Health care for the uninsured in St. Joseph

1
Health care for the uninsured in St. Josephs
County

• Econ 30500 Economics of Poverty
• Professor Warlick
• Claire Anderberg, Jaime Dennig, George Fisher,
  Eileen Offer, Oscar Padilla, Sharon Zhu

2
Objectives

• 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

3
Statistics

• 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 athompso_at_co.st-joseph.in.us
4
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.20Jos
eph20County20Health20Department20-20Health20
Assessment.pdf
5
Hoosier Healthwise
http//www.stjosephcountyindiana.com/sjchd/PDFs/20
06AnnualReport.pdf
6
Assistance for low income families

• 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.ck
findiana.org/st_joseph/enrollment.html
7
Hoosier HealthwiseSCHIP and Medicaid of Indiana

• Whos 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/ho
osier_healthwise/getcare.html Interview with
David Roos (Vice President St. Joseph County
Health Department droos_at_ckfindiana.org)
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Benefits Covered

• - Emphasis on preventative care and check-ups
• There are different packages available
• 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
droos_at_ckfindiana.org) l
9
In case of an emergency

• 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
10
Memorial Hospital

• Activity (1/1/20051/1/2006)
• Admissions
• 18,158
• Inpatient surgeries
• 4,912
• Outpatient visits
• 157,043
• Outpatient surgeries
• 8,720
• Emergency room visits
• 48,527
• Births
• 3,251
• Number of beds
• 325
• http//www.usnews.com/usnews/health/hospitals/dire
  ctory/numbers_6421290.htm

11
Top 100 Hospital In U.S. in 2005

• Methods
• 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
• 100 Top Hospitals National Benchmarks for
  Success 2005
• http//www.100tophospitals.com/default.aspx

12
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.

13
Allocation of Dollars and Persons Served under
Adopted Charity Policy
2001 2002 2003
Persons served in the last 12 months 2,321 2,181 2,799
Charity Care Allocation 1,406,977 1,477,122 1,939,266
http//www.in.gov/isdh/regsvcs/acc/fiscal03/00505
3.pdf
14
Unreimbursed Costs of Charity Care,
GovernmentFunded 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.

15
Specialized Programs UnreimbursedCosts
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

16
Uncompensated Care
2003 2004 2005
Net Patient service revenue 313,328 335,189 364,300
Provisions for bad debt 16,436 18,341 23,716
Percent of total 5.24 5.47 6.51
http//www.qualityoflife.org/aboutus/publications.
cfm
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Options for Uninsured- Underinsured

• Payment plans if possible.
• Collect as much as possible if continued
  procedures are needed.
• Discounts on procedures.
• Collect as much as possible all things
  considered.
• Refer to various help agencies.
• Religious groups, clinics, etc.

18
St. Josephs Regional Medical Center

• Established in 1882 by the Sisters of Holy Cross
• Centers 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.

19
Outreach Programs

• 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.

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St. Josephs County
21
Outreach Clinics/Services

• Sister Maura Brannick Health Center South Bend
• Healthy Family Center Mishawaka
• Family Medicine Center South Bend
• St. Josephs Urgent Care Center
• Mobile Medical Unit

22
Mobile Medical Unit

• 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. Josephs Regional Medical
  Center Chief Executive Officer.

23
Mobile Medical Unit
24
Mobile Medical Unit

• Staffed by a Family Nurse Practitioner,
  mammographer, and intake coordinator.
• Services Provided Mammograms, physicals, womens
  health, health screenings, minor illness, health
  maintenance

25
Mobile Medical Unit

• Areas the MMU Serves
• 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
• http//sjmed.com/PDF/MMU_2007_April_Schedule.pdf

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Problems with Outreach Services

• 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

27
Working Together

• St. Josephs and Memorial have begun
  collaborating their efforts through
  advertisements and funding
• Local Businesses and Media are working to spread
  the word as well

28
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

29

• 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.

30

• 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.
  Josephs. Those such as eye specialists and ear
  nose and throat specialists are offered for free
  by the doctors of the St. Joseph Medical Center.

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What happens in the case of an emergency?

• Patients are directed to St. Josephs 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. Josephs 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

32

• 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.

33

• 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

34
ND Health Services does not take care of payments
for you

• The services listed below are the financial
  responsibilities of a patient
• Laboratory tests
• X-rays
• Injections, including allergy shots
• Medications
• Medical supplies
• Medical procedures
• Consultations with physicians outside
  University Health Center
• Hospitalization and / or treatment at a
  community hospital or emergency room

35
ND Health Services only takes Megalife Insurance

• 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.

36
Options for Payment

• Deferred payment
• Payment in installments
• Rector funds (on a case by case basis)

37
Who is Uninsured?

• 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.