Transcript Health care for the uninsured in St. Joseph`s County

Health care for the uninsured
in St. Joseph’s County
Econ 30500 – Economics of Poverty
Professor Warlick
Claire Anderberg, Jaime Dennig, George Fisher, Eileen
Offer, Oscar Padilla, Sharon Zhu
Objectives
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How do Indiana State programs help
alleviate financial stresses?
Economic burden to Memorial Hospital
How are hospitals reaching out to the
community?
Health care for extreme poverty
Health care on campus
Statistics
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Non-elderly Americans (65 and under) w/o health
insurance increased 10% from 2000-2002 to over 44
million (17% of population)
Over 49,500 uninsured in St. Joseph County
 Increases in uninsured have been linked to employers
dropping health care coverage and increasing costs of
health care coverage
The uninsured do not come from one social, economic,
or racial class
 They come from all walks of life
“Cover the Uninsured Week” – report by Ann Thompson [email protected]
Uninsured of St. Joseph
County
“Only questions with more than 50 respondents are included in the county profile, as a sample less than 50
would not provide statistically stable results. Due to the relatively small size of the SJC sample (236
respondents), analysis based on age, race and sex could not be completed”.
http://www.stjosephcountyindiana.com/sjchd/PDFs/St.%20Joseph%20County%20Health%20Department%20
-%20Health%20Assessment.pdf
Hoosier Healthwise
http://www.stjosephcountyindia
na.com/sjchd/PDFs/2006Annual
Report.pdf
Assistance for low income families
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CKF (Covering Kids and Families of St. Joseph County)
helps families in the process of applying for
health care aid through “Hoosier
Healthwise”
Goal of CFK is “to ensure that all eligible
families have access to affordable
healthcare”
There are many different places around
South Bend that to go for help in enrolling
for Hoosier Healthwise
http://www.ckfindiana.org/index.html
http://www.ckfindiana.org/st_joseph/enrollment.html
Hoosier Healthwise
SCHIP and Medicaid of Indiana
Who’s Eligible - “children, pregnant women, and low-income
working families” – Must meet income requirements
(150% of poverty level)
How do they receive health care? – Each family is assigned
a PMP (primary medical physicians). The program
provides you with a list of doctors to choose from in your
area
- PMP must be picked within 30 days of beginning the
program, and you must maintain a PMP for 12 months
unless you supply “good cause”
- Choose a Managed Care Organization
- You can only receive care from within your MCO
http://www.in.gov/fssa/maternal/hoosier_healthwise/whoiselig.html
http://www.in.gov/fssa/maternal/hoosier_healthwise/getcare.html
Interview with David Roos (Vice President St. Joseph County Health Department
[email protected])
Benefits Covered
- Emphasis on preventative care and check-ups
- There are different packages available
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Ex. Package A includes – hospital care, doctor visits, check ups,
prescription drugs, lab services, substance abuse services,
mental health care, dental care, vision care, transportation,
chiropractors, etc. at NO COST
Package C offers the same services but with co-payments for
prescription drugs and limited other services (151%-200% of the
poverty level – not the poorest)
All payment goes directly to the health care providers
and not to the families enrolled
-Pay premiums with SCHIP but not with Medicaid
http://www.in.gov/fssa/maternal/hoosier_healthwise/benefits.htm
Interview with David Roos (Vice President St. Joseph County Health Department
[email protected])
In case of an emergency…
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Participants in the Hoosier Healthwise system
are told to contact their PMP first
If the doctor is not in but can speak with the
patient, the doctor will further direct them
In the event of an immediate emergency they
must go to the hospital and contact their PMP
from the hospital
(the use of the PMP is to hopefully prevent emergencies by using
preventative care)
http://www.in.gov/fssa/maternal/hoosier_healthwise/benefits.html
Memorial Hospital
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Activity (1/1/2005–1/1/2006)
Admissions:
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Inpatient surgeries:
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48,527
Births:
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8,720
Emergency room visits:
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157,043
Outpatient surgeries:
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4,912
Outpatient visits:
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18,158
3,251
Number of beds:
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325
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http://www.usnews.com/usnews/health/hospitals/directory/numbers_6421290.htm
Top 100 Hospital In U.S. in 2005
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Methods
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Scoring hospitals on a set of weighted performance measures
centered on clinical excellence, operating efficiency and financial
health, and responsiveness to the community:
Risk-adjusted mortality index
Risk-adjusted complications index
Risk-adjusted patient safety index
Core Measures Score
Severity-adjusted average length of stay
Expense per adjusted discharge, case mix- and wage-adjusted
Profitability (operating profit margin)
Cash to total debt ratio
Growth in patient volume
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100 Top Hospitals: National Benchmarks for Success —
2005
http://www.100tophospitals.com/default.aspx
Allocation of Dollars and Persons Served
under Adopted Charity Policy
Most nonprofit hospitals adopt a charity
benefit policy to serve the medically
indigent. On an annual basis, the hospital
will confirm the eligibility and set aside
dollars to ensure low-income persons can
be offered needed inpatient and
outpatient hospital services.
