Forward to April 2006 DC Voter Back to League of Women Voters home page Back to Febr4ary 2006 DC Voter
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|Balancing Homeland Security and Civil
Clarence Darrow The Search for Justice
Bed and Breakfast
National Program Planning
Travel with the League
Unit Meetings March 21-23
Naturalization Ceremony Reception
LWVDC Membership Form
Calendar, March 2006
Background on Proposed National Capital Medical Center
Balancing Homeland Security and Civil Liberties
Saturday, March 25, 2006 10:30 a.m. to 12:30 p.m.
Program: Reception, panel presentation and audience question and answer session.
Co-sponsored by League of Women Voters of the National Capital Area and the District of Columbia Public Library System, Division of Sociology, Education, and Government.
See February issue of DC VOTER for article entitled: Homeland Security: Emergency Management Agency of the District of Columbia.
SAVE THE DATE: TUESDAY, APRIL 18, 2006 at 7:30 p.m.
Clarence Darrow ...The Search for Justice
|1 10:00 am, LWVDC Board Mtg.||2||3 10:00 am, NCA Board Mtg||4|
|5||6||7 April DC Voter deadline||8||9 9:30-11:00 am, Library Study Cmte Mtg||10||11|
|12||13||14 9:45-11:00 am, voter registration at naturalization ceremony for new US citizens||15||16||17||18|
12:45 pm, Northwest Day
6:30 pm, Capitol Hill
|22 9:45 am, Upper 16th St.||23 9:45
am, Chevy Chase/Ingleside
7:30 pm, Northwest evening
|24 April DC Voter mailing||25 10:30 am-12:30 pm, Balancing Homeland Security and Civil Liberties|
A Memorandum of Understanding was announced January 5, 2006, by Mayor Anthony Williams and Howard University President Patrick Swygert, for a hospital to be built on the D.C. General site (nine acres south of RFK Stadium called Reservation 13). It will be called the National Capital Medical Center. The proposal must be approved by City Council.
"The nucleus of the NCMC would be a new, fullservice, world-class, Trauma Level hospital that would contain between 200-300 beds," says the MOU. "It is the intent of the University and the overarching goal of The NCMC to ensure that all residents of the District have access to high-quality healthcare. Accordingly, the University pledges that the proposed NCMC will be unambiguously committed to serving all citizens of the District."
The estimated cost is $400 million. The District and Howard would split construction costs, with a cap of $212 million for each partner, and the university would be responsible for its first three years of operation. Starting in the fourth year, any operating deficits would be covered by a new nonprofit corporation that would run the medical center and Howard's existing hospital on Georgia Avenue NW. The proposed hospital will have 250 beds, largely transferred from the current Howard University Hospital on Georgia Avenue so the total beds in the city will remain the same.
The District has a certificate of need process for all major health care expansions, which is designed to prevent a community from building an excess of expensive health care facilities. The District proposes waiving its CON for the project.
The University expects to pay for most of its share of the NCMC's cost, as much as $212 million, through tax-exempt revenue bonds backed by the Federal Housing Administration. The mortgage insurance would help Howard obtain a lower interest rate on its borrowing.
Though the District would waive its CON, the mortgage insurance, might require a CON.
Those who support the CON argue: The certificate of need is intended to encourage accountability within health care and to discourage unnecessary duplication of services.
FHA considers it a fundamental element of the FHA review process, said spokesman Lemar Wooley in a Washington Post article.
"We cannot imagine a D.C. Council charged with stewardship over the city's treasury approving such an enormously expensive major health facility that bypasses the certificate-of-need process... The review process is the taxpayer's principal means of ensuring -through the work of independent experts - that the proposed hospital is needed, does not duplicate existing services, is cost effective and well financed, and has well-thought-out management and operational plans"-Washington Post editorial Jan 10
Those who are aqainst the CON argue: Certificate of Need is not required because Howard already produced certificate of need for its beds, which will be transferred.
The city needs access to primary care doctors, of which there is a severe shortage in three-quarters of the city.
The District already has plenty of hospitals. The District has more than twice as many beds per capita as the national average; and there are currently more than a thousand beds licensed which are not in use by current hospitals. Even Howard can fill only slightly more than half of its 482 beds. Washington Hospital Center is licensed for more than 900 beds and has a suite of 21 operating rooms.
The District paid for a consulting report on the financial viability of a proposed hospital, which was completed by Stroudwater and Associates. The report found a new hospital would require subsidies, and recommended the city build an ambulatory care/urgent care center on the site.
The healthcare industry in general is moving away from its historical hospital-based model toward ambulatory care (outpatient visits), wellness centers, and in-home care (end-oflife and hospice). This move is caused by an increase in chronic illnesses caused by poor diets and sedentary lifestyles, increased medication options to treat illness, a shift to prevention and illness management, and consumer demand. By building a hospital, the District is investing in a shrinking industry.
