CHA Budget Comes Under City Scrutiny

Various labor and healthcare groups have rallied to the Cambridge Health Alliance’s side in recent weeks, forming a coalition called “Put Patients First” to urge Mass. Gov. Deval L. Patrick ’78 to steer clear of further cuts to Medicaid. At the same time, city councillors and residents have demanded greater budgetary accountability from the CHA and expressed concerns regarding health service cuts that the alliance had made.

At a December council meeting, Cambridge Mayor E. Denise Simmons proposed an order that would have withheld the CHA’s city funding and stopped health clinic closings for the next six months if the alliance failed to submit a plan to solicit community input. The order, which failed, was also supported by City Councillor Marjorie C. Decker, who is demanding “line-item accountability” for the CHA’s expenditures.

“When we’re cutting services, not only do we have a responsibility to know what we’re paying for, but we also should have some voice in choosing what we pay for in cutting services,” Decker said. “I do support the idea that the city pays the hospital $5 million dollars, but right now its unclear what we get in return for that.”

Decker said she certainly is “not looking to harm services,” and pointed out that her entire family receives health care at the CHA even though she has the financial means to go elsewhere. Decker criticized councilors for being “more anxious about making hospital administrators nervous about losing dollars than about the services that we do know today we’re losing.”

She questioned the CHA’s closure of the Oliver Farnum Senior Health Center in December—which she said forces the elderly and handicapped to travel further for health services—and its reduction of midwifery services, which she said “saves hospitals far more money than OBGYNs,” who are licensed physicians and charge more for deliveries.

Decker also demanded precise accountability by the CHA for its operation of the Cambridge Public Health Department, which she said has engaged in vague “homeland security work” that may stretch outside of Cambridge.

“I might choose, as a representative of Cambridge taxpayers, to keep the [Farnum] Senior Center, even if it’s not at full capacity, than rather to be doing homeland security work in Everett,” Decker said. “The information and facts the city council is provided with is unclear.”

CHA spokesman Doug M. Bailey acknowledged Decker’s concerns, saying “everyone’s frustrated and I understand the frustration, but we’ve been engaging in intense discussions and negotiations with [various governmental offices], and we expect to have more avenues for community input on the situation before it reaches a resolution.”

He added that the closing of the Oliver Farnum Center was an issue of “utilization” and not driven by the governor’s emergency budget cuts in October.

“If you look at who was using [the center], it mostly wasn’t seniors. It was our least profitable center, and there’s another similar one less than 2,000 feet away,” Bailey said. “You really have to study utilization and need and make decisions based on that.”

As for Simmons and Decker’s suggestion of withholding funds, Bailey said that “the solution to diminishing funding is not to diminish funding more,” and said that at this point “closing hospitals is not on the table.” He noted that even without considerations of further state budget cuts, the CHA is due to lose $95 million this year and more in 2011 because of the 2006 Massachusetts health care reform bill.

While Bailey did not say why the mental health services were among the first to be cut by the CHA, he pointed to inadequate state reimbursement for safety-net hospitals.

“Mental health and addiction treatment is 48 or 49 percent of our [healthcare] makeup, and that is not reimbursed at a rate that is feasible,” Bailey said. “I understand the thinking that hospitals are likely to cut mental health first because it’s least profitable.”

Brian Rosman, research director for Health Care For All, a health policy group, said that health-care reform did address reimbursement concerns, appropriating $90 million a year for three years to increase state payments to hospitals. But he said that “implementation by the Romney and Patrick administration appears to have really shortchanged some of the key services, particularly mental health.”

State Representative Alice K. Wolf agreed with Rosman’s reimbursement concerns, saying that state officials should be aware of the problem.

“[Health] Secretary [Judy Ann] Bigby knows this because I had a meeting with her last May, and she said, what we really need to do is raise the reimbursement rate,” Wolf said. “They have subsequently cut them twice.”

­—Staff Writer Peter F. Zhu can be reached at pzhu@fas.harvard.edu.