Editorial Budget Threatens Care For All Patients

When you start from the bottom, you can’t go down much further. Not without grave consequences, anyway.

That’s the contention of hospital administrators when they examine the budget cuts to health care proposed by Gov. Mitt Romney, part of his effort to close the state’s shortfall.

They realize the cuts have been aimed in all directions — cities and towns, higher education, courts, and the like — not just at health care. But there’s a big difference, they contend: the medical industry, particularly hospitals, have already been stripped to the bone.

The 71-cent figure has been trumpeted endlessly — that’s 71 cents on the dollar that Medicaid reimburses hospitals and other providers, on average, making Massachusetts the 47th-worst state in the U.S. for such payments.

Well, that number is about to go down, and so is the state’s contribution to the uncompensated care pool, as outlined in the cover story of The Healthcare News this month. Meanwhile, other cuts will force some 50,000 people from MassHealth, meaning hospitals will be forced to give more free care — exacerbating the problem with the pool.

What the Mass. Hospital Assoc. and others worry about is whether these additional funding cuts will affect core services. Already, some institutions are having to scale back their range of offerings, while locally, Noble Hospital is shelving a needed expansion plan due to the budget uncertainty. But what happens when basic services are threatened?

Some scenarios creep into the realm of the previously unthinkable. Ellen Lutch Bender, director of Health Care Strategies for the law firm Brown Rudnick Berlack Israels in Boston, wondered recently in The Boston Globe whether Massachusetts is heading for a system of differentiated care, a sort of segregation in which people with means receive higher-quality care and more services than those without.

Other possibilities seem more immediate — and close to home, such as the threatened closing of a state-funded mental health unit at Parkview Specialty Hospital in Springfield, which could lead to the facility’s closure, the transfer of 200 patients, and the loss of 675 jobs.

In fact, those jobs are at the heart of one of the arguments against Romney’s proposals. If health care and related fields account for one-seventh of all jobs in the Commonwealth — the largest-employing sector by far — then the loss in revenue the state would experience by losing those jobs would eventually far outweigh the short-term savings afforded by the cuts.

In fact, some say, the state’s very reputation as not only a provider of top-notch health care but as an innovator in medicine and biotechnology could be at risk. The warnings may be extreme, but the worries are genuine in this gun-shy industry that has heard its cries for more equitable funding fall on deaf ears in Boston for too long.

Hospital closures are nothing new to Massachusetts, and the audited statements of acute-care hospitals filed with the Legislature, made public in January, revealed that at least four more are in serious economic distress. That’s a major problem that should catch lawmakers’ attention, Bender said. “Who sees the warning?” she wrote in the Globe. “Today we do not have enough beds in the system; loss of any more will be crippling.”

For its part, the MHA — joined by a chorus of administrators — keeps banging the drum, warning not only of financial peril but a threat of lower-quality care for patients.

Already, uninsured residents are taking to emergency rooms for primary care, and hospitals are required by law to treat them there. The combination of additional budget cuts, a greater percentage of the free care burden placed on hospitals, a spike in residents without insurance, and physicians being chased out of state by liability issues threatens to slow down and perhaps worsen the care that all constituents of the system receive.

Administrators are talking about creative methods to keep the ship afloat without deep cuts, from instituting a mandatory drug-return program to creating a set of universal forms and processes for insurers, among others. Any steps, they say, are preferable to the wave of cuts that threaten to further strain Massachusetts’ largest industry.

Only, it’s more than a business. Patients’ health, and perhaps lives, are at stake. Romney is certainly in a tight spot, but the one faced by health care providers is even tighter. It’s time for the governor to pay attention.