washingtonpost.com
What to do with the hospital D.C. now owns

By Julius W. Hobson Jr.
Washington
Sunday, July 11, 2010; C05

The District is getting back into the business of running a hospital. The D.C. Council and the mayor's office say it should, at least for a little while, having agreed to create a new "Not-For-Profit Hospital Corp." to govern Southeast's troubled United Medical Center until a buyer can be found ["The D.C. Council's sickbed," editorial, July 5]. But D.C. Chief Financial Officer Natwar M. Gandhi has questioned the financial viability of such an arrangement. The new entity brings something less than $55 million in debts and liabilities, as well as monthly losses of as much as $1 million.

The council should listen to Gandhi. What the city could not previously sell during good economic times certainly won't sell in the middle of a recession.

But this doesn't have to be the end of the story. The Post and others sometimes don't seem to understand the value of safety-net hospitals such as UMC and the services they provide patients least able to afford high-quality health care. Safety-net hospitals provide a unique service that private profit and nonprofit hospitals often find financially difficult to provide.

But I have a bias. I was chairman of the board of the D.C. Health and Hospital Public Benefit Corporation, the governing body for D.C. General Hospital and the city's clinics when the city closed the hospital in 2001. Essentially, D.C. General was shuttered as a means of erasing a budget deficit and enabling the Financial Control Board to terminate its own existence. At that time, we argued unsuccessfully that contracting with Greater Southeast Community Hospital (now United Medical Center) to provide the safety-net services offered by D.C. General would not work out. More than $100 million later, it has not. We also knew that other hospitals in the city, as well as Prince George's Hospital Center, would be hurt by the closure.

The D.C. government is re-creating at UMC what it dismantled at D.C. General, except under worse conditions. Here are three other options that don't involve pouring money into UMC.

-- First, the health-reform law recently passed by Congress presents a golden opportunity to provide health-care services that meet the needs of all D.C. residents, particularly the high percentage who depend on Medicare and Medicaid. The District could create accountable-care organizations consisting of primary-care physicians, specialists and at least one hospital. In such an ACO, providers would be responsible for achieving high-quality care based on improvements that can be measured, leading to reduced spending growth.

-- Also, the District could construct three or four urgent-care centers east of the Anacostia River. Such centers, which have worked well around the country, could become feeder systems for the remaining hospitals in the city. These centers could also be a part of ACOs. In addition, the city could also initiate an interstate compact with Maryland for some D.C. residents to receive trauma care at Prince George's Hospital Center, based upon proximity.

-- A final option is building a state-of-the-art 125-bed public hospital at a location easily accessible to far Southeast and Southwest residents. That facility would then become the city's safety net hospital, taking some of the pressure off other hospitals in the city by providing for patients least able to pay.

Any, or all, of these options, which could provide a system of care, would be preferable to holding on to an old facility for the sake of having a hospital in Anacostia. City residents and patients deserve better.

Julius W. Hobson Jr. is a policy adviser and lobbyist with the law firm Polsinelli Shughart, whose clients include the National Association of Public Hospitals. He is also a lecturer at the George Washington University's Graduate School of Political Management.

Post a Comment


Comments that include profanity or personal attacks or other inappropriate comments or material will be removed from the site. Additionally, entries that are unsigned or contain "signatures" by someone other than the actual author will be removed. Finally, we will take steps to block users who violate any of our posting standards, terms of use or privacy policies or any other policies governing this site. Please review the full rules governing commentaries and discussions. You are fully responsible for the content that you post.

© 2010 The Washington Post Company