Copyright 2000 Chicago Sun-Times, Inc.
Chicago
Sun-Times
August 24, 2000, THURSDAY, Late
Sports Final Edition
SECTION: EDITORIAL; Pg. 31
LENGTH: 790 words
HEADLINE:
Nation's teaching hospitals victims of cuts
BYLINE: By
Anthony L. Barbato
BODY:
The nation's teaching
hospitals are in trouble.
These vital institutions -- which
train our future physicians and nurses, conduct some of the most important
medical research in the world and provide care for the poor and
uninsured -- are suffering from increasing financial pressures and
decreasing federal (and, in many cases, state) support.
Rising costs,
insufficient reimbursement from Medicare and reductions in government support
through the Balanced Budget Act of 1997 have made it more difficult for teaching
hospitals to remain financially viable and fulfill their critical missions. Some
have experienced double-digit losses, forcing them to cut staff and reduce
services. In time, some teaching hospitals might be forced to eliminate
expensive, but vital, training programs or, ultimately, cease to exist. This
poses a serious threat to the health of this nation. Teaching hospitals are the
foundation of our health care system. We all stand to lose if they are unable to
continue fulfilling their critical missions of advancing medical education and
knowledge, serving the needy and providing a disproportionate amount of care to
the underinsured and uninsured.
Poor, underinsured or uninsured
Americans are especially at risk. An estimated 45 million to 48 million people
lack health insurance. While teaching hospitals account for only 6 percent of
all hospital beds nationally, they provide 39 percent of the hospital care to
this country's poor at an expense of more than $ 5.5 billion annually.
My own institution, Loyola University Medical Center, provided $ 42
million in charity care in 1999, about double the national average for teaching
hospitals. These institutions cannot continue to absorb these un-reimbursed
expenses year after year. If teaching hospitals are unable to care for the poor
and uninsured, who will?
Medicare is not offering much assistance.
Nearly 60 percent of all hospitals will lose money on patients insured by
Medicare by the end of 2004 as continued federal cutbacks and rapid growth in
health care costs threaten hospitals further, according to a study released by
the American Hospital Association. This analysis takes into account some $ 8
billion in relief from the Balanced Budget Act Refinement Act over the next
three years, which boosted Medicare payments by only 1 percent.
Teaching
hospitals and academic medical centers perform most of the clinical research in
this country, advancing medical knowledge and treatment, bringing us cures and
therapies that can prolong and enhance the quality of life. Breakthroughs in
cancer treatment, organ transplantation, heart surgery and many other areas have
taken place at teaching hospitals and academic medical centers.
They
also provide vital community services, such as trauma centers, where victims of
car crashes, fires or other major traumatic events receive the most advanced,
critical care by some of this country's best-trained physicians and nurses.
These institutions house burn centers, neonatal intensive-care programs and
transplant centers, which offer highly specialized and sensitive care. They
operate community outreach programs, which bring health care directly to the
less advantaged and medically underserved.
President Clinton and the
Congress wisely recognize that the Balanced Budget Act, which called for the
greatest reduction in Medicare spending in history, was more damaging in its
impact than intended and needed revisions. In 1999, both houses approved relief
legislation that mitigated some of the cuts, recognizing that contributions of
teaching hospitals merit special support. This was a good first step, but hardly
enough.
The mitigation package restored about $ 16 billion for all
health care institutions. When considered in the context of the act's total
Medicare budget reduction of approximately $ 120 billion, however, this is a
modest amount that will do little to help the institutions most at risk.
For teaching hospitals to survive, Medicare reimbursements must be
adjusted to keep up with inflation as well as the continually rising cost of
health care. Support for graduate medical education must
continue, and at levels that reflect realistic costs.
Unless the
Balanced Budget Act is substantially changed -- and far more than the
modest amount of the mitigation that was passed -- a large number of
academic institutions are at the risk of going broke and shutting their doors.
For the nation, this is an unfortunate and unhealthy prospect.
Anthony
L. Barbato, M.D., is chairman of the board of directors of the Association of
Academic Health Centers, Washington, D.C., and president and chief executive
officer of Loyola University Health System, Maywood.
LOAD-DATE: August 24, 2000 
