A disproportionate share…

Yesterday’s Boston Globe contained an opinion piece regarding the ongoing struggle of some of our Massachusetts hospitals to be adequately compensated for the care they provide to “publicly insured” patients.  These hospitals, embroiled in a legal battle with the Commonwealth over just reimbursements for their “disproportionate share” of such patients, have joined forces to raise awareness and to press forward with their goal of increasing payments.

Not too long ago, I worked for one of these hospitals: Quincy Medical Center.  QMC is the local health care resource for a large and mostly working class community that is located just ten miles from some of the most prestigious medical institutions in the United States.  During my time there, I frequently heard cries from some quarters that “there are too many hospitals in Massachusetts” and that “only the strong survive”… and so… “we should just let QMC close”.  While I was there, the hospital was engaged in a much publicized separation from long time partner, Boston Medical Center, which was itself engaged in much publicized turmoil sparked by reduced reimbursements for it’s own disproportionate share of said patients.

The public policy implications surrounding Quincy Medical Center’s future role in the health care environment raise many good and important questions.  Questions such as:

• For the large elderly population in Quincy, will longer (perhaps much longer, given traffic on the x-way) ambulance rides into Boston or further south make for better health care?
• For the growing Asian population in Quincy, will scattering medical care services to multiple locations versus localizing that care nearby in an institution that has invested in enhancing its ability to serve Asian populations (e.g., offering ready translation services) make for improved medical care?
• Will sending patients to higher cost (and for many services, comparable quality) in town hospitals make the most sense economically?
• Will area emergency departments, typically already quite crowded, be able to handle the 40,000 visits that currently are served in QMC’s ED?

Hospitals such as Quincy Medical Center should be supported and payments for all health care services they provide need to be fair.