Copyright 1999 The Houston Chronicle Publishing Company
The Houston Chronicle
October 24, 1999, Sunday 4 STAR EDITION
SECTION: A; Pg. 23
LENGTH:
808 words
HEADLINE: Threat to medicine's lifeblood;
Health demands grow as funds decline ;
Balanced Budget Act forces
teaching hospital to juggle its dollars
SOURCE: Hearst
News Service
BYLINE: NICOLE FOY
DATELINE: SAN ANTONIO
BODY:
SAN ANTONIO - It's a typical busy afternoon in the emergency center of
University Hospital and Lisa Ochoa is struggling to keep up.
Ochoa, in
her third year of an internal medicine residency, races from room to room,
checking charts and vital signs. Despite the hectic pace, she is calm and
collected when talking with patients.
But shortly after finishing her
rounds and paperwork, Ochoa collapses into a chair and confides: "I've been in
this system for seven or eight years and every year it gets harder. "It's mainly
because they're so many of them," she says, motioning toward a patient waiting
room, "and so few of us."
Ochoa said she knows little about the Balanced
Budget Act of 1997. But unwittingly, she has just described a main concern for
health providers dealing with the federal law.
In the past, Congress
authorized higher Medicare payments for teaching hospitals because of the costs
they incur in training graduate medical students, conducting research and
operating state-of-the-art technology. The Balanced Budget Act cuts those
subsidies $ 2.9 billion to $ 7.1 billion for the five-year period from 1998 to
2002.
Sydney Rountree, chief financial officer of the University Health
System in San Antonio, bluntly described the effect on her operation. "This is
cause for great alarm for us," she said.
To cope with a predicted loss
of about $ 10 million in Medicare reimbursement payments through 2000 and other
shrinking revenues, the University system is reducing the number of residency
positions, cutting staff and discharging patients earlier.
For Ochoa,
that means caring for more patients. For patients, it can mean longer waits,
shorter stays in the hospital and more costly care.
"We work long hours
and all that, but it's really the patients who have no money who are feeling the
brunt of it," Ochoa said.
The University system, the primary teaching
base for the University of Texas Health Science Center, provides research and
training, but also is a main medical care provider for indigent people in South
Texas.
The federal subsidy for the teaching hospitals involves Medicare
support for every medical resident. The University Health System expects that
for the period between 1998 and 2000, it will lose about $ 800,000 in payments
for graduate medical education.
As a result, the number
of residency positions has been reduced from 328 to 300 in the past two years,
and Rountree said she could not rule out the possibility of more cuts.
Medicare, the health program for people 65 and over, gives subsidies to
teaching hospitals to provide graduate medical training and
care for the poor. These medical education payments to the
University system are expected to drop from $ 8.4 million in 1997 to $ 5.7
million in 2000, Rountree said.
"I'm not saying that there isn't a need
to control costs in health care," said Dr. James Young, dean of the center's
medical school. "But somehow, some way, the message needs to be conveyed to
Congress: 'Stop, you've gone too far.' "
The nation's teaching hospitals
have been urging Congress to change the Balanced Budget Act to protect their
research and education missions. They are urging that the reductions in Medicare
payments be frozen at current levels rather than continuing to phase in deeper
cuts, as the act requires.
Although the University system is operating
in the black, the local taxes it receives to care for the indigent are nearly $
12 million short of the actual cost of treating those patients. In the past, it
has juggled money to cover those deficits, but that is threatened because of
shrinking revenue.
Adding to the budget crunch, University faces cuts in
state Medicaid funding meant to compensate for caring for a disproportionate
share of uninsured patients. In 1998, the system received about $ 34 million for
that responsibility. Next year's payment is about half that amount, or $ 16
million, Rountree said.
A windfall from the state's settlement of a
lawsuit with the tobacco industry has helped soften the federal and state cuts,
providing $ 20.9 million this year alone. Overall, the hospital's 1999 budget
stands at $ 375 million, with a surplus of $ 8.3 million.
The University
system has cut its overall staff during the past two years from 3,800 to about
3,400, increasing the pressure to do more with less, Rountree said. And the
budget crunch has cut the fund for medical technology and equipment nearly in
half, from $ 14.5 million to $ 6.4 million.
Dr. Charles Davis, medical
director of University's emergency center, said the strain on the system is
evident.
"The budgets are so tight we're going to have to really pick
and choose as to what technology and staff positions are absolutely necessary,"
he said. "But when you look at it, we're extremely fortunate with what we have
now."
GRAPHIC:
Photo: Dr. Lisa Ochoa, left, a third-year resident at University Hospital in San
Antonio, examines emergency room patient Gloria Tovar. Federal budget cuts could
mean Ochoa, and other medical residents, will have to handle bigger workloads in
the future. For uninsured patients like Tovar, it may mean longer waits to see a
doctor, shorter stays in the hospital and more costly care.; Gloria Ferniz / San
Antonio Express-News
LOAD-DATE: October 25, 1999
