Logosm.gif (1927 bytes)
navlinks.gif (4688 bytes)
Hruler04.gif (5511 bytes)

Back to Public Benefit Corporation main page

Robert A. Malson, President, District of Columbia Hospital Association
Testimony to the Committee on Health and Human Services
June 22, 2001




Dorothy Brizill
Bonnie Cain
Jim Dougherty
Gary Imhoff
Phil Mendelson
Mark David Richards
Sandra Seegars


DCWatch Archives
Council Period 12
Council Period 13
Council Period 14

Election 1998
Election 2000
Election 2002

Election 2004
Election 2006

Government and People
Anacostia Waterfront Corporation
Boards and Com
Campaign Finance
Chief Financial Officer
Chief Management Officer
City Council
Control Board
Corporation Counsel
DC Agenda
Elections and Ethics
Fire Department
FOI Officers
Inspector General
Housing and Community Dev.
Human Services
Mayor's Office
Mental Health
Motor Vehicles
Neighborhood Action
National Capital Revitalization Corp.
Planning and Econ. Dev.
Planning, Office of
Police Department
Property Management
Public Advocate
Public Libraries
Public Schools
Public Service Commission
Public Works
Regional Mobility Panel
Sports and Entertainment Com.
Taxi Commission
Telephone Directory
University of DC
Water and Sewer Administration
Youth Rehabilitation Services
Zoning Commission

Issues in DC Politics

Budget issues
DC Flag
DC General, PBC
Gun issues
Health issues
Housing initiatives
Mayor’s mansion
Public Benefit Corporation
Regional Mobility
Reservation 13
Tax Rev Comm
Term limits repeal
Voting rights, statehood
Williams’s Fundraising Scandals


Appleseed Center
Cardozo Shaw Neigh.Assoc.
Committee of 100
Fed of Citizens Assocs
League of Women Voters
Parents United
Shaw Coalition



What Is DCWatch?

themail archives

Testimony before the
of the Council of the District of Columbia 

The Status of the Closure of the DC Health and Hospitals Public Benefit Corporation and Transition of Services Formerly Provided at DC General Hospital To Greater Southeast Community Hospital

Presented by Robert A. Malson, President
District of Columbia Hospital Association

June 22, 2001


Chairperson Allen and members of the Committee on Human Services, I am Robert Malson, President of the District of Columbia Hospital Association (DCHA). As you know, DCHA represents all full service and most specialty hospitals in the District of Columbia, plus our affiliates, Malcolm Grow Medical Center at Andrews Air Force Base and the National Naval Medical Center in Bethesda, Md. The comments I make today represent the most recent views expressed by the hospitals' chief executive officers – the DCHA Board of Directors – speaking collectively on behalf of the hospital industry in Washington, DC, and should not in any way be interpreted as representing any single individual hospital.

I appreciate this opportunity to express the Association’s views about the status of the closure of the Public Benefit Corporation and the transition of services formerly provided at DC General Hospital. As you know, I testified before this committee last September about how the proposed changes might impact the residents and hospitals of the District of Columbia and how some of the pitfalls might be avoided. The DCHA Board of Directors, consisting of all the hospital CEOs, met yesterday and agreed that they appreciate the comments the Mayor has made on several occasions that private hospitals will not be expected to bear additional uncompensated care burdens under the new system. They are particularly pleased with the Mayor’s commitment to make "mid-course corrections" as the transition proceeds to make the new system work.

We have also been working closely with the Department of Health’s transition and Alliance officials on several efforts as we all work to ensure that no patient falls through the cracks. I want to emphasize that the hospitals are committed to continuing their tradition of providing quality patient care. However, we still believe there are some issues that must be addressed during this transition for the best interest of the patients that need health care services.


Last September, I reported that our major concern was the inability of the private acute care hospitals to absorb all of the patients who were served by the PBC because of such issues as transportation, clogged operating rooms and intensive care units, and over-used emergency rooms. Specifically I said, "Whether such a facility is operated by the PBC or some other entity is not the issue; it is a question of service to patients near to where they live and where they need care."

