December 8, 2006

elevate: Answering the Tough Questions

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Medical Center leadership answers the tough questions about what the elevate program is and what it means for the people who work at VUMC.

Question: If Vanderbilt receives money from the government for uncompensated care, will it share that money with the attending physicians who help provide the care?

Answer: To alleviate part of the burden of providing care to indigent patients, safety net hospitals such as ours are entitled to receive lump payments from the state and federal government, including Medicare “disproportionate share hospital” payments and TennCare “essential access” payments.

Such payments go to support hospital operations. Certain federal laws aimed at discouraging questionable patient referrals and unnecessary hospital care severely limit the ability of most hospitals to transfer funds to attending physicians. These laws apply to Vanderbilt and its clinical faculty.

I should note that departments in the School of Medicine use varying faculty compensation programs, such that a clinician who cares for a non-paying patient may or may not experience a drain on faculty income; in some departments, any given patient's ability to pay has no particular bearing on the faculty member's compensation, while in other departments — surgical departments, for example — time spent providing care to an indigent patient does detract from the time the clinician has available to optimize his or her income by caring for paying patients.

Hospital income is ploughed back into our institution, supporting academic and research programs, and funding improvements to our medical facilities. Viewed in this way, any payment to our hospitals substantially benefits our faculty clinicians.

While special government payments recognize safety net hospitals, they unfortunately make no specific provision for safety net physicians. Physician groups (and academic departments) are free to compensate their members for care provided to non-paying patients, but, again, hospitals have no such leeway.

— Warren Beck, M.B.A., director of the Department of Finance