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Urban Health Campus on Capitol
Hill/PBC2
The Government of the District of Columbia is trying to shut down the
public safety net health care system.
The Mayor's Planned Privatization of the Safety Net
- Costs to close out DC General Hospital estimated at more than $90 million
- Cost of providing care in the privatized safety net will amount to $83 million a year or
$415.5 million over a five year period, excluding the cost of correctional care,
pharmaceuticals, school health, trauma care, and care provided to patients in the custody
or care of DC and federal agencies
- DC General Hospital is the largest provider of trauma care in the District, and the
District's trauma care system as a whole lacks the capacity to absorb the care provided by
DCGH
- The following associations propose keeping an inpatient facility at DCGH: the American
Medical Association, the National Association of Public Hospitals, the American Public
Health Association, the DC Medical Society, the DC Hospital Association, the DC Nurses
Association; also in favor of this proposal are DC residents and the DC faith community
- Ambulance transport times will increase by as much as 4 to 20 minutes, costing lives as
critically ill and injured patients are transported to more distance facilities
- Privatization places responsibility for the health of the city's most vulnerable
residents to a for-profit company based in Arizona with questionable finances and minimal
experience in caring for special populations-patients with HIV/AIDS, substance abusers,
the homeless, foster children, the elderly, prisoners and other special populations
- Dismantles the safety net in the United States Capital to try out an untested emergency
access model and assumes that private doctors and hospitals will welcome the uninsured
into their offices and facilities for minimal reimbursement
The PBC2: A Viable Alternative
- Replaces DC General Hospital with a new, $100 million state of the art facility with no
capital investment on the part of the City
- Rests on a nexus of public and private, federal and local partnerships with
organizations such as the National Institutes of Health, Howard University, and local
Federally Qualified Health Centers; expands the Community Health Program from six to more
then 30 comprehensive health centers with the potential to secure additional Federal
Section 330 funding
- Transforms the existing site of DC General Hospital into an Urban Health Campus serving
as the hub of a vertically integrated system of primary, specialty and inpatient care,
school health, home health and long-term care interconnected by a single information
system
- Brings private sector efficiencies to bear on public health care delivery, including a
Practice Plan for PBC providers and a single set of work rules for all unions, resulting
in an efficient, incentive-driven work environment
- Continues ongoing efforts to improve school health services as well as the existing
programs for medical education, prisoner care, low and no-cost pharmaceuticals, children
with special needs, and other vital services not included in the Mayor's plan
- Operates efficiently within the allocated budget of $75 million
- Preserves and protects an institution with a proven track record in delivering care to
the District's low income and uninsured patients: In November of 2000, DC General received
a score of 94% from the Joint Commission on Accreditation of Health Care Organizations
Back to top of page
Two Approaches to Delivering Care to the Under- and Uninsured Residents
of the District of Columbia
Issue |
PBC 2 |
GSCH |
Accredited Health System |
- 94% JCAHO score on hospital and ambulatory care network
- 3 years of network integration experience spanning primary, specialty and acute care
|
- 84% JCAHO score on hospital only
- Network relationships are still fluid; inadequate contractual relationships to assure a
continuum of care
|
Experience in Community-based Primary Care |
- Historic safety net including public and private community-based health centers
- Services include enabling services such as social services, nutrition, care management,
mobile health vans and home visitation
|
- No community-based health care experience
- No social support for vulnerable populations
- Private medical offices that have not historically served the uninsured population are
not experienced and/or staffed to perform enrollment functions
- Private physicians do not welcome homeless, dually diagnosed patients in their waiting
rooms with private pay patients
|
Commitment to Medical Education |
- House medical residency programs in medicine and pediatrics in cooperation with Howard
University
- House oral maxillofacial surgery residency program
|
- DCHC has no participation in area's graduate medical/dental education programs
|
Continuity of Physician-Patient Relationships |
- Maintains virtually 100% of relationships between patients and their historical safety
net provider
- No disruption in care or medical homes
|
- Abandons existing relationships
- Forces patients to find new medical homes
- Forces patients/providers to assemble new medical record
|
Provider Inclusion in Governance |
- Provider role in corporate governance
|
- Physician-owners are out-of-state investors
|
Trauma Care |
- Maintains Level 1 trauma on-site at DC General
|
- Closes DCGH trauma center
- Forces lengthy re-route of trauma/critical care patients from Wards 5,6 and 7
- No current contracts or in-house capability for trauma service
|
Physician Experience |
- Decades of primary and acute care experience in unique medical/dental needs of medically
underserved
- Hospitalists trained in critical care of patients with end-stage, multi-system failure
- Public health system for chronic TB patients with capacity of 21 isolation rooms
- Operate an experienced Level 3 NICU managing care of city's most fragile infants
- Pediatric emergency care team assuring care 24/7 to parents who lack transportation to
Children's Hospital
|
- Provider and hospital network have limited experience with the health issues of the
uninsured
- Uninsured with non-life threatening need are historically referred to DCGH; hospital
staff lacks expertise with homeless, TB and AIDS patients; typically private MDs round
once a day on insured patients
- No experience in long-term management of chronic TB patient; no dedicated isolation
rooms
- No Level 3 NICU
- No Pediatric emergency physicians; eliminates pediatric emergency services in Southeast
Washington
|
Experienced Management Team |
- CEO, Medical Director and Executive Staff offer decades of experience operating health
systems for the under- and uninsured and in managed care systems and practices
|
- Local executive team is experienced in for-profit health enterprise, primarily in acute
care settings
|
Pharmacy System and Formulary Management |
- Defined pharmacy benefit
- Existing ambulatory delivery system
- Formulary management by experienced Pharmacy & Therapeutics Committee (P&T).
