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More uninsured patients cause struggle for local hospitals
BY SARAH TOMPKINS
sarah.tompkins@nwi.com | Wednesday, July 29, 2009
While about 700 working Hoosiers
each week lose health insurance
during the declining economy, local
hospitals and doctors are left to
figure out how they can continue to
treat more and more uninsured.
Further, the expectation of full
reimbursement for the cost of care
from Medicaid and Medicare patients
is a growing financial hurdle.
"The rising indigent load is a
very significant problem," said Jim
Lipinski, CFO of the Northern
Indiana Region of Sisters of St.
Francis Health Services. "Other
hospitals in our region have seen
similar trends."
In one year, Methodist Hospital
in Gary saw almost a 20 percent
increase in uninsured patients, said
CFO Loren Chandler.
St. Margaret Mercy Hospital in
Hammond saw a 15 percent increase
during that same time.
Meanwhile, the race for national
health care reform policy remains a
hot political issue as legislators
work to provide universal health
coverage for the uninsured. The
proposed health care reform plan
includes reducing Medicaid payments
to hospitals and doctors, which
could cause problems for providers.
"If they start taking away the
money before taking away the
uninsured, then it's not going to
work," Lipinski said.
In Hammond, St. Margaret Mercy
writes off about 8 percent of its
business as charity work because
patients cannot pay for the care,
Lipinski said. In addition, 75
percent of the hospital's business
comes from a combination of patients
in the Medicare program for the
elderly and the state Medicaid
program for the poor.
"Medicaid doesn't come anywhere
close to covering the cost of
Medicaid services," Lipinski said.
"We get paid by the state to provide
the care for Medicaid, but it's a
major losing operation. Medicare is
better, but many argue that it still
doesn't cover the cost of care."
According to Chandler, reducing
Medicaid reimbursement would
devastate hospitals like Methodist.
The hospital - similar to others
that treat a large number of
uninsured, Medicaid and Medicare
patients - receives government
funding to help compensate for the
partial reimbursements and charity
write-offs.
"That still doesn't get us to a
point where the hospitals are making
a profit, and we need to get to that
point so we can reinvest in
equipment, in our people and
recruiting doctors," Chandler said.
"The profits a hospital makes is
really a reinvestment into the
community it serves."
Communities in Illinois are
experiencing similar issues.
The Chicago Southland Chamber of
Commerce has been meeting with
hospital leaders and other health
care providers to discuss how to
handle the increasing uninsured
population.
"Part of the problem is people
just showing up in the hospital
emergency rooms because they have no
health care, and that is the
resource of choice," said Mike
Wojcik, chairman of the chamber's
health care council.
Nearly one-fifth of the country's
120 million hospital-based visits in
2006 were uninsured patients,
according to the U.S. Department of
Health and Human Services. Wojcik
said the chamber is working to
educate people on other health care
resources they may not know are
available.
Dr. Anthony Wilko, medical
director of emergency medicine at
St. Margaret Mercy hospitals, said
emergency room wait times can
stretch up to two hours. Some
patients they treat fall short of
emergency status, he said, seeking
care for sore throats and other
routine conditions normally seen by
family physicians.
In other cases, uninsured
patients put off visiting a doctor
for care because they cannot afford
to pay for an appointment. And when
these patients do come into the
emergency room, many are seriously
ill with something that could have
been prevented, Wilko said.
"Sometimes problems can be put
off," he said. "Instead of going in
and having their chest pain
evaluated, they may wait. That can
make a difference between a timely
and untimely outcome."
And regardless of the number of
uninsured patients doctors see in
hospital emergency rooms, the
majority of the uninsured's health
care bills are never paid. Lipinski
said the Sisters of Saint Francis
are mission-driven hospitals and
would continue to care for whomever
walked in their doors.
"We're going through an extensive
study of all the costs of running
the hospital," he said. "We are
trying not to have to go through a
major layoff."
Eventually, he said cuts would
have to come from somewhere -
hospitals may not replace equipment
like MRI machines, introduce new
technologies, halt or delay
construction projects or reduce
hiring.
At Methodist Hospitals, officials
said some doctors treat poor
patients free of charge. But as
reimbursement rates remain stagnant
and the volume of uninsured patients
increases, Chandler said eventually
something has to change.
"You're going to have to start
limiting the care," he said.
Fast Facts
301.6 million -- U.S. population
in 2007
15 -- Percent of the U.S.
population that was uninsured in
2007
6,080,522 -- Population of
Indiana in 2007
12 -- Percent of uninsured
Hoosiers in 2007
800,000 --Number of Hoosiers
receiving Medicaid services in 2008
450,000 --Number of Hoosiers
currently enrolled in the
state-sponsored Healthy Indiana
Plan, or HIP
Sources: U.S. Census Bureau,
Kaiser Family Foundation, Indiana
Family and Social Services
Administration
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