Greater Southeast Community Hospital, one of the region's busiest medical facilities, is faced with critical dilemma of how it can continue to attract affluent white suburban patients while effectively serving the lower-income, urban black community that has come to depend on it.
Built a decade ago to serve both the District of Columbia and southern Prince George's County, the hospital, formerly known as Cafritz, has enjoyed a near monopoly in the southeast Washington , south-county area.
A number of new hospitals proposed or already under construction in Prince Geroge's, however, threaten to take away much of the kind of business that keeps Grater Southeast financially solven - that provided by white suburbanites. In addition according to a hospital-commissioned consultant's study of the problem, they will take most of the hospital's doctors with them.
The Greater Southeast medical staff, the study concludes, generally "lacks the commitment, energy and time to provide comprehensive health care to nonwhite residents" who increasingly use the hospital.
"Many active physicians want to admit their white and midle classnon-white patients to a facility located in a more suburban environment," concluded the consultant, Bedford Health Associates, of Katonah, N.Y.
The firm's president, Thomas P. Weil, has conducted more than 80 similar studies throughout the country over the past 10 years. For the Greater Southeast study, the consultant conducted extensive interviews with 13 hospital "leaders" and analyzed mail responses from 75 "active" physicians. The 419-bed facility has 173 "active" doctors out of the 347 who use it at one time or another. Virtually all of the doctors are Maryland-based.
"Many doctors," the consultant said, "belive that reimbursement from the District of Columbia's Medicaid program is inadequate and that their white patients, with higher reimbursement levels from (private insurers), will be offended by the increasing percentage of nonwhite patients (from Greater Southeast) in their physicians' offices . . ."
So great will be the impact of the new hospitals in southern Prince George's County - which has long lacked adequate hospital beds - that as many as 40 per cent of Greater Southeast's current patients will flock to the new facilities, the consultant concluded. With an expansion planned for 75-bed Hadley Hospital in Southeast Washington, the consultant said, Greater Southeast stands to lose another 10.9 per cent.
Altogether, the hospital, which straddles the District-Maryland line, faces the strong possibility that it will lose more than half its current patients and suffer an annual revenue loss of $22.3 million.
Dr. Andrew J. Armer, a Clinton neurologist who is the elected head of the hospital medical staff, said the new suburban facilities could draw even more patients from Greater Southeast than the consultant projected. He rejected, however, as "absolute nonsense" the notion that doctors at Greater Southeast lack a commitment to treat poor , black District residents.
Greater Southeast was built on federally donated land, eith a combination of private and public funds, including a $650,000 grant from Prince George's County. Its 25-member board of directors is required to have at least 40 per cent of its members from the county and 40 per cent from the District.
Problems at the hospital have developed as the neighborhood surrounding the hospital, located at 1310 Southern Ave. SE., has changed racially from majority white, when the institution was first planned, to 90 per cent black today. Reflecting that change, the hospital has become increasingly populated by lower-income blacks from the District who gain priority admissions of middle-class suburbanites have had to be postponed for lack of space.
"The problem is thatboth sides have gotten so rigid," Armer said. "I was about to drop my (hospital) privileges, but I decided it was important not to desert the hospital; that another year of forcing communications would be worthwile - "
"The problem of racism," he said, "is more a function of (white) patients than doctors." Armer noted that more than 16 per cent of the hospital's doctors are graduates of predominantly black Howard University Medical School, comprising the largest single alumni group at Greater Southeast.
"Whites find themselves rooming (in the hospital's semiprivate rooms) with black people severely ill," Armer said. "They don't like that. It's not a very good attitude on their part, but middle-class - black or white - they don't like to go there."
Based on doctors' perceptions, the consultants' study concluded that a 300-bed hospital under construction in Clinton is the largest potential patient draw from Greater Southeast. Nearly one-third of Greater Southeast's patients are expected to shift their allegiance there, the consultant said.
Greater Southeast is providing some seed money expert support to a proposed 120-bed hospital in Fort Washington, not far from Clinton, which, its critcs claim, is simply an effort to protect the parent hospital's financial interest in the suburbs. The Fort Washington group, which includes two Greater Southeast board members, has been unable to obtain necessary government approvals.
Armer said he would "certainly be active" in the new Clinton hospital, the Southern Maryland Hospital Center, which, he said, "would take the cream of the crop in terms of southern Maryland patients. People from wealthy areas like Tantallon (where Armer lives) don't want to go into (Greater Southeast). It is in an area where you have crime problems . . . even with armed guards."
There are those hospital administrators who view the projected exodus of suburban patients and their doctors as not necessarily a bad thing, however because they believe in institution would become more of a community hospital for Southeast Washington.
George B. Caldwell, the hospital's president and chief administator, noted that the District east of the ANacostia River has 30 per cent of the city's people and only 4 per cent of its hospital beds and that the occupancy rate at Greater Southeast often exceeds 100 per cent of its normal capacity.
"If the doctors bring their patients elsewhere, it puts us in a better position to serve the community we're in," Caldwell said.
The prospect of competing hospitals is not the only problem Greater Southeast has had with its doctors, however.
Many of the doctors currently practicing there say they are disenchanted with the hospital because they feel they have not been consulted in policy changes. There are currently no doctors on the executive committee and only two on the 25-member board. In a recently settled court suit, a group of doctors charged the hospital adminstrators with by-passing them in making key staffing decisions.
The "principal concern" of many doctors practicing at Greater Southeast, the consultant found, is their fear that the hospital plans to hire an increasing number of physicians on fixed salaries - a national trend now ell under way - that offers hospital administrators greater control over how departments operate.
The long-time practice has been to rely primarily on doctors who collect fees from each patient, with no ceiling on physician's earnings. Greater Southeast's 20-odd salaried doctors earn roughly between $40,000 and $80,000 a year, according to hospital officials, while so-called "fee for service" physicians make well into six figures.
Armer confirmed that there is widespread opposition to replacing "contract" doctors with salaried physicians. He said he opposes flat salaries because "you tend to work 40 hours and do what you want with the rest of your time. You take away the motivation to really put more into it.
Two years ago the anesthesia department, whose doctors woeked on a fee-for-sercice contract, was restaffed with salaried physicians. The same thing occurred a year ago in the patholgy department, whose chief had been earning several hundred thousand dollars a year.
"The (hospital) board has instituted a review of all these contracts," Shapiro said. Hospital president Caldwell, however, denied that there is a master plan to put all hospital physicians on salary.
Armer pointed out that when and if the affluent patients leave Greater Southeast for the suburbs, operating costs will remain the same in the face of a projected $22.3 million loss in annual gross revenues.
The hospital "will have to make ends meet," Armer said, by charging insurers and patients the same fees but paying doctors less, thus "taking the doctors' profit."