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District of Columbia Hospital Association
Statement on the Public Benefit Corporation
March 1, 2001




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Press release Statement Issue Statement

District of Columbia Hospital Association
1250 Eye Street, NW, Suite 700, Washington, DC 20005-3930
Tel: 202-682-1581 Fax:202-371-8151 E-mail: info@dcha.org Web: www.dcha.org

March 1, 2001
For information, contact:
Robert Matson - 202/289-4926
Joan Lewis - 202/289-4923


The District of Columbia Hospital Association (DC HA) today issued a statement calling for the Mayor and D.C. Financial Responsibility and Management Assistance Authority (Control Board) to address many unresolved concerns regarding the plan to privatize services at the Public Benefit Corporation (PBC). "Private hospitals are concerned that the proposed April 2nd closure of D.C. General Hospital will leave many patients with few options to access care in a timely manner and will overcrowd other emergency rooms and intensive care units," said DCHA President Robert Malson. "Thirty days is not enough time to develop a plan to be responsive to patient and community needs," he said.

The DOHA Board of Directors met last week and developed a joint statement expressing its doubts that the decision to privatize health care services to over a third of the city's uninsured, as well as thousands of Medicaid and Medicare patients, will meet the community's needs. Among the concerns outlined in the DCHA statement are the following;

1) the time-line to close D.C. General Hospital on April 2nd is unrealistic to take cane of all of the patient care concerns;

2) many patients who get care at the PBC live in Wards 5, 6 and 7, and will seek care close to their homes, not necessarily where the proposal expands primary and acute services;

3) once D.C. General closes, no Level I trauma center will be available in Southeast, and no plans have been made to provide appropriate care for these patients, at least in the near term;

4) private hospital emergency rooms are already overcrowded and ambulance rerouting is a common occurrence, all of which could compromise patient care;

5) the Mayor's plan calls for providing reimbursed coverage for those patients now cared for by the PBC, but no plan is in place to maintain this type of financial commitment for the uninsured into the future;

6) the District's track record for paying providers appropriately and on time is abysmal, and there are no assurances that the city will improve this function.

DCHA is a not-for-profit membership organization which represents and advocates for hospitals in the District of Columbia in their missions to serve their communities.

(The DCHA statement is attached to this news release)

Children's National Medical Center, District of Columbia General Hospital, George Washington University Hospital Georgetown University Hospital, Greater Southeast Community Hospital, Hadley Memorial Hospital, Howard University Hospital, National Rehabilitation Hospital, Providence Hospital, Psychiatric Institute of Washington, D.C., Riverside Hospital, Saint Elizabeth's Hospital-Commission on Mental Health Services, Sibley Memorial Hospital, Veterans Affairs Medical Center, Walter Reed Army Medical Center, Washington Hospital Center.
Affiliate Hospitals: Malcolm Grow Medical Center, Andrews AFB, MD; National Naval Medical Center, Bethesda, MD

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Statement of the District of Columbia Hospital Association on the Public Benefit Corporation
March 1, 2001

DCHA has repeatedly expressed its concern about the fate of the patients now cared for by the D.C. Health and Hospitals Public Benefit Corporation (PBC). DCHA has held the position since summer 2000 that a small community hospital at the D.C. General Hospital site is the preferred model for the PBC, and that while some PBC services could be absorbed by private acute care hospitals, such services as adult medicine, including trauma and emergency care, must be kept at the current location. DCHA believes that for the optimum care of and maximum access for patients, this is the only position that supports the integrity of the hospitals' collective missions to serve the community

However, DCHA is aware that recent events have overtaken this original position. The city's proposal to restructure the PBC has raised a number of concerns, with special attention to the reported April 2nd closure of D.C. General Hospital, only a month away.

Concern far Patients - Clinical care and access to care must come first. Care and access must not be compromised for the 90,000+ outpatients, 50,000+ emergency room visitors, and 10,000+ inpatients now treated by the PBC.

