Copyright 1999 The Columbus Dispatch
The Columbus
Dispatch
September 6, 1999, Monday
SECTION: NEWS , Pg. 1B
LENGTH: 715 words
HEADLINE:
REIMBURSEMENT POLICIES HURT PEDIATRIC HOSPITALS FEDERAL LAW DOESN'T ALLOW
CHILDREN'S FACILITIES TO FULLY RECOVER THEIR COSTSFOR TRAINING, DOCTORS.
BYLINE: Mark D. Somerson, Dispatch Medical Reporter
BODY:
About 500 doctors served residencies
at Ohio State University Medical Center last year. For training them, Ohio State
received $ 25 million from the federal government -- about $ 50,000 per
resident.
Across town at Children's Hospital, about 150 doctors trained
last year. Children's received about $ 34,000 -- $ 227 per resident. "It's been
this way for decades,'' said Dr. Thomas N. Hansen, Children's chief executive
officer. "But it's become an issue as costs have increased and revenues have
shrunk because of managed care.
"This is a glaring problem for us in the
children's hospital business.''
After graduating from college, medical
students pay tuition to attend a four-year school. After graduating from medical
school, hospitals pay them to train there.
The training, depending on
the specialty, lasts three to eight years and costs teaching hospitals tens of
millions of dollars annually. Getting some of that money back is a tricky
proposition for teaching hospitals in general and a particular problem for
children's hospitals.
A loophole in the federal graduate-
medical-education law keeps most independent children's hospitals from
being fully reimbursed for training.
About 60 independent children's
hospitals nationwide train residents; six are in Ohio.
When the federal
reimbursement plan was created, a number of sources, including insurance
companies, contributed to the pot of money. The main source, however, was
Medicare.
Over the years, the other sources for the most part have
dropped out, and Medicare was left to provide about $ 7 billion annually.
Medicare patients are typically senior citizens.
"Children's
hospitals don't do a lot of Medicare business,'' said Jerry Friedman, director
of the Association of Ohio Children's Hospitals. "This funding mechanism is an
artifact of how the feds have chosen to subsidize graduate medical
education.''
Two bills introduced this year in Congress would
provide a quick fix and would appropriate money for independent children's
hospitals. But hospital administrators and legislators are hoping for an
overhaul. Congress has directed the Medicare Payment Advisory Commission and the
Bipartisan Commission on the Future of Medicare to create a long- term solution,
but both groups have indicated that no agreement will be found this year.
The two bills, which are sponsored by Democrats and Republicans in the
House and Senate, would provide about $ 285 million a year for as many as four
years for children's hospitals, including about $ 30 million for Ohio's
hospitals.
The funding would come from discretionary spending, not the
Medicare trust fund.
Sen. Mike DeWine, R-Ohio, is one of the legislators
promoting the bills, Children's Hospital officials said. Children's in Columbus
would receive about $ 7 million a year.
The hospital spends about $ 11
million a year to train residents, Hansen said. "All we are looking for is
parity.''
Even adult-care hospitals are feeling a pinch. A recent study
published in The New England Journal of Medicine examining Medicare
reimbursements for resident training at adult-care hospitals found disparities
among cities and states. For example, teaching hospitals in New York received
three to four times as much for each resident as those in Los Angeles or
Cleveland.
The funding formula is based, in part, on the number of
residents at each teaching hospital and the number of Medicare patients treated
there.
The greatest disparity in funding is between independent
children's hospitals and adult-care hospitals.
"We don't know how much
longer we can go on doing this,'' said Morna Smith, director of child advocacy
and community relations at Children's Hospital in Columbus. "We have not had to
face that question yet because we have been creative with cost shifting and
grants.
"But because of dramatic cost cutting in the mid-1990s, due to
managed care, we've had to cut back on training.''
Smith said that in
the past five years 70 percent of Children's pediatric residents have entered
primary care pediatrics, and more than half have stayed in Ohio to practice.
If children's hospitals cut back on training residents, communities will
feel the impact, Friedman said. "We are talking about the future here.''
GRAPHIC: Photo, Tim Revell / Dispatch Doctors Tyler
Rogers and Missy Bartels talk with Travis Kempton, 10, at Children's Hospital.
Most independent children's hospitals aren't fully reimbursed for training.
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