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District
of Columbia Committee on Human Services
Department
of Health
Health
Care Safety Net Administration
Committee
on Human Services
Statement
of James A. Buford
Acting
Director
November
21, 2002
Thank you
Chairperson Allen and members of the Committee and good morning. I am
James A. Buford, Acting Director of the Department of Health. Joining
me this morning is Brenda Thompson, Deputy Director of the Health Care
Safety Net Administration; Phillip Husband, Special Counsel; Imeh
Jones, Chief Financial Officer, and Denise Pope, Administrator, Health
Regulation Administration.
We appreciate
the opportunity to appear before you to brief you. on the Healthcare
Alliance contract with the Greater Southeast Community Hospital.
As you know
the Healthcare Alliance is a public-private partnership between
Greater Southeast Community Hospital Corporation, Unity Health Care,
Children's National Medical Center, George Washington Hospital and the
Department of Health to provide health care coverage to eligible
uninsured residents of the District.
For the past
eighteen months the Health Care Alliance has provided services to more
than 37,000 individuals. Many of these individuals are now receiving
regular preventive health care, dental care, access to prescription
drugs, and early hospitalization. As members of the Alliance they have
access to a comprehensive array of primary care services, case
management, and health education programs. Disease management programs
have been developed to better serve high-risk individuals with chronic
diseases.
The creation
of the Healthcare Alliance gave rise to new concepts and methodologies
for health care delivery that now forms the core service component for
uninsured District residents. A snapshot of improved outcomes are:
- a
service delivery structure that utilizes a patient-centered
care model as a guiding principle for care;
- a program that provides services only to District residents;
- an
expanded array of service delivery sites that include six
hospitals, 28 neighborhood clinics and 780 primary care providers
and specialists;
- the
network of providers coordinates services with each member's
medical home (primary care provider) for continued focus on
primary care and disease prevention; and
-
a system for data collection and reporting that provides information
regarding the cost, disease status, treatment and utilization of the
services provided through the Alliance.
The initial year of the Alliance
closed in May of 2002 having succeeded in two very significant areas:
- The number of individuals enrolled in the Alliance exceeded 25,000
and the number of individuals served exceeded 35,000 - resulting in considerable access
to health care services for the uninsured.
- The number of providers increased from three to six hospitals, the
number of primary care providers expanded to include the "non-profit"
neighborhood clinics, and the number of physicians and specialist grew to approximately 800
participating practitioners. Again, the pathways to health care services to the
uninsured were expanded.
Madam Chair the financial statement for the first program year is
incomplete. The reconciliation process has been delayed because of a significant number of claims being
incorporated at the end of the process delaying closure for another ten days (December 2).
Program Year Two
The second program year is now into its fifth month. The
enrollment is steady and utilization of all services is increasing. At
the rate at which we are currently spending - remaining in budget by
year-end will be a major challenge. Our plan is to take mid-year
measures to address budget pressures that will include the following:
- Clarify presumptive eligibility (eliminate) - reduce the number
of individuals served who are later determined ineligible - as
well as the number of individuals who are served only one time.
- Retroactive payment of claims - to reduce the number of claims
that are paid in advance and subsequently denied.
- Pre-authorization of hospital admissions - to reduce the number of
inappropriate hospital admissions.
- Consider
reducing the payment of the access maintenance cost at the DC
General campus.
We also plan
to cover the $4.7 million reduction that the Health Care Safety Net
Administration had to take in its 2003 budget.
We will provide you
with a copy
of our year one program close out statement as soon as we can make it
available.
Additionally, we will inform you of the measures that are
implemented to address the 2003 budget pressures and what we project
their value to be.
Recent
Events
Another challenge - I am sure you have read the
extensive media coverage of the financial situation of National
Century Financial Enterprise Inc. - Doctors Community Healthcare
Corporation, and its subsidiaries in the District--the Greater
Southeast Community Hospital and Hadley Memorial Hospital. As a result
of the bankruptcy filed by National Century a few days ago - Doctors'
Community Healthcare Corporation filed bankruptcy yesterday, November
20, 2002. These events have national implications-but they also have a
more immediate local impact on the Greater Southeast Hospital and
Hadley Memorial Hospital. A ripple effect on the District's entire
health care system is unfolding as we meet today.
This situation
presents challenges and opportunities for the Department of Health and
the District leadership-with regard to our attempts to ensure health
care coverage for the underserved community of the District, and our ability to effectively
undertake the mandate of assuring health services for District residents.
The recent information regarding the financial difficulties at National
Century and Doctors Community Healthcare Corp. has caused us to have
concerns about the financial viability of Greater Southeast Hospital and
thus the need to increase our monitoring of the hospital with regard to
quality of care issues. Additionally, we are concerned about the
hospital's ability to carry out its responsibilities as the prime
contractor for the Alliance Partnership.
Daily
Monitoring
With regard to our monitoring, we have assigned a monitoring
team to assess and monitor the hospital and DC General campus services on
a daily basis. The actions taken to date include:
- Monitors
assigned to Greater Southeast Hospital to ensure that the quality of patient
care meets appropriate standards.
- Daily
meetings and conference calls have been initiated with staff members to review
information collected at these locations over a 24-hour period.
- Discussions
held with the leadership of the hospital (GSCH) to acquire real time
information.
- Detailed
financial information has been requested to more fully assess the
current
and future financial condition of the hospital.
- A review of
contractual and other legal issues to inform decision-making.
- A review of
options for ensuring continuity of patient care in the event Greater
Southeast is unsuccessful in acquiring the resources to sustain operations
and service delivery.
Contingency Plan
As we go forward in this "bankruptcy environment," we
are hopeful that the Greater Southeast Hospital is successful in its
efforts to secure funding that will support its operating cost for the
period of its reorganization.
And in this environment it is the primary responsibility of the Health
Care Safety Net Administration is to ensure the provision of quality
health care services to the eligible uninsured residents of the District
through the Alliance. Additionally, the department also has a
responsibility to ensure that residents in the southeast quadrant of the
District have access to quality health care.
After careful consideration of the facts, we have concluded that we must
put in place a contingency plan that will allow us to continue to meet
the health care needs of our uninsured residents without interruption if
the efforts of GSCHC are unsuccessful. Our contingency plan is to
recommend the termination of GSCHC as the prime contractor for the
Health Care Alliance Initiative.
The termination of the contract does not mean the loss of a provider,
but will ensure the ongoing viability of the Alliance program for the
uninsured. If it is possible, we will continue to have GSCHC participate
as a provider of inpatient care in the Alliance network.
We will work with the other hospital partners in the Alliance to expand
their participation in this effort. And the Department of Health - for
the balance of this current program year only will assume some of the
responsibility of the prime contractor.
Closing
Madam Chairman and Committee members, I will end by reiterating that our
energies should will be directed at addressing the issues at hand-and on
giving considerable thought to the actions we must implement,
recognizing the implications of whatever plans we develop have for
maximizing uninterrupted and continued access to the level and scope of
care which our residents depend upon -- and particularly those individuals
most at risk -- our uninsured and medically underserved population.
Thank you for the opportunity to testify before you today. We would be
please to answer your questions.
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