Reducing long emergency room lines and caring for the uninsured are more urgent problems for the city, which could be more easily solved by using the money to build a network of smaller primary care clinics and/or urgent care centers in lowincome areas. Many lower income people use the hospital emergency room for primary care visits (for example, medication refills), and many people of all incomes use the emergency room for significant but non-life-threatening illnesses (for example, cuts that require stitches).
"I don't think the National Capital Medical Center will do much to help us in terms of bottom-line health outcomes," said Dr. Eric Rosenthal, an emergency room physician and Capitol Hill resident, to the DC Examiner. "The advocates haven't put out any evidence suggesting that it will."Though the NCMC project is touted as a way to bring health care to the poor, it is actually located on the west side of the Anacostia, and would probably force the closure of Greater Southeast Community Hospital, the only acute-care medical facility now serving patients east of the Anacostia River. And if Greater Southeast is forced to close, there won't be any hospitals in the city's poorest neighborhoods.
Howard University Hospital on Georgia Avenue already operates at a deficit, and many of its medical teaching programs have lost national accreditation over the past ten years, demonstrating a lack of management capacity for a new hospital.
Transfer of beds from Howard U Hosp will free up a portion of the school's land at the heart of the District's gentrification boom, a potential windfall to Howard.
The city's experience with DC General and the Public Benefit Corporation, both of which were private non-profits, is that these nonprofit entities do not operate in the black, offer poor quality care, and are difficult to shut down once they are operating.
Mayor Williams and the Council have redirected funds that used to support DC General into the Health Care Alliance and expansions to Medicaid, a health benefit programs for low income residents. A new hospital would divert funding from these important projects that pay for the entire range of health care services. Both programs pay for hospitalization, and, after investing $200 million plus, the city might take Alliance funding and give it to the new hospital, forcing low-income patients to that facility.
The agreement does not guarantee free care to uninsured District residents.
While the District's involvement would be capped at $212 million for half the hospital's construction, construction costs often increase dramatically once a project has begun. With a major investment in schools planned, and a baseball stadium, the District cannot afford the debt.
Residents of the Georgia Avenue corridor have expressed concern that Howard University is not financially capable of handling two massive operations simultaneously, and would eventually close Howard University Hospital in favor of the NCMC.
DC Examiner, Jan 16, 2006, wrote, "D.C. Mayor Anthony Williams recently signed an exclusive contract with Howard University Hospital to build a new $400 million National Capital Medical Center and trauma facility on the old D.C. General site. But this joint-venture should be DOA when it arrives at the D.C. Council's swinging doors."
The Hill, Hillscape, Jan. 11, 2006: "The real deal in the DC-Howard pact to build the $242 million National Capital Medical Center is that Howard gets to dump its money-losing hospital ($17.3 million in the red last year) into the new facility, where someone else will pick up the inevitable deficits.
"There is nothing in the exclusive rights agreement about the problem of District health care: that some 70,000 residents are without insurance, and they mostly live east of Rock Creek Park, and they'll come in numbers to the emergency room of the new hospital because that's what they have done in the past for anything from a nosebleed to a brain injury. The NCMC will eliminate any chance of Greater Southeast Hospital's financial viability, hinting of the nightmare of not one but two public hospitals asking for perpetual handouts."
Howard University contends: "District hospitals services are poorly distributed geographically
'There is a need for additional hospital capacity as the District grows.
"Forty two percent of the District's population lives in the Eastern quadrants; and the District needs a hub for its new community health network, where doctors can refer patients for diagnostic testing, specialty care and medical procedures.
"The current clustering of District hospitals could be problematic in the event of a major disaster."
"The NCMC will be an important part of a communitybased system of care with a focus on prevention and wellness, and it will also have the capacity to support the District's new primary care network known as Medical Homes. If approved, this significant project will serve as an economic engine to enhance the transformation of S. Reservation 13 into the planned mixed-use Hill East Neighborhood."
There was been a hospital on the DC General site for more than 100 years, and there is a strong emotional attachment to having a hospital there (similar to the emotional belief that having a Major League Baseball team makes DC a "real city".). Many residents of that quadrant of the city perceive they are unequal to other quadrants, and believe a new hospital will equalize their standing.
Many residents east of the Anacostia River, and others who live adjacent to the D.C. General property, say people are dying because hospitals are too far and doctors' offices are too few. Build the hospital and lure additional primary care providers, supporters say - the east has for too long been neglected - this according to the DC Examiner.
Howard University Hospital on Georgia Avenue needs a new facility; this could reduce the costs of that facility.
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