Mark David Richards
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District of Columbia City Council Human Services Committee
Councilwoman Sandy Allen, Chair
Friday, April 27, 2001
Testimony of Robert L. Cosby, Ph.D.
Executive Director - Non Profit Clinic Consortium (NPCC)
Concerning the Contract for Comprehensive Healthcare Services for the DC
Good Morning. My name is
Robert Cosby and I am the Executive Director of the Non Profit Clinic
Consortium (NPCC). NPCC represents 13 free and sliding fee scale,
non-profit neighborhood health clinics that provide primary health care to
the underserved in Washington D.C. NPCC clinic patients typically are
those that are uninsured, under insured, immigrants and the homeless. NPCC
clinics provide care for 66 percent of the District's uninsured. This
includes almost 10,000 children not eligible for Medicaid.
I would like to address my
comments regarding the DCFRA#00-R-039 contract re: Comprehensive
Healthcare Services for the DC Uninsured. Specifically I will limit my
remarks to the contracts' proposed impact upon NPCC clinics and the
patients seen at our NPCC clinics.
First, NPCC supports the
implementation of this contract. I know that this is not the popular
position, but let me share why I believe that this is the right decision
at this time.
This contract for the
uninsured will provide more access to specialty care and tertiary care for
NPCC clinic patients than was available previously. Just as a reminder,
how patients used to get care was often dependent on who you knew. There
was little if any formal mechanism or system to provide specialty care for
NPCC clinic patients. I might add that PBC clinic patients also had
difficulty scheduling or receiving care. There were several phone calls to
colleagues, contacts and friends that were known who would try to get
patients into see specialists. Of course, there was always entrance to the
Hospital via the emergency room, but we know that to be both expensive and
time consuming. So, this contract will mean more access, which will mean a
better deal for NPCC patients. Better than over the last ten years.
Second, this contract will
provide pharmacy coverage for a greater number of uninsured patients.
Uninsured NPCC clinic patients need pharmacy coverage. In recent times,
the only way for a patient to access the DC General pharmacy was to become
a DC General or PBC patient, meaning the patient was transferred to a
physician practicing at D.C. General. This was often time consuming and
impractical. Unfortunately it was necessary for the PBC to meet some of
its volume requirements for funding. Although not explicitly pointed out
in the contract due to various points of negotiation, in meetings with
contractors and with the DoH, NPCC has been told that pharmacy will be
available to the uninsured at least at the same rates as was offered to
PBC patients in the first year and expanded to cover more uninsured in the
second year. That is a major win for uninsured DC residents.
Third, it is tragic to see the
crumbling of the DC General Hospital and the PBC infrastructure. We know
this to be so largely because they could not operate within the resource
limits given to them by the District. You all know this to be true. The
new contract attempts, for the first time, to develop an integrated health
care delivery system, not just a subset, as was offered earlier. No other
integrated plan was approved. The DoH indicated in a letter to NPCC, and
after a series of consensus meetings, and reinforced by the contractors,
that NPCC clinics and their uninsured DC resident patients will receive
more care than was available previously at the PBC. Specialty care,
tertiary care, more integrated primary health care delivery, and pharmacy
are four critical areas now missing. If the contract delivers on these
areas, as I believe the contractors will, more care is provided.
I want to re-emphasize that
NPCC strongly supports the Mayor and Dr. Walks and the Department of
Health in implementing this contract. It is the right thing to do. The
contract is not status quo. The contract states that more uninsured
District residents will receive care. Let's stop with the blaming and
start building something that will benefit a larger portion of the
community. Lyndon LaRouche and others have tried to portray this as a
racial issue, one that is about those East of the River vs. West. It is
not, it is much more fundamental. This is an issue about care for
uninsured persons and expanding care vs. keeping it the same as it was. No
one is talking about the fact that despite good intentions how the old
system left out lots of poor uninsured people. We need a comprehensive
solution that provides care for more people. This contract is a major
start. Let's get on with its implementation.
I am available to answer any
questions you might have regarding my testimony. I can also be reached at
the NPCC office at 202/785-1894.