More uninsured patients cause struggle for local hospitals 

Jul 29
2009

BY SARAH TOMPKINS
sarah.tompkins@nwi.com

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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