Concern for Payment - Dollars must follow the patients and providers must be fairly reimbursed. An arbitrary reimbursement system, based on who was or is a patient of PBC or its successor, will not create an integrated delivery system that is responsive to the city's most vulnerable. DCHA believes that the city has a fundamental obligation to provide health care services for the poor and uninsured, but the current privatization effort by the city is really a long-range strategy ultimately to shift all of the costs of care for the uninsured to private providers.

DCHA is confident that a restructuring of the PBC offers possibilities for improving access to care, quality of care, appropriateness of care delivery, and reduction of costs. The city's approach must include all 6f these as goals, not just the reduction of costs.

(See the attached Issue Statement for a list of specific concerns needing immediate resolution.)

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District of Columbia Hospital Association
ISSUE STATEMENT on the Public Benefit Corporation
March 1, 2001


The DCHA Board has identified a number of unresolved issues which are of increasing concern as the April 2nd date approaches.

  • The current time-frame for closure of D.C. General is completely unrealistic. Effective transition has not been planned or costed out for this thirty-day period, either for care of patients, accommodation for trauma patients, improved/increased transportation for EMS patients or for routine emergency patients.
  • The majority of PBC patients are Ward 5, 6, and 7 residents, who will seek care as close as possible to their homes, not necessarily where capacity/access has been expanded by the city's plan.
  • If the 27 Intensive Care Unit (ICU) beds at D.C. General are closed, rerouting time, which is already a problem, will increase. Time before appropriate maximum care can be rendered is a matter of life and death for many Level I trauma victims. Emergency services, already at capacity in the private hospitals, will be further exacerbated by the redistribution of the current ambulance cases that now use D.C. General. Patient care could be compromised.
  • D.C. General has historically taken 40 percent of the city's trauma patients; with only a month to go, it is unclear how the new proposal will address where these patients will get care or how their care will be paid, at least in the near term, if D.C. General closes on April 2.
  • No specific plans have been made for the care of special needs patients, including HIV/AIDS patients and TB patients.
  • According to the current proposal, private hospitals will continue to provide the same amount of unsponsored care they have been providing, without a need to absorb additional uninsured patients. However, even if a system is developed to determine if the uninsured now seen by the PBC will get to the city's contracted provider(s), no steps have been taken to determine how the "future PBC" patients will be identified. Those individuals who would traditionally have sought care at the PBC (but have not yet had a medical need) will not be identified as PBC patients, and the burden of their care will fall to private hospitals, without reimbursement.
  • One proposal calls for "disproportionate share hospital" dollars (DSH) to be shifted to fund the city's contract for PBC patients. This means that the private hospitals, already providing two- thirds of the care to the uninsured, will have no safety net funds to continue their charity care. DSH funds are designed to support those facilities providing a large amount of care to persons without insurance, and those hospitals may well provide more care under the new plan (because of proximity to patients) than they do now. Eliminating their DSH funds will put an already fragile acute care system in further financial jeopardy.
  • The cost of insuring the PBC patients must be estimated actuarially; estimating their costs based on the current Medicaid managed care rate is unrealistic (current Medicaid managed care patients are largely mothers and children who are inexpensive by comparison to the PBC patient population which includes many more adults, and many with co-morbidities and chronic diseases). Quick estimates indicate that per member-per month costs would be nearly twice the current rates for the Temporary Assistance for Needy Families (TANF) population. Failure to reimburse any contractor appropriately in year 1 will result in budget demands that the city will not be able to meet in years 2, 3 and beyond. Providers who contract in year 1 may decline to participate in the future.
  • The District's track record of paying providers appropriately and on time is abysmal. Providers will need assurances that the city's budget will include necessary cost-of-living increases in the future.

Overall Strategy:

DCHA believes that the concerns raised above must be addressed before any change in services at the PBC are put into place. The Board also believes that the restructuring of the PBC need not be an "all or nothing" approach, but one which makes the best decisions for patient access and care.

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