April 27, 2010

Save DC Captive: Protect city-subsidized insurance for DC's free medical clinics

This is excerpted from testimony delivered by George A. Jones to City Council, regarding the proposed elimination of the Medical Liability Captive Insurance Agency, which provides malpractice insurance to community health centers like Bread for the City. Click here to hear Councilmember Mary Cheh discuss this issue with journalist Pete Tucker on "Spectrum Today," WPFW 89.3 (6-7pm) last week.

Thank you for the opportunity to testify today in support of the continuation of the District of Columbia’s Medical Liability Captive Insurance Agency (The DC Captive).

The DC Captive was established in 2008 largely as a replacement for the DC Free Clinic Medical Assistance Act which, from 1986 to 2008, essentially provided malpractice coverage to the staff and volunteers of 4 DC nonprofit clinics: Bread for the City, La Clinica del Pueblo, Whitman Walker and Washington Free Clinic. This ensured that otherwise cost-prohibitive malpractice insurance would not prevent us from providing free primary care to tens of thousands of uninsured DC residents.

During the 20 years that the DC Free Clinic Act was in effect, not one time was a malpractice suit brought against any of the Clinic’s indemnified by the Free Clinic Act.

Still, some 3 or 4 years ago, the DC Government informed the clinics covered under the DC Free Clinic Act that it no longer wanted to have the unsecured risk associated with the Act. Instead, the DC government wanted to develop a special insurance product that would be funded by the government and would continue to provide DC’s nonprofit clinics with medical malpractice protection at little to no cost.

It was understood by the clinic community that the DC Government was making a firm commitment that this replacement, the DC Captive, would be sustained permanently.

Now, less than two years later, the DC Captive which we worked so hard with our government counterparts to establish, is threatened with no discussion or real notification given to the clinics or our patients. The DC Government seems prepared to renege on its promise to indemnify the community clinics, threatening the ability for tens of thousands of DC residents to receive free or affordable primary medical care.

I want to make it clear that the clinics are not here to beg for a public handout. When one considers the uncompensated care and private resources the community clinics bring to the DC healthcare system, it’s easy to see that it is in the District Government’s best interest to preserve our ability to provide healthcare to DC resident.

Please consider the following simple analysis of the return on the District’s investment:

Over the past 5 years, Bread for the City has provided an average of 8,000 medical visits to about 2,700 unique patients each year. Our average cost per patient visit was $122 in 2009 (when we provided 9,100 visits).

Of those 9100 visits, 51% were members of the DC Healthcare Alliance, which reimbursed us $95, or $27 less than it cost us to provide the care; 20% were Medicaid visits, which paid us on average $40 per visit, or $82 less than our actual cost; and 29% of our patient visits yielded no public or third party compensation, thus costing us the full $122 per visit. In short, BFC provided close to $600,000 of free care to District residents last year alone. That care is paid for with private funds that BFC raises at no cost to the District or our patients.

Patients like Ms. C who works in a liquor store and lives in the apartment above the store. She takes 7 different medications for her diabetes, hypertension and thyroid disease. She and her husband have a combined income that makes them ineligible for the DC Health Care Alliance. Without the free primary care provided by Bread for the City, this family would simply have no access to the medical care and medications they need to remain active, working adults.

Were it not for our primary care clinic, these patients might otherwise turn to local emergency rooms for matters like the flu, or a sprained wrist, or other non-emergency ailments. Compare our average cost of $122 with the emergency room’s estimated $1,000 average cost for non-emergency visit, i.e. those not requiring an overnight stay.

I feel confident the other nonprofit clinics included in the DC Captive could provide similar numbers and patient stories that expand on the level of value the District and its citizens receive through our efforts.

At the end of the day, our cost-effective model, our high quality of care for these patients, and the fact that not one claim has ever been made against the Free Clinic Act or DC Insurance, all represent ample reasons for the Council to restore the funding for the insurance that sustains our operation.

Again, thanks to the Council for allowing me to present this testimony this afternoon. I would be happy to address any questions the committee members might have.

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