Copyright 1999 The Columbus Dispatch
The Columbus
Dispatch
September 13, 1999, Monday
SECTION: NEWS , Pg. 10A
LENGTH: 496 words
HEADLINE:
STUDENT DOCTORS FUND HOSPITAL-BASED EDUCATION FAIRLY
BODY:
The federal funding formula for
graduate medical education is inequitable; it should be
overhauled. In the meantime, Congress should support a temporary fix in the
system that compensates hospitals for training resident physicians.
In
1965, lawmakers, concerned that the rate of training wouldn't keep pace with
demand, reimbursed the cost of graduate medical education via
Medicare payments to hospitals for inpatient care. Last year, that policy
translated into about $ 50,000 per resident at Ohio State University Medical
Center.
Yet in the same period, Children's Hospital received about $ 227
per resident.
Obviously, something is out of joint.
Similar
inequities affect roughly 60 independent children's hospitals nationwide where
residents are trained. Six are in Ohio.
Such a funding gap is
unacceptable. Children's hospitals don't do a lot of Medicare business, which
typically involves older patients. So these hospitals simply miss the boat. The
process is unfair; it should be restructured to provide equity.
When the
federal reimbursement plan was created, the main source of funds, Medicare, was
supplemented by other sources, including payments from insurance companies. Over
time, the alternative sources have dried up while Medicare continues, providing
about $ 7 billion a year.
How hospitals handle their money has changed,
too. Before managed care, hospitals combined money sources to pay for various
programs. Now, managed-care policies dictate where insurance reimbursements will
go. And the burden of indigent care for children has increased. In May, fewer
than one-fourth of the estimated 275,000 eligible children in Ohio alone were
enrolled in a Medicaid program designed for them.
The buck for those
cases often is passed to the billing offices of children's hospitals, which must
absorb the costs from an ever- shrinking revenue base.
Two bipartisan
bills introduced in Congress this year would create a temporary solution,
appropriating money from discretionary sources instead of Medicare.
Sen.
Mike DeWine, R-Ohio, is a chief proponent of the bills, which would channel
about $ 7 million a year to Children's Hospital in Columbus.
A permanent
overhaul of the entire reimbursement system also is advisable.
Those who
complain that such a repair would bring a new program into the mix just as
federal lawmakers struggle to cut spending and balance the budget miss the point
of the original Medicare-based plan, which was to help pay for the graduate
education of all student doctors.
Spending emergency discretionary money
to pay for the 2000 federal census -- something lawmakers have anticipated for a
decade -- is a reach. Spending money to train pediatric physicians is not.
Times have changed. The time has come to change -- temporarily and then
permanently -- how hospitals are repaid for medical training, both to improve
the lot of children's hospitals and help them retain these crucial programs.
LOAD-DATE: September 14, 1999
