- The Washington Times - Tuesday, December 10, 2002

D.C. officials yesterday acknowledged serious problems with the city's indigent health care program and urged collaboration with the medical community to resolve them.
"I am not going to stand up here today and say that everything is perfect," Mayor Anthony A. Williams said at a daylong summit. "As we examine all these complex and difficult issues, let us do so with a spirit of cooperation and with a sense of common purpose. The time for grenade throwing and relentless naysaying is over. We want the dialogue to begin, and we want to listen to you, the experts."
Mr. Williams told health officials he accepted that the D.C. Healthcare Alliance must be more effective in reimbursing hospitals for services and must assess the effect of extra patients on the emergency rooms citywide and ambulance diversions on emergency medical service operations.
But he cautioned that the city doesn't need "pie-in-the-sky" proposals that would force a "cash-strapped District government" to build or manage a new public hospital in response to calls from D.C. Council members.
Hospital and clinic administrators welcomed his remarks as a first step toward working with the city on its indigent health care plan, a process that many providers said had not included them in the past.
"It seems that the city is finally beginning to hear us," one health administrator said privately. "Maybe this wouldn't have happened if they had been listening all along."
During the summit, health providers met to identify problems and propose solutions to the issues surrounding the alliance, including recruitment, training and retaining nurses and other staff, reimbursing hospitals in a timely manner, streamlining patient eligibility into the alliance and coping with overwhelmed emergency rooms.
"If you decided to pay for the best tailor and get the best fabric to make a suit and he makes it in size 6, no matter how good a tailor, I can't fit into size 6," said Sister Carol Keehan, chief executive officer and president of Providence Hospital, referring to the hospital's overburdened emergency room. "If the system worked so well, the alliance patients wouldn't need to be coming through my emergency room."
The Washington Times has detailed increasing patient wait times caused by overcrowded emergency rooms and ambulance diversions as a result of closed emergency rooms since the alliance contract partially closed D.C. General Hospital in spring 2001.
Mr. Williams and the financial control board created the alliance, a reform plan to partially privatize the city's indigent care. Doctors Community HealthCare Corp. of Scottsdale, Ariz., through its hospital, Greater Southeast Community Hospital, became the prime contractor of the alliance, which includes other hospitals and clinics, for use by about 28,000 members.
But last month, Doctors Community HealthCare filed for bankruptcy protection after its lender, National Century Financial Enterprises of Dublin, Ohio, did the same two days earlier. Doctors Community HealthCare owns Greater Southeast and Hadley Memorial in the District, one hospital in Chicago and two in California.
After those disclosures, city officials considered replacing Greater Southeast with D.C. Chartered Health Plan after lobbying by company officials, city sources said. Chartered is a private for-profit health maintenance organization for D.C. Medicaid patients that administers alliance claims. The firm is owned by Jeffrey E. Thompson, a politically connected accountant whose companies have received millions of dollars in no-bid contracts from the District. He bought the company out of bankruptcy in 2000, a year before the alliance contract and days before a no-bid extension of the $44.9 million city contract, about 98 percent of the firm's business, city documents show.
Administration officials, concerned about the political fallout of such a move, announced last week that the city's health department would take over from Greater Southeast for six months until plans for the alliance's future could be settled.
"We have to look at several options, including a managed care type [of operation]," said James Buford, acting director of the D.C. Department of Health. "I am not sure what we will select."
Even so, many have expressed concern that the health department is not equipped to take on the responsibility, pointing to the lack of systems in place to oversee the alliance or collect and analyze data as to its effectiveness.
But Mr. Buford said the department is preparing itself for the responsibility.
"It normally takes up to two years to put everything in place," said Mr. Buford. "The program is growing stronger. And we will develop the capacity to fulfill our current and expanded responsibilities."

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