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Public Benefit Corporation
Urban Health Campus on Capitol Hill/PBC2
March 2001




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Urban Health Campus on Capitol Hill/PBC2

The Government of the District of Columbia is trying to shut down the public safety net health care system.

The Mayor's Planned Privatization of the Safety Net

  • Costs to close out DC General Hospital estimated at more than $90 million
  • Cost of providing care in the privatized safety net will amount to $83 million a year or $415.5 million over a five year period, excluding the cost of correctional care, pharmaceuticals, school health, trauma care, and care provided to patients in the custody or care of DC and federal agencies
  • DC General Hospital is the largest provider of trauma care in the District, and the District's trauma care system as a whole lacks the capacity to absorb the care provided by DCGH
  • The following associations propose keeping an inpatient facility at DCGH: the American Medical Association, the National Association of Public Hospitals, the American Public Health Association, the DC Medical Society, the DC Hospital Association, the DC Nurses Association; also in favor of this proposal are DC residents and the DC faith community
  • Ambulance transport times will increase by as much as 4 to 20 minutes, costing lives as critically ill and injured patients are transported to more distance facilities
  • Privatization places responsibility for the health of the city's most vulnerable residents to a for-profit company based in Arizona with questionable finances and minimal experience in caring for special populations-patients with HIV/AIDS, substance abusers, the homeless, foster children, the elderly, prisoners and other special populations
  • Dismantles the safety net in the United States Capital to try out an untested emergency access model and assumes that private doctors and hospitals will welcome the uninsured into their offices and facilities for minimal reimbursement

The PBC2: A Viable Alternative

  • Replaces DC General Hospital with a new, $100 million state of the art facility with no capital investment on the part of the City
  • Rests on a nexus of public and private, federal and local partnerships with organizations such as the National Institutes of Health, Howard University, and local Federally Qualified Health Centers; expands the Community Health Program from six to more then 30 comprehensive health centers with the potential to secure additional Federal Section 330 funding
  • Transforms the existing site of DC General Hospital into an Urban Health Campus serving as the hub of a vertically integrated system of primary, specialty and inpatient care, school health, home health and long-term care interconnected by a single information system
  • Brings private sector efficiencies to bear on public health care delivery, including a Practice Plan for PBC providers and a single set of work rules for all unions, resulting in an efficient, incentive-driven work environment
  • Continues ongoing efforts to improve school health services as well as the existing programs for medical education, prisoner care, low and no-cost pharmaceuticals, children with special needs, and other vital services not included in the Mayor's plan
  • Operates efficiently within the allocated budget of $75 million
  • Preserves and protects an institution with a proven track record in delivering care to the District's low income and uninsured patients: In November of 2000, DC General received a score of 94% from the Joint Commission on Accreditation of Health Care Organizations

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Two Approaches to Delivering Care to the Under- and Uninsured Residents of the District of Columbia

