ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Monday, February 12, 1996 TAG: 9602130048
SECTION: EDITORIAL PAGE: A6 EDITION: METRO
LIKE MEDICAL facilities across America, this state's two teaching hospitals are being profoundly affected - and stressed - by a revolution in how health care is organized and financed.
That's why the University of Virginia wants its Medical Center to have more freedom from state personnel policies, purchasing procedures and real-estate rules. It's why Virginia Commonwealth University wants to spin off the Medical College of Virginia Hospitals to a separate public authority.
And the danger to the hospitals' viability and thus to medical education in Virginia, if changes aren't made, is why the General Assembly should accede to the universities' requests.
Insurers and employers - which is to say, the paying health-care consumers - are no longer willing to help subsidize the medical-education component of such hospitals.
Nor are they willing - certainly not like they once were willing, however unwittingly - to subsidize the treatment of the medically indigent. Such people, particularly at VCU, comprise a disproportionately big part of the teaching hospitals' clientele.
The more a hospital must absorb such costs, the less it is able to do well in an increasingly competitive market.
Nor has the state, unfortunately, been willing to subsidize its teaching hospitals. If anything, the hospitals have been subsidizing the state: The two universities' medical schools are among the lowest in the country in per-student taxpayer funding, and rely on hospital and clinical revenues to help keep them afloat.
Even so, the hospitals are subject to the same rules and regulations as if they were state-funded agencies. Those rules can be costly: If the Medical Center could have made just one rather modest lease deal on its own rather than have to wait 18 months for state approval, UVa figures, it could have saved $3 million.
The divergence in approach - a separate authority at VCU vs. "codified autonomy" at UVa - reflects a divergence in situation. The Medical College of Virginia Hospitals in Richmond faces much more daunting competition from other health-care providers in its market, and must take more patients who can't pay. It needs more maneuverability in entering into partnerships with private-sector enterprises.
For its part, the UVa Medical Center - while it sends newly minted doctors to Roanoke for postgraduate training and continues to serve patients from throughout Southwest Virginia - is still historically, physically and academically more closely entwined with the rest of the university than are the hospitals and health-related schools at VCU.
As they struggle to find money to meet demands for more higher-education spending, including at the UVa and VCU medical schools, surely Virginia's lawmakers can agree to fiscal improvements and flexible arrangements at the state's teaching hospitals that take no bite from the budget. Surely, too, they can recognize the value of preserving high-quality medical education within the commonwealth.
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