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AAMC Spearheads New Quality Initiative State Budget Cuts Put Strain on Teaching Hospitals Innovations in Medical Education: "Communicating in Other Ways" "A Shot in the Dark": the smallpox vaccination program Viewpoint: Women in Medicine: The Work that Remains A Word from the President "A Day in the Life of a Medical Student"
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State Budget Cuts Put More Strain on Teaching HospitalsMany states are expecting a new round of Medicaid cutsThe specter of massive state budget reductions is leaving teaching hospital executives with haunting visions of overcrowded ERs, reduced services, and rising uncompensated care. With states facing their bleakest fiscal conditions in years, Medicaid, which can make up more than half of a state's annual expenditures, is squarely on the chopping block, with harsh implications for academic medicine. Overall, 49 states and the District of Columbia have undertaken Medicaid cost-containment actions for FY 2003. Now, about halfway through the fiscal year, nearly two-thirds of states have had to implement, or are planning, a second round of Medicaid cuts, according to a report released last month by the Kaiser Commission on Medicaid and the Uninsured. "We are just beginning to learn the real impact of what's going to happen this year," said Lynne Davis Boyle, AAMC's director for healthcare legislative affairs. "But we do know that it will be a very challenging time for the financial well-being of teaching hospitals." A 'problematic situation'Some states, like Kansas and Wisconsin, are specifically proposing to cut Medicaid funding for GME and disproportionate share hospital (DSH) payments to teaching hospitals. Kansas state legislators are aiming their budget cuts at Medicaid IME payments - to the tune of $1.9 million for KU's teaching hospitals. "It's a very problematic situation," according to Janice Arbuckle, associate dean for administration at Kansas University School of Medicine, which stands to lose $3.7 million in overall Medicaid funding. "In raising awareness of the severity of the situation, we've had to overcome great inertia," she said. "It's been hard for people to even understand the complex funding of GME, much less the impact of the budget cuts on the people of Kansas." Following are some examples of cuts proposed in other states: California: Last May, state lawmakers recommended cutting $55 million from Medi-Cal's DSH payments, spurring protests by doctors, nurses, and patients outside San Francisco General Hospital's emergency room. Illinois: The state's 2003 budget cut Medicaid hospital payments by $100 million. This was in addition to the nearly $2 billion the federal government has cut from Medicare payments to Chicago-area hospitals since 1997. Teaching hospitals, serving large indigent and uninsured populations, will be hit the hardest. Even before the cuts, Illinois ranked among the states with the lowest Medicaid reimbursement, as a percentage of costs. Ohio: Gov. Bob Taft (R) announced a plan that would cut state Medicaid spending by $468 million over the next two years. The cost-containment package will freeze provider payment rates, institute prescription co-payments, and eliminate Medicaid services for 800,000 adults. Concern in South CarolinaThe growing rolls of the uninsured are also worrying to healthcare advocates in South Carolina, where Medicaid insures a full 44 percent of the state's children. The state has funded just $103 million of the $185 million in state appropriations needed to maintain its current Medicaid program. The $82 million shortfall translates into program reductions of nearly $270 million, according to Maggie Michael of the Medical University of South Carolina Children's Hospital Center. As a result, "safety-net hospitals like MUSC Children's Hospital will be flooded with newly uninsured children in need of healthcare services," she predicted. "Overburdened emergency rooms will be the primary site of care for these children, creating additional strain on these providers." The hospital is urging state residents to contact their federal legislators, asking them to consider alternate funding options, such as a cigarette tax, to restore the Medicaid budget, Michael said. Undergraduate medical education is being affected in many states as well. In West Virginia, a 3.4 percent state budget reduction enacted in November eliminated $520,000 from the Joan C. Edwards School of Medicine's $15.1 million state support, with more cuts - up to an additional 10 percent, some predict - expected in July. In the meantime, the medical school has enacted a hiring freeze and has reduced all departmental operating budgets by 10 percent. West Virginia Gov. Bob Wise (D) has proposed an increase in the cigarette tax to cover part of the projected state deficit, and the Edwards School of Medicine (at Marshall University) has asked the legislature to explore an increase in the soft-drink tax, with a portion going to medical schools throughout the state. Currently, a one-cent tax on all soft drinks supports only the West Virginia University School of Medicine. By Martha Frase-Blunt |
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