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Robert L. Cosby, Executive Director, Non Profit Clinic Consortium
Testimony to the Committee on Human Services on DC General Hospital
April 27, 2001




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District of Columbia City Council Human Services Committee
Roundtable Hearings
Councilwoman Sandy Allen, Chair
Friday, April 27, 2001

Testimony of Robert L. Cosby, Ph.D.
Executive Director - Non Profit Clinic Consortium (NPCC)
Concerning the Contract for Comprehensive Healthcare Services for the DC Uninsured

Good Morning. My name is Robert Cosby and I am the Executive Director of the Non Profit Clinic Consortium (NPCC). NPCC represents 13 free and sliding fee scale, non-profit neighborhood health clinics that provide primary health care to the underserved in Washington D.C. NPCC clinic patients typically are those that are uninsured, under insured, immigrants and the homeless. NPCC clinics provide care for 66 percent of the District's uninsured. This includes almost 10,000 children not eligible for Medicaid.

I would like to address my comments regarding the DCFRA#00-R-039 contract re: Comprehensive Healthcare Services for the DC Uninsured. Specifically I will limit my remarks to the contracts' proposed impact upon NPCC clinics and the patients seen at our NPCC clinics.

First, NPCC supports the implementation of this contract. I know that this is not the popular position, but let me share why I believe that this is the right decision at this time.

This contract for the uninsured will provide more access to specialty care and tertiary care for NPCC clinic patients than was available previously. Just as a reminder, how patients used to get care was often dependent on who you knew. There was little if any formal mechanism or system to provide specialty care for NPCC clinic patients. I might add that PBC clinic patients also had difficulty scheduling or receiving care. There were several phone calls to colleagues, contacts and friends that were known who would try to get patients into see specialists. Of course, there was always entrance to the Hospital via the emergency room, but we know that to be both expensive and time consuming. So, this contract will mean more access, which will mean a better deal for NPCC patients. Better than over the last ten years.

Second, this contract will provide pharmacy coverage for a greater number of uninsured patients. Uninsured NPCC clinic patients need pharmacy coverage. In recent times, the only way for a patient to access the DC General pharmacy was to become a DC General or PBC patient, meaning the patient was transferred to a physician practicing at D.C. General. This was often time consuming and impractical. Unfortunately it was necessary for the PBC to meet some of its volume requirements for funding. Although not explicitly pointed out in the contract due to various points of negotiation, in meetings with contractors and with the DoH, NPCC has been told that pharmacy will be available to the uninsured at least at the same rates as was offered to PBC patients in the first year and expanded to cover more uninsured in the second year. That is a major win for uninsured DC residents.

Third, it is tragic to see the crumbling of the DC General Hospital and the PBC infrastructure. We know this to be so largely because they could not operate within the resource limits given to them by the District. You all know this to be true. The new contract attempts, for the first time, to develop an integrated health care delivery system, not just a subset, as was offered earlier. No other integrated plan was approved. The DoH indicated in a letter to NPCC, and after a series of consensus meetings, and reinforced by the contractors, that NPCC clinics and their uninsured DC resident patients will receive more care than was available previously at the PBC. Specialty care, tertiary care, more integrated primary health care delivery, and pharmacy are four critical areas now missing. If the contract delivers on these areas, as I believe the contractors will, more care is provided.

I want to re-emphasize that NPCC strongly supports the Mayor and Dr. Walks and the Department of Health in implementing this contract. It is the right thing to do. The contract is not status quo. The contract states that more uninsured District residents will receive care. Let's stop with the blaming and start building something that will benefit a larger portion of the community. Lyndon LaRouche and others have tried to portray this as a racial issue, one that is about those East of the River vs. West. It is not, it is much more fundamental. This is an issue about care for uninsured persons and expanding care vs. keeping it the same as it was. No one is talking about the fact that despite good intentions how the old system left out lots of poor uninsured people. We need a comprehensive solution that provides care for more people. This contract is a major start. Let's get on with its implementation.

I am available to answer any questions you might have regarding my testimony. I can also be reached at the NPCC office at 202/785-1894.

Thank you.

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