|
- No pharmacy benefit
- No experience in formulary management
- No experience in pharmacy distribution outside of a hospital
|
Maintenance of Effort |
- Uninsured patients who present at an out-of-network emergency room will be managed under
the hospital's uncompensated care policy; post-discharge, patients will be followed up in
primary care system with a goal of avoiding future inappropriate care outside of the
system
|
- WACH, and thus the city, will be financially responsible for all emergency room
services, relieving hospitals of their charity care obligation
|
Quality Monitoring |
- Offers population-specific quality monitoring and reporting indicators
- Offers specific disease management programs, two which can be implemented in year one,
that cross care settings and are culturally relevant
|
- Propose no specific indicators reflecting experience with the population
- Propose no population-specific disease management
|
New Medical Center at D.C. General Campus |
- Commitment to build new, state-of-the-art medical center with acute, trauma, urgent care
and medical/dental specialty services
|
- Abandons acute and trauma services at DC General Hospital
- No long-term commitment to maintaining primary and specialty services on DCGH campus
|
Cost to Taxpayers |
- $75 million total per year
|
|
Back to top of page
YES!! THERE IS AN
ALTERNATIVE TO CLOSING D.C.
GENERAL HOSPITAL: PBC 2
WHAT PBC 2 MEANS TO YOU
City leaders like to say we have no choice but to accept a contract with a private
provider, who will shut down D.C. General and replace. it with an urgent care access
facility, that provides no trauma care. And no prisoner care. And no school nursing. And
no continuum of care for patients in the PBC system, which dates to 1806.
But they are wrong! THERE IS AN ALTERNATIVE PLAN. IT IS BEFORE THE CITY AND HAS
BEEN BEFORE THE CITY FOR MONTHS. We call it: the Urban Health Campus on Capitol
Hill (PBC2), and the focus is on PATIENTS and PATIENT CARE, with a plan that addresses
every aspect of that focus. Our mission and vision is to create a modern community
hospital on the campus of DC General and an integrated health care system, with expanded
primary care in our city's neighborhoods. Our primary goal is to address the
medical needs of District residents to the greatest extent possible - regardless of any
individual's ability to pay for services.
Our plan to improve DC General Hospital (PBC) includes the following improvements to
health care services in the District of Columbia
A New $100 million dollar, state-of-art facility; and improved services
- The proposed hospital building would replace the current buildings, some of which date
to the 1920s
- The new Urban Health Campus Medical Center would operate 190 beds with a daily average
of 160 occupied beds
- The Urban Health Campus would also include a Level 1 Trauma Center, Emergency Room and
an Urgent Care Center as well as a Women's Health Care Center, a modem birthing facility
and a Senior Wellness Center.
- "Centers of Excellence" would be established to assist patients with
management of chronic diseases that disproportionately affect African-Americans and
low-income city residents. For example a Diabetes Management Care Center as well as an
HIV/AIDS Management Center would provide patients with comprehensive treatment
- A new strategic partnership would be formed with Howard University's Cancer Center,
Howard University Hospital and the Howard College of Medicine, as well as other
organizations such as the National Institutes of Health.
Back to top of page
THE ALTERNATIVE TO CLOSING D.C. GENERAL IS PBC2
Expanded Community Health Program
- Our proposal would increase the number of community health care clinics to more than 30
locations from 6 currently operated by the PBC today.
