THOUGH NO ONE would mistake D.C. General Hospital for a luxury health resort, it has risen dramatically over the last six years from the pits of neglect and mismanagement to an acclaimed level of reliable, accredited medical care. It can be said--and has been, even by some who used to be among the hospital's roughest critics--that the care now delivered at D.C. General compares favorably with that at most city hospitals. But late last year, the hospital reported another critical condition: severe lack of money, with projections of a $10 million deficit for the current fiscal year. Now this story, too, may have an encouraging twist: the same management that improved health care at D.C. General is doing something about the hospital's financial state.
There's more to this than a mere quick-fix budget compromise, too: the D.C. General Hospital Commission, the independent citizens' group responsible for the last recovery of the hospital, has assembled a thoughtful financial report pointing to some specific changes in the way the hospital does business--and asking for still others. Already, the commission has taken steps to reduce the prospective deficit for fiscal years 1983 and 1984 from $31 million to about $10.5 million; and to meet that, the commission is asking for $4.2 million from the city and several other measures to make up the rest of the amount.
Essentially, the measures would move D.C. General away to an even more independent status. For example, the commission seeks immediate establishment of a separate bank account for the hospital; exemption of D.C. General from strictures of the city's merit personnel act; exemption from the reimbursement limit in the D.C. Medicaid program and continuation of another Medicaid payment arrangement that was set up for the current year.
Already, the commission has moved quickly on other financial fronts, reducing the budget for these two years by a total of $5.2 million; deciding to close one resident-intern quarters and lease it to the city for an alcoholic rehabilitation center; negotiating along with other city hospitals a new agreement with Medicaid that yielded an additional $3.3 million for this year, and making other cost-cutting or revenue-producing arrangements for facilities.
There are still other long-range and probably more controversial proposals under study, including possible private contract management of D.C. General, group practice arrangements for doctors to care for and bill patients directly instead of being salaried employees with civil service benefits, and consolidation and elimination of certain other services.
Not all of these steps can or should be taken without careful review of the possible effects on public health care, and the commission itself has been cautious while swift in its response. What the city should not do is stash this report on that infamous shelf--by now it's a mausoleum--where too many useful proposals are left untouched by helping hands. D.C. General Hospital is too important to ignore.