U. of C. tries new approach to uninsured
U. of C. tries new approach to uninsured
Non-emergency visits run up hospital costs
By Bruce Japsen
Copyright by The Chicago Tribune
Published July 8, 2006
Known around the world for teaching the latest medicine and conducting cutting edge research, the University of Chicago Hospitals is taking on yet another mission: educate the uninsured on how to get quality medical care without showing up in its expensive emergency room.
In any hospital, the emergency room is typically the priciest setting for care. But at an academic center like University of Chicago, it can be 60 percent more expensive than it would be at a community hospital because teaching facilities also train future doctors and conduct research.
So when patients like James Kinney end up in the U. of C. emergency room for a pulled muscle, which could have been treated at a nearby clinic or community hospital for a fraction of the price, it adds a staggering amount to everybody's health-care costs.
Kinney, a 64-year-old uninsured electrician, came to the hospital when he developed excruciating pain in his hip. He was treated but also referred to a new program to help him get follow-up care and develop a relationship with other doctors and clinics.
"I was not aware of where else I could go," Kinney said. "I could hardly take the pain."
Kinney is like millions of Americans across the country who unwittingly turn to the hospital emergency room because they don't know their options, don't have insurance or are overwhelmed by a health-care system that has difficulty explaining how it all works.
A clinic visit might cost $100, while an emergency room stop costs about $1,200, most of which is absorbed by the hospital. Extrapolated across more than 200 of the nation's major academic medical centers and thousands of similar experiences at each facility each year, costs for treating patients in teaching hospital emergency rooms easily runs into billions of dollars a year, these hospitals say.
Rather than blame the thousands of uninsured patients, the hospital is taking a unique approach: Employees in its emergency room are educating their patients after treatment begins.
In University of Chicago's "Healthy Community Access Program," staff at the emergency room link patients to a primary-care doctor often closer to their home. They even have the ability to schedule follow-up appointments in designated slots at affiliated clinics.
The idea is for the patient to avoid a long emergency room wait while at the same time find a "medical home" so they get regular, preventive care that can be handled by dozens of other outpatient options more quickly, effectively and closer to their home. Staff members are on duty between 8 a.m. and 11 p.m. daily, and the hospital hopes to expand the service to 24 hours.
About $1.5 million in federal grant money over two years is paying for the program. U. of C. hopes to get more federal support but has agreed to continue the program beyond this year with or without government aid.
The program comes at a time when hospitals are under fire for their missions of providing charity care to the poor and, in some cases, aggressively targeting the uninsured to pay their bills. In this case, patients get treatment and are then informed of their options.
`Medical home' helps patient
"This is a novel approach for a private hospital that is mutually beneficial for the patient, the primary care provider, the hospital and the health system as a whole," said David Carvalho, deputy director of the office of policy, planning and statistics for the Illinois Department of Public Health.
"You are better off as a patient if you have a medical home. All of the research shows that it's even more important that you have a medical home than medical insurance. Having that relationship with a primary-care provider is very important," Carvalho said.
The clinics and participating doctors say they have the capacity to take on the patients and earn enhanced federal reimbursement and support to serve the uninsured, plus others who cannot afford to pay. The costs to the clinics is several times cheaper than the hospital emergency room, the clinics, hospital and federal officials statistics show.
"The University of Chicago is a great place to come if you need a lung transplant, " said Michelle Obama, vice president of community affairs for the U. of C. Hospitals. Obama said many patients seeking treatment in emergency rooms do not have a primary-care doctor managing chronic conditions, and that was the case with nearly 35 percent of the nearly 60,000 patients who came to the adult emergency room at the U. of C. last year.
After treating Kinney's pulled muscle in January, hospital emergency room staff interviewed him and linked him with a neighborhood clinic, Chicago Family Health Center, which is just 2 miles from his home. He is treated at the center every three months or so for his pain, which doctors say is akin to arthritis.
"They recommend that place because it was in my neighborhood and everything seems to be working out just fine," Kinney said. "I have been back [to the health center] two or three times."
Industry improves efforts
The hospital industry admits its facilities are not doing enough to curtail the tide of unnecessary emergency room visits of the uninsured.
"The health-care system has not done a good job of explaining itself," said Rick Wade, a senior vice president at the American Hospital Association. "What they are doing at [University of Chicago] is an example of what more hospitals have to do to stem the tide of inappropriate visits to emergency rooms and have the emergency rooms be used for what they are supposed to be used for."
Hospitals say the uninsured lead complicated lives that make the emergency room an easy choice, Wade says. They work multiple jobs at odd hours that lead them to emergency rooms more than others.
"A lot of those people are afraid of the system and they are possessed with the notion that they are not going to be treated unless they show up to the emergency room," Wade said. "To them, they don't have anywhere else to go. They typically should have been treated by a primary-care doctor earlier somewhere else."
At Chicago Family Health Center, the uninsured pay a small co-payment of $10 for a routine visit, although some patients who cannot afford it are not required to pay. The balance is covered by donations to the clinic and federal grants designed to improve access to health-care in areas of the U.S. considered under-served.
Without a "medical home," U. of C. officials say patients who show up in emergency rooms miss out on preventive medical-care service and early detection of potentially life-threatening illness.