- All clinics would be networked through computer software systems that-will enhance
QUALITY care, including access to specialty care, and make it easier to access patient
records and link all city clinics with the Urban Health Campus.
Long-Term Acute Care, Substance Abuse and Mental Health Care
- 60 long-term acute care beds and up to 160 mental health care beds would be located at
the Urban Health Campus, and substance abuse treatment programs would be enhanced.
Enhanced School Health Program
- Our plan would keep and improve school health care services by networking all school
nurse computer systems with the newly networked neighborhood clinics. School nurses would
have access to clinic appointments schedules as well as patient records from local clinics
- Improved screening and immunization programs such as hearing testing, dental screening
and other screenings required for EPSDT.
Practice Plan for PBC Physicians
- Specialty doctors associated with the Urban Health Care Campus would organize a
corporation for the purpose of delivering specialty care
Medical Education Program
- Graduate medical education programs with medical schools such as Georgetown and Howard
universities would continue and be expanded.
Restructure PBC's Board of Directors
- The makeup of PBC's Board of Directors would be changed to include more representation
from the local community and other PBC2 partners.
We are confident that the PBC2 can provide the above improvements to health care in
the District of Columbia while at the same time:
- operating within an allocated budget,
- earning increased revenues,
- operating efficiently, and
- providing quality health care to the District's insured AND uninsured residents.
Back to top of page
Urban Health Campus on Capitol Hill
Under the leadership of its new Chief Executive Officer, Michael Barch, the District of
Columbia Health and Hospitals Public Benefit Corporation (PBC) is completing plans to
implement an Urban Health Campus (UHC) on Capitol Hill at the site of the historic
D.C. General Hospital in Southeast Washington. Formulated in response to the Control
Board's Request for Proposals (RFP) for the privatization of the safety net, the PBC's
plan offers an alternative roadmap for fast-tracking to reality a fully integrated and
fiscally sound health care delivery system for medically vulnerable residents of the
District of Columbia.
Within two years, a modern medical center with 190 beds will replace the aging D.C.
General main buildings, which currently are a substantial drain on PBC resources. Compared
with projected capital costs of keeping the current facility going -- in excess of $110
million over the next six years -- the new hospital could cost less than $100 million and
be funded with non-District dollars, Our hospital model maintains quality, comprehensive
health care with achievable revenue increases and minimized expenses - a far less
expensive plan for D.C. taxpayers than the RFP/privatization.
The hospital will be located in a campus-like environment that includes mental health,
long-term acute care, substance abuse services and Federal/D.C. collaborative programs.
Its feasibility rests on plans to leverage private, federal and local government resources
through mutually beneficial partnerships. Partners could include the National Institutes
of Health, Howard University Hospital, Howard's College of Medicine, St. Elizabeth's
Hospital, Non-Profit Clinic Consortium members and Unity Health Care. These partnerships
will be forged to meet several fundamental goals, including building revenue streams for
the PBC, containing costs, and enriching the depth and breadth of quality health services
accessible to low income citizens.
To emphasize primary care at the neighborhood level, and the concomitant reduction in
expenses associated with central emergency room operations, the PBC's community health
centers will collaborate with non-profit NPCC health clinics throughout Washington,
greatly expanding access for lower-income and uninsured residents. By joining together,
PBC efficiencies and cost controls will be improved and patients will be better served. We
will seek Section 330 Federally Qualified Health Centers (FQHC) status, providing new
federal funding. The community approach to primary care will be buttressed by PBC
initiatives to emphasize health education, preventive medicine, immunizations and
screenings as part of the School Health program in all D.C. Public Schools. In addition,
the PBC's physicians will organize themselves into a practice plan corporation for the
purpose of delivering specialty care. By restructuring the specialty physicians we
anticipate greater efficiencies, increased patient volume and an overall improvement in
quality care. Implementation of the UHC can be accomplished with an annual budget of $75
million for safety net services to the uninsured and underinsured. It will be implemented
concurrent with the ongoing redesign and contraction of the PBC system, which includes
outsourcing of services and reductions in force. The net result will be reduced expenses,
a steadily increasing revenue stream and maintenance of quality care for those citizens
the PBC was formed to serve.
The above is in contrast to the Greater Southeast proposal, which reduces access to
trauma care, does away with inpatient care in Ward 6, does not speak to corrections care
and virtually fragments all care through an HMO-like insurance program, which depends
largely on a network of physicians. This plan even, with its deficiencies, will cost $84
million a year at a minimum, according to the Washington Post, compared with the more
cost-effective and more comprehensive PBC2 plan. |