Now we are seeing overcrowded emergency rooms, with ambulance diversions and re-routing becoming routine. According to the May 2001 Reroute Report Summary issued by the DC Fire and EMS Department, the District’s hospitals were on diversion or reroute for more than 1200 hours last month. The reasons given for over 1100 hours of that time were for staffing or that the emergency department was full.

This appears to be a national phenomenon, not solely attributable to the closing of DCGH. But, I can comfortably say that the public’s confusion over the status of the DCGH emergency room and where to seek care, has led to significant increases in visits of patients with ambulatory sensitive conditions at all the emergency rooms, particularly Providence, Howard and the Washington Hospital Center. These hospitals have experienced double digit percentage increases in uninsured patients in the emergency room, in outpatient clinics and in inpatient admissions.

In addition to significant increases in most emergency departments, we have also begun to see a significant increase in inpatient admissions city-wide. In April, inpatient admissions were up 10 percent citywide – over and above the DCGH situation. This makes the absorption of PBC patients – whether insured or uninsured – an increasingly difficult proposition.

We are well aware that one of the Mayor’s objectives in this privatization initiative is that the DC Healthcare Alliance will increase primary care access sites, which DCHA wholeheartedly supports. But all good intentions will not change patient behavior overnight and patients will still go to emergency rooms when they are ill, even if it would be more appropriate to go to a clinic or private physician for immediate treatment. We applaud the Alliance’s initial outreach effort to notify thousands of former DCGH patients to educate them on where they should seek care. However, more needs to done to educate potential Alliance enrollees who qualify below the 200 percent of the federal poverty level.


Confusion has existed since the contract was signed with respect to enrollment and eligibility. At one point, only patients seen at the PBC within the past two years were going to be eligible. Now, we understand that eligibility has been broadened to include all those who need care with incomes below 200 percent of the federal poverty level. This is an important distinction and one that will enfranchise many more of the city’s uninsured. DCHA and its members enthusiastically support this change.

However, we are still concerned that the plan to enroll beneficiaries is inadequate because it limits enrollment sites to eight – the six clinics (former PBC), DCGH and Greater Southeast Community Hospital. This limited enrollment plan completely disregards the utilization patterns of many of the city’s uninsured: they enter the system through the hospital emergency departments. Experience has shown that a significant percentage of uninsured patients wait until they are very ill before seeking treatment and then, present themselves in an emergency room. Hospitals have worked closely with the Income Maintenance Administration (IMA) in recent years to develop an effective system of assisting potential Medicaid enrollees with the application process. In the past year, IMA has provided a Roving Supervisor who can certify Medicaid enrollees on-site.

The DCHA Board of Directors feels strongly that there must be similar procedures instituted in hospitals that allow: (1) hospitals to assist eligible Alliance patients with enrollment; and (2) direct those enrollees to the most accessible primary care or other appropriate site for follow-up care. We have relayed this concern to Karen Dale, Chief Operating Officer for the Alliance at DC Chartered Health at this week’s DCHA Government Relations/Financial Policy Committee Meeting. We hope we can work with her to develop these enrollment procedures as soon as possible.


The timetable for the District’s transition to privatization of public health services to the uninsured and undersinsured was accelerated to meet the June 25th date when all inpatients are expected to be transferred from DCGH. As mentioned earlier, all private hospitals emergency departments and inpatient units are flooded with current and former DCGH patients who do not have enough information at this point as to where they should seek health care. We know that Greater Southeast Community Hospital and its Alliance partners are doing their best to upgrade and expand the facilities to accommodate the new patient load, but those efforts will not be ready for a few more months.

Therefore, in the interest of assuring that quality health care services are available and accessible to the former DCGH patients, as well as those patients who would have sought care at DCGH, it is important to monitor emergency room and other services provided by non-Alliance hospitals.

