News & Events

As the safety net frays (MS)

THE MASSACHUSETTS health reform law is not working in this recession for a safety-net hospital like Boston Medical Center. To understand why, it pays to visit the hospital’s facility in Mattapan for children with chronic conditions like cerebral palsy, HIV/AIDS, and developmental delays. The Mattapan center serves children of all ages who desperately need the medical, educational, and even vocational care the center offers.

Some of what the center does gets reimbursed on a fee-for-service basis. But those fees do not begin to cover all the mental health care the children get or the lessons in how to inject themselves with medication or swallow a big, foul-tasting pill. That’s where financial support from BMC comes in. But the parent institution can no longer provide that support without the extra funds it previously earned as a hospital serving a disproportionate share of the region’s poor.

The center – known as SPARK for Supporting Parents and Resilient Kids – faces a 27 percent cut in its funding in the fiscal year that begins Oct. 1. The Legislature should make sure BMC receives enough support from the state, including federal stimulus money, to avoid such a crippling reduction.

The Patrick administration has not been blind to the problems BMC faces. Last week, it proposed to steer $80 million from the federal stimulus package to the hospital, but according to BMC that would still leave it $93 million short. The governor’s original budget included a Medicaid reimbursement rate that covered just 64 cents of each dollar of care provided by the hospital. The state says the rate is now 86 cents, but BMC says it is still well below full reimbursement. Fully 41 percent of BMC’s patients receive Medicaid, the insurance plan for the poor.

Under the state’s 2006 universal healthcare law, the need for special assistance for safety-net hospitals like BMC was supposed to vanish, since all patients would carry insurance of one kind or another. With the reform law’s promised "fair and attractive" rates, the dollars would follow patients and eliminate the need for extra aid to safety-net hospitals. But the rates aren’t fair. "All we’re asking for is $1 of payment for $1 of services rendered," says BMC’s chief executive officer, Elaine Ullian.

Boston Medical Center is not the only local hospital that provides valuable community services, like SPARK, that cannot cover their costs on a fee-for-service basis. But the big teaching hospitals benefit from hefty endowments and private insurers’ reimbursement rates that at least approach the full cost of the care provided. If BMC is to continue playing its important role in ministering to some of the region’s most needy patients, it has to get a better deal from the state.