Monday, March 18, 2013

Barking up the wrong tree at United Medical Center

A few months ago, I mentioned that United Medical Center in Washington, DC. might be suffering from unintended consequences of Obamacare, a change in funding to safety net hospitals that removes some of their ability to carry out important functions.  I suggested, "Maybe UMC--an important component of the District of Columbia health system--can help send that message to Congress over the coming months.  On this matter, the Board and the medical staff should be united, along with other safety net hospitals throughout the country."

Instead, I see this report in the Washington Post:

In the fractious universe of D.C. politics, there is one thing upon which virtually every elected city official agrees: There must be a full-service hospital east of the Anacostia River. But nearly three years after the city seized control of United Medical Center, the fate of the 354-bed facility on Southern Avenue SE remains uncertain.

The ongoing saga of the hospital, formerly known as Greater Southeast Community Hospital, underscores the disconnect between city officials’ commitments to keeping the facility open and their general reticence to either commit to subsidizing its operations or significantly change how it operates.

The hospital has four days’ cash on hand. Significant bills to several creditors, including Pepco and medical suppliers, remain unpaid. “A huge part of management’s time is figuring out which vendors to pay each week,” he said. “It’s a real juggling act.”

The prospect that city taxpayers will have to pony up yearly to keep the hospital afloat has been the subject of repeated warnings from District Chief Financial Officer Natwar M. Gandhi, who has said that having a public hospital on the city’s books puts its bond ratings at risk. The warnings have struck a chord with several D.C. Council members, who raised concerns during a vote last month on a hospital consulting contract.

It is clear to me that this is not a problem that is solvable within the city's budget, and it really should not be.  In most states, safety net hospitals rely on broader jurisdictions with greater financial resources, i.e., states and the federal government.  Here, the "state" is the District of Columbia, which is a creature of the federal government.  It is severly limited in what it can do to raise funds, and it also is limited in professional capability to manage a medical property like this.  Congress, though, has impunity as long as it believes that the problems of UMC will be subject to debate and squabbling within the District's government.  The DC government and local consituencies will only solve UMC's problems when the federal government makes the proper commitment to providing the poor people in this part of the District with "a full-service hospital east of the Anacostia River."

2 comments:

fairhavenhorn said...

Unfortunately, Washington DC illustrates the chasm between congressional understanding and local reality in almost every aspect of local government services. Unlike every other city, there is not a state government to moderate or assist Wsahington, DC.

Peter said...

Are you kidding? Congress doesn't know what's IN the ACA, let alone how to "transparitize" or modify the culture in a huge community medical center and its attendant costs. Would a letter from 10,000 concerned docs help? The problem strikes at the heart of our Medical Care dilemma: to change not only the structure and function of hospitals, but of its patients. And you can't do that on a buck and a half per head.