Health care for Washington's poor must be revamped by a variety of new payment schemes to reduce its enormous cost and the unfair burden shouldered by a handful of hospitals, a report prepared for the District government and 12 local hospitals has concluded.
The report urges a corporation be set up to encourage reforms in payment of care for Medicaid and charity patients.
The cost of health services for the District poor is of tremendous concern because of the rapidly increasing burden on taxpayers. The report estimates that in 1982, low-income patients required resources of more than $280 million, including $179 million in Medicaid costs, $69 million in charity care and bad debts at private hospitals, $31 million in aid to D.C. General Hospital, $5 million to Department of Human Services clinics and $2.5 million in charges to the D.C. Medical Charities program.
Despite these expenditures, which do not include Medicare, other District health services, such as alcoholism and drug abuse clinics, care at Veterans Hospital and private clinics, the report found many residents, especially in low-income neighborhoods, report poor access to health care.
The report found that hospitals in poor neighborhoods tend to support a higher proportion of charity and low-income patients. Further, only a small number of doctors appear to accept Medicaid patients in any large numbers.
"Indeed, the Department of Human Services informally estimates that over 25 percent of all private physician Medicaid claims in 1982 may have been filed by just 10 physician groups," the report stated. Its suggested reforms are an attempt to encourage private doctors to accept low-income patients by improving the payment process.
One of the proposed reforms is a "District of Columbia Health Care Corporation," which would be owned by the District government, hospitals and doctors. It would continue the practice, begun this spring, of setting a limit on the amount of government money hospitals receive for care of poor patients. The corporation also would try to stop duplication of health services in the Washington area, yet must not become "an elaborate new bureaucracy," the report warned.
The report detailed several ways the District could reduce its Medicaid costs, which rose 30 percent last year, including:
* Paying hospitals in advance for an established amount of care for the poor. Under this "prospective payment" plan, hospitals would have an incentive to use resources effectively to fulfill obligations to all those needing care.
* Extending the cap on Medicaid reimbursements to insurance companies as well as hospitals operating in the District, with the hope of saving $1 million yearly.
* Encouraging doctors to divert patients from hospital emergency rooms, where the average visit in the District cost $103 last year, to doctor's offices, where total payments averaged $25.
* Establishing mandatory health insurance for all District employes, as well as reorganizing D.C. General Hospital and city clinics in order to enroll uninsured poor people in a new, prepaid health system.
* Imposing a program in which Medicaid patients would be funneled through one health provider who would monitor their need for medical care. The report found that Medicaid recipients in the District, who averaged 5.1 medical visits a year, exceeded the national average of 4.61 visits a year. Those on welfare were the most frequent users, averaging four visits to a doctor's office and nearly two hospital visits a year.
Dunlop Ecker, former president of Greater Southeast Community Hospital and now an executive of the Washington Hospital Center, helped originate the project, which began in May 1982, cost $120,000 and was paid for by the city Department of Human Services, two foundations and a consortium of 12 local hospitals.
Ecker said the D.C. Hospital Association has agreed to pursue several of the report's recommendations and may encourage member hospitals to begin pilot projects on how to pay for charity care in the city. "We need a rational way to pay for Medicaid patients and charity patients so that two to four hospitals don't continue carrying most of the load," said Ecker.
The sweeping recommendations in the report are being considered by David E. Rivers, director of the Department of Human Services.
"Obviously, the one thing we're very concerned with is cost containment," said Rivers, whose department contributed $5,000 to research for the report. "I think there is some utility to the ideas."
Rivers said he will recommend specific reforms to Mayor Marion Barry by Aug. 15.