aim (better health, higher-quality care, lower costs), with a particular emphasis on continuity of care for patients. There is a pressing need to better define the taxonomy of ambulatory care services. From the state government's perspective, this clarification requires better reporting from new health care entities (eg, retail clinics), connections with regional and state health information technology hubs, and coordination among state agencies. A uniform nomenclature also would improve consumers' understanding of rights and responsibilities. Finally, the regulatory mechanisms employed—from mandatory reporting to licensure to regional planning to the certificate of need—should remain flexible and match the degree of consensus regarding the appropriate regulatory path. Conclusions: Few other states have embarked on a wide-ranging assessment of their regulation of ambulatory care services. By moving toward adopting the regulatory approach described here, New York aims to balance sound oversight with pluralism and innovation in health care delivery.