- The Washington Times - Monday, March 26, 2001

Every health professional in the District of Columbia indeed, in the nation knows that Mayor Anthony Williams is right to focus on primary health care as the vehicle to improve the health of the citizens of the District of Columbia. So why are all of our city's health and medical organizations, and many national professional associations, opposed to the plan currently being proposed? The issue is one of approach.
The proposed contract with the control board utilizes an HMO model to control costs, utilization and access. An alternative plan, which we call PBC2, would utilize providers and health administrators experienced in health care for uninsured populations to do the same. Whereas the contract approach would dismantle the current public health-care delivery system and attempt to design and implement a new one at lightning speed, PBC2 would utilize the integrated delivery system currently in place and change it in the following ways:
n The D.C. General Hospital facility would be replaced and be transformed into the centerpiece of a health campus that would focus on academic and clinical initiatives to eliminate disparities in access to care and health-care outcomes.
n PBC2 would install an electronic information system that would track patients across all points of service and levels of care.
n Eligibility will be determined and patients enrolled in the tracking system at all primary and dental care offices, urgent care centers and the Emergency Room.
n Use of the ER for primary care will be controlled by giving patients appointments (not referrals) to their primary care physician before they leave the ER and giving them prescriptions for only enough medication to last until their next appointment (within 2-3 days).
n Patients who visited the ER will be contacted the next day to encourage them to keep their appointment.
n Primary care physicians will be informed of a patient's need for hospital admission before admission occurs.
n Clinical data within the system will be used to allow poor health outcome trends and causes of frequent hospitalizations to be identified, thus allowing disease and care management programs to be designed in order to educate providers and to treat and educate patients.
n Under PBC2, all of the District's traditional safety-net providers, including the free and neighborhood clinics in all wards, would become part of one delivery system, linked by computers to share information on patients at all locations. Every visit to a dentist, doctor or ER will be a point of entry to an expanded continuum of primary, specialty, pharmacy and inpatient care in a true integrated delivery system.
n A community group of experts will be tasked with setting health-indicator goals and monitoring health outcomes.
The PBC2 plan would cost less than the total budget allocated for the one currently being proposed and maintain and enhance all existing services provided by D.C. General, its community health centers and its school health program. Moreover, assuming that the city would help with licenses and permits, a new hospital could be built within two or three years at no additional cost to the city.
The principal reason for the financial deficits at D.C. General and the PBC has been underfunding an annual subsidy of about $45 million was overrun by more than $30 million per year in the PBC's first three years of operations. Now the mayor has included in next year's budget $75 million to subsidize services to PBC patients at private organizations, a tacit admission that $75 million a year is required to maintain quality care for our citizens with the least resources.
PBC2 also maintains the high quality services of the doctors, nurses and other professionals and support staff who have achieved a 94 percent score from the Joint Commission on Accreditation of Healthcare Organizations, which is among the highest for all District hospitals. Moreover, with doctors from all of the city's safety-net clinics provided admitting privileges to the central hospital, the city's poorest patients always will have access to quality primary care in comprehensive neighborhood health centers as well as specialty and inpatient care.
The virtue of PBC2 is that it preserves the health-care safety net in the District, enhances neighborhood primary care and continues all current PBC services at less cost than the control board's contract. The proposed PBC2 is not business as usual: It promises real reform, ensuring quality health care within known cost parameters.
Best of all, it can be started today. Adequate funds exist in the current year's budget and have been included in the budget for next year. Capital funds already budgeted for PBC operations can be accessed to begin building new primary care clinics in Anacostia and Ward 7, and to provide needed renovations. PBC2 is doable and should be implemented immediately.

Michael M. Barch is chief executive officer and Dr. Robin Newton is chief medical officer of the D.C. Health & Hospitals Public Benefit Corp. The above represents the opinion of the authors and should not be construed as the opinion of the PBC or its Board of Directors.


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