Bad Medicine

The Patrick administration likes the notion of universal health coverage. It just doesn’t want to pay for it.

BMC IS NOT A “TREAT AND STREET” triage hospital; its integrated system of care means everything from coordinating a cancer patient’s multiple appointments to ensuring that a geriatric patient is eating as well as taking medication. It means providing backpacks stocked with basic necessities for children being moved to emergency foster care. It means understanding the relationship between the city’s infant mortality rate and the spike in clinic visits as a result of babies suffering from “failure to thrive.”

You cannot calculate those costs the way you price out a new CAT scan machine. The hospital has cut where it could, consolidating its two emergency rooms into a single location, for example. But 67 percent of the city’s trauma cases still pass through BMC. And the hospital has been tapping its cash reserves to the tune of $10 million a month, a pace that spells bankruptcy by this time next year.

Governor Patrick has bristled at suggestions that he is indifferent to the poor. Last winter he wrote a testy letter to Edmond English, BMC’s board chairman, to protest just such intimations: “In a time of scarcity, HHS [Health and Human Services] Secretary JudyAnn Bigby and I have to address high costs. Trying to do so does not mean we are insensitive to BMC’s mission. It means we are doing our jobs.”

But Patrick’s job also entails finding a way to keep BMC’s doors open until he helps forge a consensus on how to rein in costs. That’s called leadership.

In the end, the issue is one of basic economics. BMC is being underpaid for caring for the largest percentage of its patients. At the same time, the hospital takes it on the chin from private insurers because it lacks the leverage of a medical behemoth like Partners HealthCare, which can wring higher payments out of insurance companies. Does anyone really think Brigham and Women’s and Mass General would absorb BMC’s patients if it goes under?

Last spring, mediation between BMC and the Patrick administration collapsed after six months. In the past few weeks, Patrick and Bigby have talked with Kate Walsh, the hospital’s new CEO, in an effort to resolve the dispute outside of court.

  • sri

    It seems a shame that the Brigham and Mass general doesn’t step up to absorb some of the difficulty of caring for the poor.

  • Michael

    Why is it a shame? The state isn’t living up to its deal with the BMC and is showing why health care isn’t as cut-and-dry as everyone likes to make it out to be.