Copyright 1999 Boston Herald Inc.
The Boston Herald
August 20, 1999 Friday ALL EDITIONS
SECTION: FINANCE; Pg. 029
LENGTH: 794 words
HEADLINE:
Cash woes imperil M.D. training; Fiscal crisis threatens doctor training
BYLINE: By JENNIFER HELDT POWELL
BODY:
A fiscal crisis gripping Boston's teaching
hospitals threatens doctor training at Children's Hospital, which gets
practically no federal funds to educate pediatric specialists.
"We can't
continue to go on without a reasonable reimbursement of graduate medical
education," said Children's Chief Executive David Weiner. The hospital
will spend more than $ 30 million training 180 residents and fellows this year -
nearly what it lost on operations from October to March.
While most acute at Children's, declining support from private insurance
plans and government threatens all the state's doctor training programs.
Massachusetts hospitals will spend more than $ 800 million this year to train
more than 3,600 residents. Lawmakers in Washington are at odds over a solution.
And the differences can be considerable: The White House has proposed spending $
40 million to help children's hospitals; Congress would spend six times that
much.
Most see Washington policies as both the cause of the current
crisis and the best hope for a cure.
The money to pay for training once
came from fees for services. Private insurers paid more to teaching hospitals
than others.
Health care is generally more expensive at teaching
hospitals because they treat sicker patients, handle more uncompensated care and
have the added cost of residents and interns. But in recent years, insurers have
cut back on what they are willing to pay.
"The expense of doing business
has gone up, but the revenue has gone down and when you end up with an
intersection of those lines, you have losses," said Dr. Philip Pizzo, Children's
physician-in-chief.
Hospitals rely increasingly on federal
reimbursements for training paid through Medicare. But since the Balanced Budget
Act of 1997, those payments have declined.
"The major teaching hospitals
are totally dependent on Medicare for reimbursements for training, without it
they are in trouble," said David Dolins, Tufts Medical School exutive
administrative dean. "Without it training is going to grind to a halt."
Eventually, teaching hospitals, doctors groups and universities hope to
find a mechanism that will provide a reliable source of training money to all
hospitals.
For now, however, the nation's children's hospitals are
looking for a federal grant while other hospitals try to preserve their Medicare
funds.
"Ultimately there should be some kind of an all-payer program,"
Weiner said. "But that's going to take a number of years. In the meanwhile, the
children's hospitals are looking for a level playing field."
Adult
hospitals get about $ 77,000 per student doctor, or resident, annually from
Medicare while children's hospitals get just $ 400.
Proposals in
Congress would give children's hospitals $ 285 million a year in new
money . President Bill Clinton set aside $ 40 million for the hospitals in his
budget proposal, with the expectation that more would be added in coming years.
It's still far less than the hospitals actually spend.
The money would
be divided among nearly 60 children's hospitals across the country. Under plans
pending in Congress, Children's in Boston would get about $ 11 million.
The relief programs would last just a few years, long enough supporters
hope, for Congress to find the elusive long-term answer to Medicare's financial
woes.
Medicare covers teaching in two ways: a direct per-resident fee
and an indirect reimbursement based on the amount of services provided by the
hospital.
The Balananced Budget Act reduced the indirect payments. In
addition, the act ties the direct fee amount to the number of
residents hospitals had in 1996.
This year Bay State hospitals will get
$ 65 million less than if the act hadn't passed, according to the Massachusetts
Hospital Association. Hospital organizations want to freeze Medicare
payments at this year's level. If their lobbyingeffort fails, the payments will
drop through 2001.
Among suggested long-term solutions, one would fold
the direct fees into indirect Medicare reimbursements; another would set up a
fund supported by a new tax on insurers and a separate Medicare payment,
providing $ 17 billion annually to pay for doctor training.
Photo
Caption: ON CALL: Chief Resident Andy Koh, Intern Jeffrey Skolnik, Intern Il-Lun
Chen, Intern Alan Schooley, Intern Apple Lord, Physician-in-Chief Philip Pizzo,
Intern Bryce Binstadt, and Chief Resident Larry Rhein, left to right above,
discuss their rounds at Children's Hospital. STAFF PHOTO BY JOHN WILCOX
Photo Caption: MAKING STRIDES: Gabrielle Fleury, 7, is escorted to her
Children's Hospital room by Chief Resident Larry Rhein. The hospital will spend
more than $ 30 million training 180 residents and fellows this year. STAFF PHOTO
BY JOHN WILCOX
LOAD-DATE: August 31, 1999
