THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Thursday, February 15, 1996 TAG: 9602150007
SECTION: FRONT PAGE: A12 EDITION: FINAL
TYPE: Editorial
LENGTH: Medium: 65 lines
The state's teaching hospitals at the University of Virginia and Virginia Commonwealth University are not healthy. They think the right medicine is legislation to give them greater freedom from state control. It may not be a cure-all, but it is one essential treatment. The General Assembly should pass the legislation.
Teaching hospitals are expensive propositions. Training doctors costs more than simply allowing already trained physicians to practice. Both the Medical Center at U.Va. and the Medical College of Virginia Hospitals at VCU must be staffed to teach doctors to treat a wider range of ills than for-profit hospitals confront. Indeed, complex and costly cases are often precisely the ones referred to teaching hospitals.
Both also treat large numbers of indigent patients as part of their mission. The Medical Center provided $44.2 million in indigent care last year; the more urban MCVH almost twice as much - 35 percent of all acute indigent care in the state. About $30 million of that expense was not reimbursed by either government or insurers.
In many states, teaching hospitals affiliated with state schools are heavily subsidized by the government. Not in parsimonious Virginia. Although these crucial institutions provide services not available by any other means, though they are proud ornaments of the commonwealth, the state provides only 10 percent of the budget for the medical schools. Of 74 public medical schools, U.Va. ranks 60th in state support, VCU 66th. The actual hospitals and clinics receive no state appropriations - zero.
Contributing little doesn't prevent the state from controlling a lot, however. The teaching hospitals are mummified in endless red tape. The bureaucratic meddling includes onerous restrictions on personnel practices, purchasing and construction. Not only is compliance time consuming, it's cripplingly expensive.
Teaching hospitals are now operating in a highly competitive environment. In many cases, they must compete on cost for insurance dollars with lean private institutions. If they charge more than rival providers, they lose the business. The Medical Center is under less stress in this regard, being a dominant supplier in its region and drawing patients from a wide area. MCVH, on the other hand, faces stiff competition including a dozen hospitals in the Richmond area.
The picture isn't entirely gloomy. The teaching hospitals aren't without resources to save themselves if given room to maneuver. Their clinics can be highly competitive. Research done by faculty can generate revenue. But the opportunities are limited so long as they are bound by bureaucratic entanglements.
The solution is greater freedom. But because the two hospitals are in different situations, they are asking the General Assembly to approve different routes to greater autonomy. The Medical Center of U.Va. seeks only partial autonomy and relief from burdensome regulations. It would continue to answer to the existing board.
VCU seeks even greater latitude. It would turn the teaching hospital into a quasi-public authority with a separate board, the better to achieve the same flexibility and freedom of action as its private competitors.
The Allen administration and many members of the General Assembly appear to favor these steps to keep Virginia's teaching hospitals viable. That's good. The world has changed, and these important institutions must keep pace. by CNB