Dr. Herbert C. Smitherman

Dr. Valerie M. Parisi
The Detroit Medical Center (DMC) and Wayne State University’s School of Medicine have been at odds for some time over the matter of 12 million dollars, but that’s just a portion of the argument.

On one side, DMC’s president and CEO, Mike Duggan, says the $12 million is his right to take, according to Dr. Herbert C. Smitherman, WSU assistant dean of community and urban health. Smitherman and his colleagues, Dr. Valerie M. Parisi, WSU School of Medicine, and Kenneth P. Lee, WSU associate dean of finance and administration, oppose Duggan’s position.

In 2006, a term agreement signed between the two organizations stipulated payments to WSU of $19 million for indigent care. The payments were established to support those WSU physicians. On Feb. 1, DMC reduced the payment by $12 million ($2 million from the Department of Obstetrics and Gynecology, and $10 million from other specialties).

DMC claims that the $12 million is an overpayment and violates federal Stark and anti-kickback legislation. WSU disputes that claim.

“We provide 50 million dollars of free care. No other group in the state of Michigan provides that much,” Smitherman said. “Of the $50 million, $19 million comes to us through this disproportionate share dollars. Another $17 million comes from the state. Of the $50 million we’re covered by about $36 million. Now we have $23 million. It’s a major blow to the under- and uninsured in Detroit.”

This problem is more than just a difference of opinion, it touches the very lives of the uninsured in the community.

Smitherman says 21 percent of the Detroiters are uninsured and 33 percent are underinsured (with Medicaid). Most of the uninsured receive primary care in the emergency room. Because of this, DMC and WSU combined see 75 percent of the uninsured in Detroit. Any reduction in funding is detrimental.

“We see more uninsured than Oakwood, St. John and Henry Ford combined,” he said. “They don’t carry as much of an uninsured burden and uncompensated care as we do. Since we are so disproportionate, we have become the public hospital, but we have no public dollars.”

The only real strategy is to work collaboratively with DMC to gain more funding from the state.

“I think we can go up to the legislators in unison and say we have a unified problem,” Smitherman said. “It’s not our fault, but we have a disproportionate burden of people who are without. We (have to) collaboratively come together and the state works with us to solve that problem.”

“The longer you leave the uninsured and underinsured to fend for themselves in the emergency room and they don’t get primary care, the worse the situation gets,” Perisi said. “It bleeds right over into everyone’s premiums. That’s what the legislators should be looking at: How can we have a hospital that’s supported by our tax dollars? And then a series of primary care clinics, which is to really push out the much cheaper care which is preventive for people in their neighborhoods.”

She says that the disagreement between DMC and the WSU School of Medicine will eventually hurt the university.

“This is a cumulative debt situation. It’s over a period of years the DMC has just not paid its debt,” Perisi said. “Now we have to consider laying off people because we see no indication that any of these debts are going to be paid. It was binding.”

“We don’t want to be victimized by this situation. The other thing is not only should we be delivering a quantity of care to the un- and underinsured, I don’t think there should be a second standard,” Lee said. “There’s a bigger problem here, but the way to solve it is not to cannibalize each other. Suing DMC is not going to solve the problem. Our intent is not to bring down the Detroit Medical Center. We don’t want to destroy it. We just want to work things out in an equitable manner.”