Copyright 1999 The Atlanta Constitution
The Atlanta
Journal and Constitution
June 7, 1999, Monday, Final Edition
SECTION: Editorial; Pg. 10A
LENGTH: 570 words
HEADLINE:
FUNDING IN PERIL;
Teaching hospitals deserve helping hand from everyone
BYLINE: Martha Ezzard, Staff
SOURCE: Journal
BODY:
When
Stephanie Laster, the teenager most seriously injured in the Heritage High
School shooting, was rushed to emergency medical treatment, she was taken to
Atlanta's Grady Memorial Hospital, which offers the best trauma care in the
region. And the surgeon who operated on her was from Morehouse School of
Medicine, which along with the Emory University School of Medicine places top
faculty and approximately 420 resident physicians at Grady.
Grady, in
fact, has trained approximately 25 percent of the physicians practicing in
Georgia. But like other teaching hospitals around the country, it's in serious
financial trouble. There are reasons enough to fault Grady for inefficient
management, but fixing those problems won't save it. Like other teaching
hospitals, Grady is bleeding millions annually. Blame a combination of factors,
the most crucial of which is huge cuts in Medicare. Medicare reimbursement
formulas have always allocated substantial funds for graduate medical
education at the nation's 1,600 teaching hospitals.
The
Balanced Budget Act of 1997 turned that upside down. It slashed funding by $ 6
billion over five years, $ 16 billion over 10. Last year, Grady was $ 5 million
short. According to Adolph Mallory, Grady public affairs officer, the hospital
will lose $ 42.2 million in Medicare and $ 12.2 million in Medicaid medical
training funds by 2001. Some of the nation's premier clinical research centers
have lost even more.
Some policy makers shrug and declare that resident
physicians can be placed at other hospitals if the public teaching institutions
go under. But the patient load and variety that Grady receives are crucial to
developing doctors' competency in trauma care and surgery.
Fortunately,
Sen. Daniel Patrick Moynihan (D-N.Y.), a long-time champion of medical
education, is fashioning legislation to restore half of the funding cuts for
teaching hospitals. Georgia Sen. Max Cleland is a co-sponsor of three related
bills. Two of them deal with cuts that may have been inadvertent, caused by the
failure of managed care corporations to contract with teaching hospitals.
Grady has also faced reductions in local government reimbursements. Over
the past five years, Fulton and DeKalb counties have decreased their funding to
Grady for indigent care by $ 23 million. And 48 percent of all patients treated
by Grady last year had no insurance.
In the old days, private insurance
subsidized hospital costs for indigent care. Along came prospective
reimbursements that predetermine the maximum cost of every procedure. Then came
for-profit managed care, as beholden to stockholders as to patients. It
contributes almost nothing to indigent care.
The old way may not have
been fair, but the new way has seemingly intractable problems. Bearing the brunt
are our teaching hospitals, the incubators of medical advances that have made
U.S. health care the envy of the world.
There's been little public
debate on the issue of paying for medical education --- especially the training
of resident physicians, 80 percent of whom leave medical school with individual
debts greater than $ 100,000. But every participant in the system should pay a
little. That means for-profit managed care companies, and it means all of us.
E-mail: mezzard@ajc.com
Martha Ezzard is a member of the
Journal's editorial board. Her column runs in the Journal on Sunday and Monday.
LOAD-DATE: June 8, 1999 
