And so it begins: hospital budget cuts usa

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Boston Medical to cut staff, services

Reductions likely to hurt patients with low income; Center will sever

its ties with hospital in Quincy

By Kay Lazar, Globe Staff / December 18, 2008

Facing $114 million in state budget cuts, Boston Medical Center

announced yesterday that 250 employees will be laid off or have their

hours reduced and that patient services will be cut in key areas,

including primary care, pediatrics, and geriatrics.

More than half of the hospital's patients are low-income residents, so

the reductions are likely to hit hardest on the city's most

vulnerable, the immigrants, poor families, and senior citizens who

receive free or subsidized care at the hospital, patient advocates

said. The cuts were to take effect immediately.

Hospital president and chief executive Elaine Ullian said they will,

at a minimum, mean that patients will face longer waits for

appointments and for phone calls to be answered.

The medical center is seeing an unprecedented number of patients, and

that has forced the institution to make tough choices, she said.

" Seventy-five percent of our pediatric service is for indigent

children, " Ullian said. " Eighty-three percent of our neonatal

intensive care unit is Medicaid babies. Seventy-six percent of

obstetrics is [for] Medicaid women. So we decided to diminish the

access, so everyone takes a hit, but not shut down an entire service. "

While declining to say how many layoffs there will be, Ullian said a

significant number of interpreters will be cut from the staff. The 30

percent of the patient population that does not speak English will

have to wait longer for language services, she said.

The hospital also announced it would end its support next June of

Quincy Medical Center, another institution serving many immigrants of

limited means. For the past decade, Boston Medical Center has sent

physicians to work with and teach Quincy's doctors, in addition to

providing financial assistance.

The worsening economy has produced widespread job losses, costing many

their health insurance. That is boosting the ranks of those relying on

publicly subsidized healthcare, and Boston Medical Center, with a

workforce of 6,016, is the state's largest hospital provider of such

services.

For the hospital to make cuts in staff and services now is

short-sighted, said Mike Fadel, executive vice president of 1199SEIU

United Healthcare Workers East, which represents most of the

healthcare workers and support staff to be laid off by Boston Medical

Center.

" The healthcare workers who end up out the door will end up relying on

the very services that will be curtailed, one of the ironies of these

funding cuts, " Fadel said.

SEIU and the consumer group Health Care for All are lobbying Governor

Deval and state lawmakers to use federal funds, expected as

part of a national economic stimulus package, to make up for the state

cuts in healthcare services announced earlier this year, including

those at Boston Medical Center.

" Our job will be to continue to remind the administration that this

money has to be spent on healthcare and ensuring that consumers have

access to those services, " said Amy Whitcomb Slemmer, executive

director of Health Care for All.

The state's Executive Office of Health and Human Services recognizes

that Boston Medical Center is a " really important partner in providing

healthcare services, particularly to low-income populations, " said

Kritz, spokeswoman for the office. She said it is working

with the hospital in " identifying a whole range of strategies that

would mitigate the reductions, " but declined to elaborate.

Even with the cuts, Boston Medical Center is expected to get $1.57

billion in state funding this fiscal year, she said, and that

represents 31 percent of all of the state's payments to hospitals,

physicians, and managed-care organizations.

Cambridge Health Alliance - which includes hospitals in Cambridge,

Somerville, and Everett - is the second-largest safety net provider

for the poor and is expected to receive $956 million this fiscal year

in subsidy, Kritz said. The Alliance is also facing millions of

dollars in state budget cuts and is expected to announce cuts in staff

and services soon.

State lawmakers earmarked special Medicaid payments for Boston Medical

Center and Cambridge Health Alliance as part of the 2006 Massachusetts

health insurance law because they treat a disproportionately large

number of low-income patients. Those payments are slated to end next

year, but the state said a few months ago that it would not reimburse

Boston Medical Center for $64 million in healthcare the center

provided last year under the program. That cut is in addition to the

$114 million reduction the hospital says it now faces for 2009.

Given the magnitude of the shortfall, the layoffs and service cuts

announced yesterday are probably not the last, said Ullian, the

hospital's president.

" We understand, " she said, " that there is work ahead for us. "

http://www.boston.com/news/local/massachusetts/articles/2008/12/18/boston_medica\

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