- The Washington Times - Wednesday, August 27, 2003

Health insurer Aetna Inc., citing a lack of confidence in the quality of care available at Greater Southeast Community Hospital, has ended its contract with the troubled D.C. facility.

The insurer notified the hospital of its decision on Monday and is sending letters to health-plan members this week saying costs incurred at Greater Southeast will no longer be covered.

The decision came one week after the Joint Commission on Accreditation of Healthcare Organizations removed the hospital’s accreditation, giving the 445-bed facility failing grades in infection control, anesthesia care, staffing and leadership.

The move came as a surprise in light of Aetna’s recent high praise for Greater Southeast when the insurer announced a five-year contract extension with the hospital in June. The extension was offered in spite of the hospital’s problems with city inspectors, who suspended the hospital’s license in January after uncovering failures in patient care, staffing and upkeep.

“Greater Southeast has been a valued part of Aetna’s Washington, D.C. network for several years, and we’re pleased that our relationship will be continuing for several more,” Aetna executive Bill Stout said in a company press release June 9.

Ten weeks later, however, Aetna officials say the loss of accreditation has shaken their confidence in Greater Southeast, which is the primary hospital for the District’s low-income residents.

“The safety of our members is our primary and paramount concern,” Aetna spokesman Walt Cherniak said yesterday. “The loss of accreditation is serious and alarming.”

Mr. Cherniak said a clause in the five-year contract extension allowed the health plan to drop Greater Southeast from its coverage network if the hospital lost accreditation.

Hospital administrators plan to reapply for accreditation this fall. First, however, city hospital inspectors must decide in October whether to allow the hospital to remain open.

“Obviously our goal is to regain accreditation,” said John Ray, an attorney for the hospital. “The city has set forth benchmarks and timetables to make improvements. They wouldn’t allow the hospital to continue to operate unless it was safe.”

City inspectors suspended the hospital’s license in January after uncovering failures in patient care, staffing and upkeep.

Mr. Cherniak said Aetna officials did not have statistics readily available to say how many members would be affected by the insurer’s decision to drop Greater Southeast.

Medicaid and Medicare insurance pay for about 85 percent of the hospital’s health care bills, according to city officials.

Aetna’s D.C. network includes 309 primary-care physicians with admitting privileges at hospitals in its network. Physicians who have admitting privileges only at Greater Southeast will be dropped, Mr. Cherniak said.

The health plan would reconsider that decision if Greater Southeast regains accreditation in the fall, Mr. Cherniak said.

“But the Joint Commission is a very important stamp of approval,” Mr. Cherniak said. “When that’s revoked, it’s certainly a very serious situation.”

Meantime, city health officials have been meeting with other D.C. hospital administrators to make plans in case Greater Southeast does close. Health officials have not yet said specifically how to cover the gap in services that closing Greater Southeast would create.

Health Department Director James Buford said Monday that a contingency plan is needed to “assure the community that they will have access to viable health services.”

Under a consent decree between Greater Southeast and the Health Department, the hospital must make improvements in five areas by October to regain its license.

They include staffing levels and training, record keeping and administrative policies, power-system equipment and building maintenance, and emergency functions.

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