Teaching Hospitals

More than most states, Maryland has been successful in containing the ever-rising costs of hospital care. Through a system of sharing the burden of paying for indigent care -- and paying for the essential and expensive role of teaching hospitals -- Marylanders as a group have avoided the skyrocketing costs that have plagued other states.But the uncontrolled growth of free-standing, unlicensed surgery clinics poses a danger. While these centers provide lower costs and greater convenience and comfort for many patients, they draw business away from hospitals -- especially patients with health insurance coverage.

Leaders of Maryland's renowned teaching hospitals are feeling vulnerable as the push for a health care overhaul focuses attention on the tremendous differences in hospital costs around the country. Urban academic medical centers such as top-ranked Johns Hopkins Hospital and the University of Maryland, with its world-class trauma center, are more expensive to run than community hospitals and rural teaching hospitals. The difference can mean patient bills that are higher by thousands of dollars.

HEALTH CARE regulators and managers need to remember the children's story about the Little Red Hen.The Little Red Hen is the one who found a grain of wheat, then couldn't get anyone in the farmyard to help her plant, harvest, grind or bake. So she did it herself.When it came time to eat the freshly baked bread, however, there were plenty of volunteers. Only now it was the Little Red Hen's turn to say "no." She had earned the right to eat the bread. The freeloaders had not.In health care, however, the freeloaders are eating the bread, served to them on a silver platter, while the equivalent of the Little Red Hen is expected to keep doing the work with no reward.

University Physicians Inc., the faculty medical practice group at the University of Maryland, announced yesterday that it will pay $8.3 million to settle claims it overbilled Medicare. "It doesn't mean we were overbilling Medicare," said Jerome D. Carr, chief compliance and legal affairs officer for the faculty practice group, which is made up of the clinical faculty at the university's medical school. "The issue is whether there was documentation where one could look six years later at the medical record and say, `A Level 3 consultation was done on Jan. 22, 1995.

NEW YORK -- Two years ago, dozens of teaching hospitals across New York state embraced an unusual pilot program to ease the nationwide glut of physicians. The federal government would pay bonuses to the hospitals if they trained fewer doctors, just as it once paid corn farmers not to grow corn.But half those hospitals have dropped out of the plan after finding that they cannot function without the low-cost labor provided by doctors in training, known as residents.The development, which comes even as the government is planning to expand the New York pilot program nationwide, raises doubts about federal efforts to curb the number of doctors in the nation, and it illustrates a conundrum of health care today.

CONGRESS, the president and federal regulations have made a mess of the health-care system. However well-intended, their actions have lowered the quality of care for millions of Americans -- especially senior citizens -- and seriously eroded the viability of hospitals, nursing homes, home health-care companies and health plans for the elderly. Much of the fault lies in Washington's myopia about the bottom line: Saving dollars wins out over spending more to deliver adequate health-care services to Americans.

Outpatients are receiving more services when they visit Maryland hospitals, driving up their overall bills so rapidly that state regulators want to take action. The collective outpatient bill at Maryland hospitals rose 14.15 percent in the 12 months that ended April 30 - nearly double the 8.43 percent increase in inpatient charges, according to data presented yesterday at a meeting of the Health Services Cost Review Commission. Outpatient care accounts for about 30 percent of the state's hospital spending of more than $10 billion a year.

The House of Representatives is expected to pass long-stalled legislation today that would expand access to a promising medication for heroin addiction, particularly in cities like Baltimore that have serious drug problems. The legislation, which has been approved by the Senate and is expected to be signed by the president, would lift a key restriction on the distribution of buprenorphine, an opiate substitute that curbs cravings for heroin or prescription painkillers and comes with advantages over the better-known addiction medication, methadone.

President Clinton's call to increase the supply of family doctors could force hospitals such as Johns Hopkins and the University of Maryland into a battle to preserve their roles as specialty centers.For Mr. Clinton's reform to work, teaching hospitals would have to train more than double the current number of physicians planning careers in primary care, a field that has been derided as low-paying and lacking the intellectual allure of the medical specialties.The administration wants to reverse that perception, recognizing that specialists order more tests and perform costlier procedures than do generalists.

Everyone makes mistakes. The clerk at the store may give out the wrong change, or the post office may deliver your letter to the wrong address. And who hasn't gotten a wrong number on the telephone?Such errors are inconvenient or annoying. The mistakes people make in hospitals and drugstores, however, could be life-threatening. Unfortunately, they appear to be all too common.A new study published in the Journal of the American Medical Association reveals a high rate of adverse drug events in two of the country's finest hospitals.