Issue PBC 2 GSCH
Accredited Health System
  • 94% JCAHO score on hospital and ambulatory care network
  • 3 years of network integration experience spanning primary, specialty and acute care
  • 84% JCAHO score on hospital only
  • Network relationships are still fluid; inadequate contractual relationships to assure a continuum of care
Experience in Community-based Primary Care
  • Historic safety net including public and private community-based health centers
  • Services include enabling services such as social services, nutrition, care management, mobile health vans and home visitation
  • No community-based health care experience
  • No social support for vulnerable populations
  • Private medical offices that have not historically served the uninsured population are not experienced and/or staffed to perform enrollment functions
  • Private physicians do not welcome homeless, dually diagnosed patients in their waiting rooms with private pay patients
Commitment to Medical Education
  • House medical residency programs in medicine and pediatrics in cooperation with Howard University
  • House oral maxillofacial surgery residency program
  • DCHC has no participation in area's graduate medical/dental education programs
Continuity of Physician-Patient Relationships 
  • Maintains virtually 100% of relationships between patients and their historical safety net provider
  • No disruption in care or medical homes
  • Abandons existing relationships
  • Forces patients to find new medical homes
  • Forces patients/providers to assemble new medical record
Provider Inclusion in Governance
  • Provider role in corporate governance
  • Physician-owners are out-of-state investors
Trauma Care
  • Maintains Level 1 trauma on-site at DC General
  • Closes DCGH trauma center
  • Forces lengthy re-route of trauma/critical care patients from Wards 5,6 and 7
  • No current contracts or in-house capability for trauma service
Physician Experience
  • Decades of primary and acute care experience in unique medical/dental needs of medically underserved
  • Hospitalists trained in critical care of patients with end-stage, multi-system failure
  • Public health system for chronic TB patients with capacity of 21 isolation rooms
  • Operate an experienced Level 3 NICU managing care of city's most fragile infants
  • Pediatric emergency care team assuring care 24/7 to parents who lack transportation to Children's Hospital
  • Provider and hospital network have limited experience with the health issues of the   uninsured
  • Uninsured with non-life threatening need are historically referred to DCGH; hospital staff lacks expertise with homeless, TB and AIDS patients; typically private MDs round once a day on insured patients
  • No experience in long-term management of chronic TB patient; no dedicated isolation rooms
  • No Level 3 NICU
  • No Pediatric emergency physicians; eliminates pediatric emergency services in Southeast Washington
Experienced Management Team
  • CEO, Medical Director and Executive Staff offer decades of experience operating health systems for the under- and uninsured and in managed care systems and practices
  • Local executive team is experienced in for-profit health enterprise, primarily in acute care settings
Pharmacy System and Formulary Management
  • Defined pharmacy benefit
  • Existing ambulatory delivery system
  • Formulary management by experienced Pharmacy & Therapeutics Committee (P&T).
  • No pharmacy benefit
  • No experience in formulary management
  • No experience in pharmacy distribution outside of a hospital
Maintenance of Effort
  • Uninsured patients who present at an out-of-network emergency room will be managed under the hospital's uncompensated care policy; post-discharge, patients will be followed up in primary care system with a goal of avoiding future inappropriate care outside of the system
  • WACH, and thus the city, will be financially responsible for all emergency room services, relieving hospitals of their charity care obligation
Quality Monitoring
  • Offers population-specific quality monitoring and reporting indicators
  • Offers specific disease management programs, two which can be implemented in year one, that cross care settings and are culturally relevant
  • Propose no specific indicators reflecting experience with the population
  • Propose no population-specific disease management
New Medical Center at D.C. General Campus
  • Commitment to build new, state-of-the-art medical center with acute, trauma, urgent care and medical/dental specialty services
  • Abandons acute and trauma services at DC General Hospital
  • No long-term commitment to maintaining primary and specialty services on DCGH campus
Cost to Taxpayers
  • $75 million total per year
  • $83 million per year

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City leaders like to say we have no choice but to accept a contract with a private provider, who will shut down D.C. General and replace. it with an urgent care access facility, that provides no trauma care. And no prisoner care. And no school nursing. And no continuum of care for patients in the PBC system, which dates to 1806.

But they are wrong! THERE IS AN ALTERNATIVE PLAN. IT IS BEFORE THE CITY AND HAS BEEN BEFORE THE CITY FOR MONTHS. We call it: the Urban Health Campus on Capitol Hill (PBC2), and the focus is on PATIENTS and PATIENT CARE, with a plan that addresses every aspect of that focus. Our mission and vision is to create a modern community hospital on the campus of DC General and an integrated health care system, with expanded primary care in our city's neighborhoods. Our primary goal is to address the medical needs of District residents to the greatest extent possible - regardless of any individual's ability to pay for services.

Our plan to improve DC General Hospital (PBC) includes the following improvements to health care services in the District of Columbia

A New $100 million dollar, state-of-art facility; and improved services

  • The proposed hospital building would replace the current buildings, some of which date to the 1920s
  • The new Urban Health Campus Medical Center would operate 190 beds with a daily average of 160 occupied beds
  • The Urban Health Campus would also include a Level 1 Trauma Center, Emergency Room and an Urgent Care Center as well as a Women's Health Care Center, a modem birthing facility and a Senior Wellness Center.
  • "Centers of Excellence" would be established to assist patients with management of chronic diseases that disproportionately affect African-Americans and low-income city residents. For example a Diabetes Management Care Center as well as an HIV/AIDS Management Center would provide patients with comprehensive treatment
  • A new strategic partnership would be formed with Howard University's Cancer Center, Howard University Hospital and the Howard College of Medicine, as well as other organizations such as the National Institutes of Health.

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Expanded Community Health Program

  • Our proposal would increase the number of community health care clinics to more than 30 locations from 6 currently operated by the PBC today.
  • All clinics would be networked through computer software systems that-will enhance QUALITY care, including access to specialty care, and make it easier to access patient records and link all city clinics with the Urban Health Campus.

