THE CITY COUNCIL held committee hearings this week on a controversial and complicated piece of legislation that would change licensing standards for city hospitals and other health-care facilities. Supporters of the legislation claim that it would increase medical competition and reduce consumer costs. Opponents claim that it would destroy the hospitals' ability to control the quality of care within their facilities. Arguments on both sides are greatly exaggerated.
Part of the bill would streamline the costly and duplicative method by which the city government and the nationwide Joint Commission of Accreditation monitor hospital performance. That provision is both necessary and relatively uncontroversial. But the bill would go much further in setting new reporting requirements for hospitals, restricting their ability to shift hospital beds among categories of care and requiring hospitals to admit certain non- physician health-care providers to clinical privileges and full staff membership.
This last provision--admitting nurse midwives, podiatrists, pyschologists, nurse-anesthetists and nurse-practitioners--is promoted by the bill's sponsors as a way to hold down medical costs by offering alternatives to expensive physician care. This is a worthy objective. But the doctors and hospitals question whether increasing the number of practitioners who can admit people to hospitals is going to hold down costs, especially since it is the cost of hospitalization itself that determines most of the bill. They also note that if patients are sick enough to warrant admission to an acute-care hospital, they ought to be under the care of fully qualified physicians.
The D.C. Medical Society, a major opponent of the rule, says it would support admitting these practitioners to hospitals as long as they are properly supervised by doctors and their scope of activities is limited to their areas of competence. But that compromise doesn't suit the various classes of practitioner, each of which has a somewhat different ax to grind. The podiatrists, for example, want access to those teaching hospitals that now exclude them because podiatry is not part of their curricula. The clinical psychologists want to be able to admit and prescribe for their patients. And the midwives, who are now totally excluded from D.C. hospitals, want to perform uncomplicated deliveries without doctor supervision.
Each of these claims has differing merits with respect to different types of health care facilities. That is precisely the trouble with the bill. With sufficient time, effort and litigation, it would not be totally impossible under this legislation for hospitals to control the qualifications of practitioners allowed access to their increasingly specialized and expensive facilities. But the sweeping provisions of the bill would make that task much harder. The council is trying to use a blunt instrument to deal with a problem that requires the fine work of a scalpel.