----------
bjapsen@tribune.com
Non-emergency visits run up hospital costs
By Bruce Japsen
Copyright by The Chicago Tribune
Published July 8, 2006
Known around the world for teaching the latest medicine and conducting cutting edge research, the University of Chicago Hospitals is taking on yet another mission: educate the uninsured on how to get quality medical care without showing up in its expensive emergency room.
In any hospital, the emergency room is typically the priciest setting for care. But at an academic center like University of Chicago, it can be 60 percent more expensive than it would be at a community hospital because teaching facilities also train future doctors and conduct research.
So when patients like James Kinney end up in the U. of C. emergency room for a pulled muscle, which could have been treated at a nearby clinic or community hospital for a fraction of the price, it adds a staggering amount to everybody's health-care costs.
Kinney, a 64-year-old uninsured electrician, came to the hospital when he developed excruciating pain in his hip. He was treated but also referred to a new program to help him get follow-up care and develop a relationship with other doctors and clinics.
"I was not aware of where else I could go," Kinney said. "I could hardly take the pain."
Kinney is like millions of Americans across the country who unwittingly turn to the hospital emergency room because they don't know their options, don't have insurance or are overwhelmed by a health-care system that has difficulty explaining how it all works.
A clinic visit might cost $100, while an emergency room stop costs about $1,200, most of which is absorbed by the hospital. Extrapolated across more than 200 of the nation's major academic medical centers and thousands of similar experiences at each facility each year, costs for treating patients in teaching hospital emergency rooms easily runs into billions of dollars a year, these hospitals say.
Rather than blame the thousands of uninsured patients, the hospital is taking a unique approach: Employees in its emergency room are educating their patients after treatment begins.
In University of Chicago's "Healthy Community Access Program," staff at the emergency room link patients to a primary-care doctor often closer to their home. They even have the ability to schedule follow-up appointments in designated slots at affiliated clinics.
The idea is for the patient to avoid a long emergency room wait while at the same time find a "medical home" so they get regular, preventive care that can be handled by dozens of other outpatient options more quickly, effectively and closer to their home. Staff members are on duty between 8 a.m. and 11 p.m. daily, and the hospital hopes to expand the service to 24 hours.
About $1.5 million in federal grant money over two years is paying for the program. U. of C. hopes to get more federal support but has agreed to continue the program beyond this year with or without government aid.
The program comes at a time when hospitals are under fire for their missions of providing charity care to the poor and, in some cases, aggressively targeting the uninsured to pay their bills. In this case, patients get treatment and are then informed of their options.
`Medical home' helps patient
"This is a novel approach for a private hospital that is mutually beneficial for the patient, the primary care provider, the hospital and the health system as a whole," said David Carvalho, deputy director of the office of policy, planning and statistics for the Illinois Department of Public Health.
"You are better off as a patient if you have a medical home. All of the research shows that it's even more important that you have a medical home than medical insurance. Having that relationship with a primary-care provider is very important," Carvalho said.
The clinics and participating doctors say they have the capacity to take on the patients and earn enhanced federal reimbursement and support to serve the uninsured, plus others who cannot afford to pay. The costs to the clinics is several times cheaper than the hospital emergency room, the clinics, hospital and federal officials statistics show.
"The University of Chicago is a great place to come if you need a lung transplant, " said Michelle Obama, vice president of community affairs for the U. of C. Hospitals. Obama said many patients seeking treatment in emergency rooms do not have a primary-care doctor managing chronic conditions, and that was the case with nearly 35 percent of the nearly 60,000 patients who came to the adult emergency room at the U. of C. last year.
After treating Kinney's pulled muscle in January, hospital emergency room staff interviewed him and linked him with a neighborhood clinic, Chicago Family Health Center, which is just 2 miles from his home. He is treated at the center every three months or so for his pain, which doctors say is akin to arthritis.
"They recommend that place because it was in my neighborhood and everything seems to be working out just fine," Kinney said. "I have been back [to the health center] two or three times."
Industry improves efforts
The hospital industry admits its facilities are not doing enough to curtail the tide of unnecessary emergency room visits of the uninsured.
"The health-care system has not done a good job of explaining itself," said Rick Wade, a senior vice president at the American Hospital Association. "What they are doing at [University of Chicago] is an example of what more hospitals have to do to stem the tide of inappropriate visits to emergency rooms and have the emergency rooms be used for what they are supposed to be used for."
Hospitals say the uninsured lead complicated lives that make the emergency room an easy choice, Wade says. They work multiple jobs at odd hours that lead them to emergency rooms more than others.
"A lot of those people are afraid of the system and they are possessed with the notion that they are not going to be treated unless they show up to the emergency room," Wade said. "To them, they don't have anywhere else to go. They typically should have been treated by a primary-care doctor earlier somewhere else."
At Chicago Family Health Center, the uninsured pay a small co-payment of $10 for a routine visit, although some patients who cannot afford it are not required to pay. The balance is covered by donations to the clinic and federal grants designed to improve access to health-care in areas of the U.S. considered under-served.
Without a "medical home," U. of C. officials say patients who show up in emergency rooms miss out on preventive medical-care service and early detection of potentially life-threatening illness.
----------
bjapsen@tribune.com
posted by Carlos T Mock at 7:21 AM
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