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Allocation of Dollars and Persons Served
under Adopted Charity Policy
2001
Persons served
in the last 12
2,321
months
Charity Care
Allocation
2002
2003
2,181
2,799
$1,406,977 $1,477,122 $1,939,266
http://www.in.gov/isdh/regsvcs/acc/fiscal03/005053.pdf
Unreimbursed Costs of Charity Care,
Government
Funded Programs, and Community
Benefits
Based on uniform definitions of costs,
each nonprofit hospital must identify the
costs of serving its community that are not
reimbursed by government and other third
party payers.
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Specialized Programs Unreimbursed
Costs
Total unreimbursed costs of providing care to
patients unable to pay, to patients covered under
government funded programs, and for medical
education, training
($2,388,068)
Community Health
Education
0
Community Programs and
Services
($1,743,845)
Other Unreimbursed Costs
($1,196,700)
Total Costs of Providing
Community Benefits
($5,328,613)
•http://www.in.gov/isdh/regsvcs/acc/fiscal03/005053.pdf
Uncompensated Care
2003
2004
2005
Net Patient $313,328
service
revenue
Provisions
16,436
for bad debt
$335,189
$364,300
18,341
23,716
Percent of
total
5.47%
6.51%
5.24%
http://www.qualityoflife.org/aboutus/publications.cfm
Options for UninsuredUnderinsured
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Payment plans if possible.
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Discounts on procedures.
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Collect as much as possible if continued
procedures are needed.
Collect as much as possible all things
considered.
Refer to various help agencies.
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Religious groups, clinics, etc.
St. Joseph’s Regional
Medical Center
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Established in 1882 by the Sisters of Holy
Cross
Center’s Mission: To serve together in
Trinity Health in the spirit of the Gospel to
heal body, mind and spirit to improve the
health of our communities, and to steward
the resources entrusted to us.
Outreach Programs
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Michelle Peters: Director of Outreach
Services
Outreach Programs offer primary and
educational services to community
members in St. Joseph and Marshall
Counties.
Established to serve the un-insured,
under-insured and Medicaid populations in
both counties.
St. Joseph’s County
Outreach Clinics/Services
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Sister Maura Brannick Health Center –
South Bend
Healthy Family Center – Mishawaka
Family Medicine Center – South Bend
St. Joseph’s Urgent Care Center
Mobile Medical Unit
Mobile Medical Unit
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Established in December 2005
40 Foot Long “Clinic on Wheels”
“We welcome any opportunity to help those
without healthcare simply because they have no
way of coming to us. I am proud to say that
with the Mobile Medical Unit, we are coming to
them.” Nancy Hellyer, St. Joseph’s Regional
Medical Center Chief Executive Officer.
Mobile Medical Unit
Mobile Medical Unit
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Staffed by a Family Nurse Practitioner,
mammographer, and intake coordinator.
Services Provided: Mammograms,
physicals, women’s health, health
screenings, minor illness, health
maintenance
Mobile Medical Unit
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Areas the MMU Serves:
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West Side of South Bend (2 Days)
Mishawaka (1 Day)
Plymouth (2 Days)
Amish Country (Every 3rd Friday)
Schedule on the website shows where the
MMU will be every day of the month:
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http://sjmed.com/PDF/MMU_2007_April_Schedule.p
df
Problems with Outreach Services
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Struggle to spread awareness of
these programs.