Long-Term Acute Care, Substance Abuse and Mental Health Care

  • 60 long-term acute care beds and up to 160 mental health care beds would be located at the Urban Health Campus, and substance abuse treatment programs would be enhanced.

Enhanced School Health Program

  • Our plan would keep and improve school health care services by networking all school nurse computer systems with the newly networked neighborhood clinics. School nurses would have access to clinic appointments schedules as well as patient records from local clinics
  • Improved screening and immunization programs such as hearing testing, dental screening and other screenings required for EPSDT.

Practice Plan for PBC Physicians

  • Specialty doctors associated with the Urban Health Care Campus would organize a corporation for the purpose of delivering specialty care

Medical Education Program

  • Graduate medical education programs with medical schools such as Georgetown and Howard universities would continue and be expanded.

Restructure PBC's Board of Directors

  • The makeup of PBC's Board of Directors would be changed to include more representation from the local community and other PBC2 partners.

We are confident that the PBC2 can provide the above improvements to health care in the District of Columbia while at the same time:

  • operating within an allocated budget,
  • earning increased revenues,
  • operating efficiently, and
  • providing quality health care to the District's insured AND uninsured residents.

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Urban Health Campus on Capitol Hill

Under the leadership of its new Chief Executive Officer, Michael Barch, the District of Columbia Health and Hospitals Public Benefit Corporation (PBC) is completing plans to implement an Urban Health Campus (UHC) on Capitol Hill at the site of the historic D.C. General Hospital in Southeast Washington. Formulated in response to the Control Board's Request for Proposals (RFP) for the privatization of the safety net, the PBC's plan offers an alternative roadmap for fast-tracking to reality a fully integrated and fiscally sound health care delivery system for medically vulnerable residents of the District of Columbia.

Within two years, a modern medical center with 190 beds will replace the aging D.C. General main buildings, which currently are a substantial drain on PBC resources. Compared with projected capital costs of keeping the current facility going -- in excess of $110 million over the next six years -- the new hospital could cost less than $100 million and be funded with non-District dollars, Our hospital model maintains quality, comprehensive health care with achievable revenue increases and minimized expenses - a far less expensive plan for D.C. taxpayers than the RFP/privatization.

The hospital will be located in a campus-like environment that includes mental health, long-term acute care, substance abuse services and Federal/D.C. collaborative programs. Its feasibility rests on plans to leverage private, federal and local government resources through mutually beneficial partnerships. Partners could include the National Institutes of Health, Howard University Hospital, Howard's College of Medicine, St. Elizabeth's Hospital, Non-Profit Clinic Consortium members and Unity Health Care. These partnerships will be forged to meet several fundamental goals, including building revenue streams for the PBC, containing costs, and enriching the depth and breadth of quality health services accessible to low income citizens.

To emphasize primary care at the neighborhood level, and the concomitant reduction in expenses associated with central emergency room operations, the PBC's community health centers will collaborate with non-profit NPCC health clinics throughout Washington, greatly expanding access for lower-income and uninsured residents. By joining together, PBC efficiencies and cost controls will be improved and patients will be better served. We will seek Section 330 Federally Qualified Health Centers (FQHC) status, providing new federal funding. The community approach to primary care will be buttressed by PBC initiatives to emphasize health education, preventive medicine, immunizations and screenings as part of the School Health program in all D.C. Public Schools. In addition, the PBC's physicians will organize themselves into a practice plan corporation for the purpose of delivering specialty care. By restructuring the specialty physicians we anticipate greater efficiencies, increased patient volume and an overall improvement in quality care. Implementation of the UHC can be accomplished with an annual budget of $75 million for safety net services to the uninsured and underinsured. It will be implemented concurrent with the ongoing redesign and contraction of the PBC system, which includes outsourcing of services and reductions in force. The net result will be reduced expenses, a steadily increasing revenue stream and maintenance of quality care for those citizens the PBC was formed to serve.

The above is in contrast to the Greater Southeast proposal, which reduces access to trauma care, does away with inpatient care in Ward 6, does not speak to corrections care and virtually fragments all care through an HMO-like insurance program, which depends largely on a network of physicians. This plan even, with its deficiencies, will cost $84 million a year at a minimum, according to the Washington Post, compared with the more cost-effective and more comprehensive PBC2 plan.

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