Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Boston Medical Center gets screwed by the Massachusetts government

Kevin Pho, MD
Physician
September 29, 2010
22 Shares
Share
Tweet
Share

Boston Medical Center has provided care to the underserved and Medicaid population in Boston for almost 150 years. And what’s happening to the venerable institution is gut-wrenching to read.

I trained at Boston Medical Center (BMC), completing my internal medicine residency there in 2002.  A recent write-up in Boston Magazine highlights the financial trouble the hospital is going through:

Boston Medical Center is almost broke, perilously close to what its accountants euphemistically refer to as the “zone of insolvency.” It did not get here — $175 million in the red for the fiscal year ending September 30 — because it bought too many MRI machines or banked on cosmetic surgery being a big income generator. It landed in this hole because the folks on Beacon Hill like the sound of universal healthcare a whole lot more than they like the cost of it.

The piece is a powerful indictment against the Massachusetts government.  And completely on the money.

I wrote previously in a CNN.com op-ed that expanding coverage without considering costs is a recipe for disaster.  It’s true that Massachusetts has the highest rate of insured patients in the country.  It makes for good headlines for the governing party. But doing so without addressing costs was a grave mistake:

Massachusetts is finding out just how difficult it is to fiscally maintain universal coverage. In part due to soaring health costs, the state Legislature has proposed reducing health benefits for 30,000 legal immigrants and cutting funding to inner-city hospitals like Boston Medical Center, which, according to the Boston Globe, may “force it to slash programs and jeopardize care for thousands of poverty-stricken families.”

Those dependent on the care supported by Government reimbursement — the Medicare and Medicaid demographic, namely —  are going to be penalized as health reform takes hold. Consider BMC’s admirable mission to serving the poor:

To preserve Boston City Hospital’s long-standing mission to serve the poor, lawmakers wrote that obligation into legislation that created the new quasi-public hospital. Boston Medical Center, the statute stipulates, must “consistently provide excellent and accessible health care services to all in need of care, regardless of status or ability to pay.” The state, in turn, must compensate BMC for treating a disproportionate share of low-income patients by paying “rates that equal the financial requirements of providing care to recipients of medical assistance.”

BMC has kept its part of the bargain. Seventy percent of its patients are poor, elderly, disabled, or members of ethnic and racial minorities. More than 50 percent rely on free care, Medicaid, or state-subsidized insurance plans like Commonwealth Care. Many live in Boston’s most impoverished neighborhoods, and more than 30 percent speak a primary language other than English.

Massachusetts politicians are under heavy pressure to cut the state’s budget, and Medicaid costs are among the most inviting targets.  And this places the hospital in an impossible situation.  Yes, they can stop taking Medicaid patients.  But first, where else would these patients go?  The area’s high profile hospitals seen recently on ABC’s reality television show Boston Med, like Brigham and Women’s?  Unlikely.  And second, the state requires BMC to accept all comers.

A no-win situation, indeed.

Health reformers like to say that, in response to decreasing hospital payments, medical institutions need to “cut costs,” and “curb waste.”

But, as the article noted, “Demanding that BMC simply cut its way to solvency is as glib as promising that every government budget can be balanced by eliminating ‘waste, fraud, and abuse.’ Of course programs should be reviewed for inefficiencies, but there is no getting around reality: It is more expensive to treat the patients who come to BMC.”

Boston Medical Center is where I got my start out of medical school, and has played a defining role in making me the doctor I am today.  Its impending financial insolvency is heartbreaking, and is a situation that will echo across the country as Massachusetts-style reforms take hold nationally.

Universal coverage makes great headlines, helps get politicians elected, and, to be fair, is something that needed happen.  But doing so without adequately addressing its cost is going to bankrupt hospitals, especially inner-city ones like BMC.  That will hurt the Medicaid and Medicare patients dependent on them.

And that’s a goddamn shame.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.

Prev

Nurses expect to be called by their first names, should doctors follow?

September 29, 2010 Kevin 18
…
Next

Explaining the critical gap of primary care physicians

September 29, 2010 Kevin 25
…

Tagged as: Hospital-Based Medicine, Public Health & Policy

Post navigation

< Previous Post
Nurses expect to be called by their first names, should doctors follow?
Next Post >
Explaining the critical gap of primary care physicians

More by Kevin Pho, MD

  • Tragedy strikes Monday Night Football as Buffalo Bills safety Damar Hamlin suffers cardiac arrest. Is commotio cordis to blame?

    Kevin Pho, MD
  • Life as an MD online with Kevin Pho, MD

    Kevin Pho, MD
  • Essential clinician commentary on COVID-19 coronavirus from the KevinMD community

    Kevin Pho, MD

More in Physician

  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

    Katrina Gipson, MD, MPH
  • Beyond the disease: the power of empathy in health care

    Nana Dadzie Ghansah, MD
  • How to overcome telemedicine’s biggest obstacles

    Harvey Castro, MD, MBA
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the cycle of misery in medicine: a practical guide

      Paul R. Ehrmann, DO | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions
    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician
    • Changing the pediatric care landscape: Integrating behavioral and mental health care

      Hilary M. Bowers, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 20 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Cholera Outbreak Widens; What Beethoven's DNA Revealed; Grindr's Free HIV Tests
  • FDA Panel Supports Tofersen for Rare Genetic ALS
  • Pregnant, Black? Here's Your Drug Test
  • Progestin-Only Birth Control Linked to Small Increase in Breast Cancer Risk
  • Fatty Acid Tube Feeding May Backfire for Preemie Breathing Disorder

Meeting Coverage

  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Second-Line Sacituzumab Govitecan Promising in Platinum-Ineligible UC
  • Trial of Novel TYK2 Inhibitor Hits Its Endpoint in Plaque Psoriasis
  • Durable Vitiligo Responses With Topical Ruxolitinib
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the cycle of misery in medicine: a practical guide

      Paul R. Ehrmann, DO | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions
    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician
    • Changing the pediatric care landscape: Integrating behavioral and mental health care

      Hilary M. Bowers, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Boston Medical Center gets screwed by the Massachusetts government
20 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...