Trying to get more recognition out
there so that the community knows
that St. Joe is doing all of this.
Patients are missing their
preventative care because they are
unaware of these programs
Working Together
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St. Joseph’s and Memorial have begun
collaborating their efforts through
advertisements and funding
Local Businesses and Media are working to
spread the word as well
What happens to a person who is unable to purchase medical
insurance and is ineligible for Medicare or Medicaid?
The Sister Maura Brannick Health Center
Chapin Street, South Bend
•Sponsored by St. Joseph Regional Medical Center
•60 Volunteer Doctors from the South Bend/Mishawaka Area
•Multilingual Staff including Social Workers and Financial Counselors
•Onsite Dental Clinic
•$5 Co-pay covering all services and medication
To become a patient:
•Application involving financial screening
•Necessary criteria:
-Ineligible for Medicaid or Medicare
-Unable to obtain health insurance
-Must be 150% below the government established poverty line.
-Can not be a patient at another clinic
•All patients are assigned a primary care doctor.
Services at the Health Center
Preventive healthcare.
•Treatment for acute injuries or illness.
•Chronic disease management.
•Screenings.
•Free immunizations for those who qualify.
•Head Start and school physicals.
•Prenatal and OB care.
•Drug Assistance Program w/pharmacist available.
•Nutritional and diabetic counseling.
•Dental clinic on site for general preventive and restorative dental care.
Any services that are necessary but not available because of a lack of equipment or
any other reason at the Health Center are available at St. Joseph’s. Those such as
eye specialists and ear nose and throat specialists are offered for free by the
doctors of the St. Joseph Medical Center.
What happens in the case of an emergency?
•Patients are directed to St. Joseph’s Hospital for emergency care.
•Hospital bill is forwarded to the Health Center. The case is reviewed and in
most instances the bills are covered.
•If a patient must be admitted:
-Financial Advisor helps the patient apply for HCI, a government
program that will cover the cost of the stay.
-If not accepted by HCI, St. Joseph’s Regional Medical Center
absorbs the cost of the stay.
Information provided in an interview with Lilia Periquet, Social Work Coordinator (4/3/07)
http://sjmed.com/svc_outreach_HC_SB.htm
~University health insurance (Megalife) is only mandatory
for graduate and international students (undergraduates
do not need to provide proof of insurance, they only need
to call in August to remove Megalife from their billing
account).
~Students are not charged to been seen by professionals
at the health center, but supplies, medicines, procedures,
labs, and x-rays
~All charges except for lab and radiology are billed
directly to Student Accounts, they do not file claims
~An itemized statement will be given to the student or
sent through campus mail for them to file with their
insurance if they are not a part of Megalife.
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“All Notre Dame students are invited to
use our medical services regardless of
having private, school sponsored
insurance, or no insurance coverage.” Ann
Elizabeth Kleva, RN, MSA, Director,
University Health Care Services
ND Health Services does not take care of payments for you
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The services listed below are the financial responsibilities of a
patient:
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Laboratory tests
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X-rays
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Injections, including allergy shots
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Medications
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Medical supplies
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Medical procedures
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Consultations with physicians outside University Health Center
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Hospitalization and / or treatment at a community hospital or
emergency room
ND Health Services only takes
Megalife Insurance
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“The only insurance that we take is the
Notre Dame MegaLife Insurance, If you
have private insurance, we will provide
you with a detailed receipt for filing with
your insurance company for
reimbursement each time you receive a
prescription. We can also provide a
detailed statement upon request.”
Options for Payment
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Deferred payment
Payment in installments
Rector funds (on a case by case basis)
Who is Uninsured?
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Not always what you expect
Small Business owners
Transitional workers
Divorced individuals
Single working males
Notre Dame students
College Graduates
This is not just a problem contained by a certain
socioeconomic stratum, it encompasses people from all
walks of life.