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Cambridge Health Alliance Presses its Case

There is more today about the impact of Medicaid reimbursement rates and state budget cuts on Cambridge Health Alliance, the network that includes hospitals in Cambridge, Somerville and Everett. CEO Dennis Keefe sent this letter to staff today.

Dear Staff,

As you may have noticed, an editorial called "Unkindest Cuts In Healthcare" in today's Boston Globe takes aim at the state's emergency 9C and other cuts and how they have severely, and we believe unfairly, impacted both Cambridge Health Alliance and Boston Medical Center. At the Globe's invitation, I, along with Doug Bailey, Gordon Boudrow and Donna Fox, visited the Globe on Monday and presented our best case to the paper's editorial board. It appears we were convincing, as the Globe's editors seem to understand that there is a serious and perhaps unintended downside to healthcare reform, particularly if it endangers the many who depend on the state's two safety net hospitals for their care. We hope those who can resolve this tenuous situation receive this message in no uncertain terms.

One unfortunate point was the use of the term "illegal immigrant" when referring to our patient mix. While we stand by our mission of providing health care to all in need, Cambridge Health Alliance provides health care services to many patient populations. Over 85% of our patient care is for those who depend on some form of government health care, with well over 50% relying on Medicaid, Commonwealth Care, or programs for the uninsured. There are many reasons why a stable group of our patients remain residually uninsured and are ineligible for reform's coverage expansions

— immigration status is but one of these reasons; others who don't have affordable work place insurance for themselves or their family members, senior citizens who need wrap around support for their coverage, those in transition or otherwise waiting to enroll in insurance, and many others who for various reasons fall between the cracks of the state's efforts to provide insurance to all.

The main point we underscored is that despite growing numbers of patient visits (+20,000 increase for Medicaid and other low-income patients) our reimbursement per unit of service has actually decreased under health care reform - an unintended consequence in the implementation not intended by the law's architects.

Meanwhile, I am aware that many of you have expressed a willingness and eagerness to lend your voice to the debate and help send a message to policymakers. Your support is most appreciated, and we are in the beginning stages of engaging your suggestions as part of a thoughtful campaign to reverse these dangerous cuts. You should know that we have been very active and have already succeeded in winning support from members of our local, state and congressional delegations, all of whom have voiced their unanimous support and are working hard on our behalf. Health care coalitions, community organizations, and labor unions have adopted the issue and are aggressively voicing their concerns. Our attempts to interest the media in this issue and focus its attention on the causes and potential solutions are beginning to pay off, we believe. And we continue to have many conversations, meetings and dialogues with the Administration, including into next week.

During this period, you will undoubtedly hear conversations and rumors about what may or may not result from our efforts. It's entirely understandable that this time of uncertainty will give rise to fears and concerns about the future. We are engaged in very intense financial, legal, logistical, and safety scenario analyses, particularly in regard to service changes that might occur throughout our system. The seriousness of the situation precipitated by state budget cuts requires us to begin such planning and we have jumpstarted that process. As we have said previously, we are on a necessary track to transform and strengthen our health care system for the future so that we can fulfill our mission of providing healthcare to our communities and those most in need. We rank among the best quality healthcare institutions in the country and we aim to stay there.

Thank you as always for your ongoing commitment and dedication.

Dennis 11/21/2008

Dennis D. Keefe
Chief Executive Officer
Cambridge Health Alliance

This program aired on November 21, 2008. The audio for this program is not available.

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