- The Washington Times - Friday, December 8, 2000

More funding for nursing homes may not create better care

Should the government give away billions of dollars to nursing homes and not ask for quality care in return? The 1997 Balanced Budget Act may have cut Medicare reimbursement to nursing homes too much, as Morton Kondracke ("Medical payback repair overdue," Nov. 24) and Charles Roadman ("Medicare cuts threaten patients, providers," Letters to the Editor, Nov. 30) point out. But is that the whole story?

Inadequate nursing care has been a persistent problem for decades long before passage of the 1997 act. Our millions of members and supporters know this all too well. For many, it is a painful part of their present. Others fear it in their future.

Amazingly, none of the congressional proposals diverting part of the budget surplus to nursing homes requires that the money be spent on nursing care. As far as we know, there is no guarantee that those funds would be spent, for example, for bigger nursing staffs something sorely needed by the very same elderly and disabled featured so heart-wrenchingly in advertisements put out by the nursing-home industry.

Before we give away billions in taxpayers' money, we should be sure it will provide good nursing care.

MARTHA A. MCSTEEN

President

National Committee to Preserve Social Security and Medicare

Washington

Gore's fight for presidency lacks public appeal

In a democracy, citizens can speak for themselves. History shows that education and verbal skills are less important to building a social movement than passion and an inherent sense of wrongs to be righted. Think of farm-labor leader Cesar Chavez or Rosa Parks, whose sore feet and righteous indignation helped ignite the civil rights movement in the 1950s.

Despite the public relations opportunities presented by the 24-hour news cycle, the Democrats have been unable to produce and groom for television even a handful of the aggrieved citizens whose authentic complaints supposedly lend moral authority to the call for recounts.

Instead, viewers of 24-hour news are shown an interchangeable array of those citizen's representatives, such as Gore surrogates, party loyalists and paid operatives all spouting the same carefully phrased (and inaccurate) slogans.

A few hundred lawyers and no visible clients suggest little numerical or emotional depth exists to the so-called complaints.

The surrogates, however, are never short on passion. They convey a hypertense, indeed, a fanatical sense that something important is at stake.

What is at stake for these surrogates?

I'm guessing it's not the voting rights of invisible, aggrieved citizens that troubles them but rather the threat of losing their access to a taxpayer-financed spoils system whose government contracts, legal fees and other bonuses enrich them.

Indeed, the difficulty the Gore team has in finding aggrieved citizens whose passion for the outcome equals that of the Gore surrogates may be that, after decades of gridlock, the voters on whom the Democrats consistently have relied (trial lawyers excepted) have begun to recognize they're being had.

Lacking any belief that the Democrats can really deliver benefits worth fighting for, many so-called supporters of Vice President Al Gore apparently showed up at the polls to vote against a scare-induced image of Texas Gov. George W. Bush and, in the light of day, see that they gain little in a Gore victory.

The principal winners in a Gore victory would be the elites who run the party and so desperately argue their case on round-the-clock television.

JOHN BYRD

Reston

D.C. General backers have earned city's support

Throughout its four-year history, the D.C. Health & Hospitals Public Benefit Corp. (PBC) has struggled to preserve D.C. General Hospital and its community health centers, which serve those in need. The PBC stands at the brink of financial collapse as the result of a combination of archaic information systems, poor internal billing processes and devastating reimbursement decisions by the District agencies that should have been supporting the hospital and clinics.

Historically, the office of the District's chief financial officer has not offered its full support, and neither has the city's Medicaid office nor its Department of Health. With all the negative press, many thought the triennial hospital/ clinic accreditation survey by the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) would deliver the deathblow to the corporation.

Everyone at PBC knew the accreditation survey would be tough for management and staff. The survey was scheduled to begin the Monday after Thanksgiving, so many staff members would have to give up their holiday weekend to make final preparations for the survey team's arrival. The JCAHO survey team apparently had read a full inch of negative press clippings about the hospital.

The survey would include the community health centers, which were in a horrible state of affairs when they were inherited from the city's Department of Health. (The PBC had been forced to use dollars intended for patient care to renovate the clinics, which had never been licensed or even inspected.) With the organization in political turmoil, 20 senior managers gone and 100 resignations having taken place during the previous months, many worried about whether the staff would be too demoralized to rise to the occasion. The JCAHO score in 1997 was 92 percent (compared to a national average of 86 to 88 percent). However, the PBC was told that the test criteria had become more stringent.

At the JCAHO team "exit interview," the management team sat holding its breath awaiting the results of the survey. The lead surveyor announced " … you have major deficiencies in the area of 'Environment of Care' because your buildings are so old… . However, your preliminary JCAHO score is 94 percent."

The room erupted with screams and tears of joy. The management and staff of D.C. General Hospital and affiliated community health centers had done it they had proved themselves to Mayor Anthony A. Williams, the financial control board, the congressional overseers, the press and the whole city. They had proved that despite the city's neglect, the PBC staff is a first-class health care delivery team.

The biggest problems for the PBC now are politics and bureaucratic manipulations of the almighty dollar. The PBC staff and management have shown what they can do with no support from the District. The PBC's new information system and billing processes soon will be fully operational.

The corporation has a new chief executive officer, Michael Barch, a former CEO of George Washington Hospital. He is an experienced CEO, respected by his local colleagues, and has a long history of commitment to the underserved. He has a vision for an "urban health campus on Capitol Hill," a partnership with other organizations to ensure cost-effective acute care, mental health care and long-term acute care. His model, which is gaining broad-based support in the hospital community, uses federal dollars and special partnerships to support services and help build a smaller, more modern hospital to replace D.C. General.

To quote the JCAHO team, "The PBC has proven that you can't judge a book by its cover… . The PBC staff and management earned their high score." The staff has done its part. It's time for the politically appointed PBC board and the city's politicians to use this monumental PBC staff success story as a foundation for launching a bold new vision for health care delivery to the underserved of the nation's capital. The year 2001 needs to be one when we move past petty politics to focus on patients to build a vision for cost-effective health care delivery for all patients in the city.

VICTOR G. FREEMAN, MD

Washington

Victor Freeman is a District resident, physician and member of the PBC Board of Directors.

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