The non-Alliance hospitals are committed to do whatever is necessary to make sure that no patient falls through the cracks during this abbreviated transition period and beyond. This means that emergency patients will be cared for appropriately, and NOT transferred to an Alliance provider unless requested by the patient. This practice has been followed for decades with respect to DC General Hospital and uninsured patients who came to private hospital emergency rooms. Private hospitals only transferred patients back to DCGH when the patient requested it or when the private hospital did not have the appropriate clinical services. Alliance patients should not be transferred indiscriminately, but private hospitals do need financial support to expand their coverage to these newly eligible patients.

The DCHA Board yesterday strongly agreed that an interim short-term appropriation should be made to support non-Alliance hospitals now covering those gaps in services that are currently unavailable through the Alliance providers. DCHA suggests that a reimbursement mechanism, separate from the Alliance contract, begin for Emergency Room/Trauma Services because data for those services can be easily collected, quantified and analyzed. In addition, this is the area of service we anticipate will require the most access to alternative providers during the transition.

DCHA offers its assistance to convene a small working group of hospital financial officers on potential strategies for short and long term reimbursement issues. The goal of such a group would be twofold: (1) to make sure that Alliance patients have access to necessary emergency care; and (2) to make sure that private hospitals continue to be able to serve their communities.

Let me assure you that the private hospitals are committed to maintaining the levels of uncompensated care they have been providing for years. To this end, DCHA is collaborating with Health Safety Net Administration officials on standards to determine the hospitals’ Maintenance of Effort (MOE) levels and an appropriate definition of "charity care." There is a meeting scheduled for next week to discuss these issues and we will be glad to keep the Council apprised of the progress of those discussions.


DCHA and its member hospitals are doing everything possible to see that the Alliance succeeds. But I will reiterate what I said last September, "If this plan is incomplete or is bungled in its execution, the negative impact will be felt first by the most vulnerable of our citizens and second, by all of us, including those who have health insurance."

While the Mayor has stated his commitment to provide health care services to the poor, there is still great uncertainty about how the city and the private hospitals will share the responsibility for this city’s most vulnerable residents. The DCHA Board of Directors is committed to their missions to serve our communities, but we cannot do this alone, and we certainly cannot do this if we are not involved in the critical processes I outlined earlier. Our expertise must be part of the dialogue and the solution.

Once again, thank you, Mrs. Allen, for holding this hearing and for this opportunity to present the Association’s comments and concerns. I will be pleased to answer any questions the Committee may have.


BAD-DEBT: The amounts from patient accounts which are "written off" because they are unpaid despite attempts to collect payment from either the patient and/or the insurance company.

CHARGES: The dollar amount billed for a service by a health care provider, similar to the "retail" price.

CHARITY CARE: The amount from patient accounts which are "written off" because a patient cannot pay for services rendered by the health care provider. These are services for which the provider never expected payment.

COSTS: The actual dollar amount incurred in providing a health service.

DISCHARGE: The formal release of a patient from a hospital after an acute episode of illness.

INPATIENT SERVICES: Health care treatment rendered to a patient while residing in the hospital.

MANAGED CARE: An entity that "manages" or controls what it spends on health care by closely monitoring how health care providers render services to patients.

OPERATING MARGIN: The percent difference between operating expenses and operating revenue.

OUTPATIENT SERVICES: Health care treatment rendered to a patient without being admitted to stay overnight in the hospital.

PAYOR MIX: The percentage of patients from each category of payors. The major payor classes included in the payor mix are: Medicare, Medicaid, Blue Cross, commercial insurance, managed care contracts, and self-pay patients.

UNSPONSORED CARE: The actual cost of services rendered to patients for which the health care provider does not expect to receive payment. Unsponsored care is a combination of bad-debt and charity care.

Back to top of page

Send mail with questions or comments to webmaster@dcwatch.com
Web site copyright ©DCWatch (ISSN 1546-4296)