More uninsured patients cause struggle for local hospitals

Rising number of uninsured, proposed health care reform hurt doctors

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

Sarah Tompkins – sarah.tompkins@nwi.com | Posted: Sunday, July 19, 2009 12:00 am

Embracing technology

This article is an oldie but still very relevant, thus my repost.

Embracing technology
Brokers need to get with the program on self-service, administrative technology

Like all good business people, brokers put a premium on their relationships with clients. But in the Internet age, the sharpest also realize that even with a good product, a smile and a firm handshake, you need something more to close a deal.

Many experts believe that something more can be found in technology that makes life easier and more efficient for both the employer and the broker. And if brokers have not caught on to the benefits, they need to do so now, or they are not going to survive.

“Information flows fast and furious between clients, insurance carriers and producers,” observes Michael Wojcik, senior vice president of the Chicago broker firm The Horton Group. “The new technology allows us to accomplish a lot more in a shorter period of time. Brokers that are technology-challenged right now will have a harder time keeping up.”

Quick, efficient, valuable

The debate over how much of the sales and administration process to automate is not new. Ever since high technology invaded the benefits world, brokers have wavered between the efficiency of self-service and the relationships bred from face-to-face interaction, coming to rest somewhere in the middle. But now, although in-person exchanges are still important, brokers are realizing that it is more vital to handle their clients’ benefits issues quickly, efficiently and with as much value as possible. In fact, some believe it is necessary to facilitate face-to-face relationships.

With advances in self-service technology, “clients can handle basic administration without having to call in the insurance broker, so now they can talk about more strategic things such as the future direction of the employee benefit programs,” says Alan Cohen, CEO of OnlineBenefits, a broker partner that provides technological solutions. “Face-to-face interaction is still critical, and on a strategic level, you will always need it.”

It is just that there are other issues that will not necessarily be solved by talking things through. As Wojcik points out, information flows much faster now than it used to. That means employers and carriers expect to get what they need sooner than ever.

“If you do business with 10 or 11 organizations that require you to provide census data on eligibility, you have to provide it to them,” says Richard Travers, managing partner of the New York broker firm Travers O’keefe.

In fact, say Wojcik and Cohen, insurance carriers, not always among the most rapid companies to adopt new benefits technology, have started considering certain capabilities a given when it comes to broker relationships. Many of them, for instance, only will accept RFPs over the Web.

Moreover, employee-consumers are more comfortable researching and buying insurance products over the Web, and they have neither the time nor the patience to attend meetings when they can get the information via computer.

“People skim the Net; they don’t surf it anymore,” comments Michael Hope, a sales consultant at Spindustry, a technology solutions firm that works extensively with brokers. “Research is big. HR people aren’t just taking the agent’s word for it anymore. They’re looking around.”

There’s an overall comfort with the net, period. Five years ago, people probably didn�t want to buy CDs and books over the Web, but they do now.

story

Posted by Craig at December 31, 2003 04:50 PM

Southland hospital execs in accord on critical issues

Southland hospital execs in accord on critical issues

While Congress struggles to craft a health care reform bill acceptable to constituents and President Barack Obama, regional providers are not sitting back.

Nearly 200 business people recently heard a panel discussion packed the Holiday Inn Tinley Park Convention Center for a Chicago Southland Chamber of Commerce event focused on present and future health care coverage.

Michael Wojcik, Chamber health care vice chairman and senior vice president of The Horton Group, moderated the discussion, featuring panelists Arnold Kimmel, CEO of Metro South Medical Center (formerly St. Francis) in Blue Island; Michael Holmes, executive vice president and COO of St. James Hospital and Health Centers in Chicago Heights and Olympia Fields; Eileen Gillespie, vice president and chief nurse executive at Advocate South Suburban Hospital in Hazel Crest; and Vince Pryor, CEO of Ingalls Health System in Harvey.

“We’re in the midst of history-making health care reform that will affect all of us,” said Wojcik, who participated in health care transition meetings for the Obama administration.

Panel members echoed each other on critical issues. These include the rising number of under- and uninsured patients, the dramatic increase in emergency room visits, lengthy delays in Medicaid and Medicare payments and the need to streamline services while raising safety procedures and customer satisfaction.

Both Metro South and Ingalls have invested millions of dollars in information technology with the goal of having all patient records centralized in each hospital’s internal network; this saves time, money and facilitates patient care.

“We’ve evolved (in the last year) from a Catholic not-for-profit hospital to a for profit, tax-paying hospital,” Kimmel said.

While maintaining the excellence in cardiology established under St. Francis, Metro South has added “enhanced services for women and infants.”

Community outreach includes free blood pressure and diabetes screenings at area businesses.

“This is not only good medicine but good business too,” Kimmel said.

St. James has operated in the red for the last nine of 10 years, Holmes said. Fortunately, the 98-year-old provider is under the wing of the Sisters of St. Francis of Mishawaka, Ind.

As St. James continues to work toward profitability, it has streamlined services; cardiology and oncology departments are at Olympia Fields while women’s care, pediatrics, rehabilitation and hospice are centered in Chicago Heights.

“We also are working on patient satisfaction and making certain we have the right employees in the right places,” Holmes noted.

Gillespie said that “educating, empowering and partnership with patients” are critical to preventive care.

South Suburban has positioned itself as a leader in caring for victims of violent crimes.

“We have nurses 24/7 who are uniquely qualified (to work with) victims of sexual abuse,” she said.

Gillespie also emphasized the increasing shortage of primary care physicians can be addressed by highly trained nurse practitioners.

Meanwhile, mental health is an area that remains underserved and one in which hospitals need to partner.

“We also need tort reform. It’s easy for doctors to move across to Indiana where there has happened,” Gillespie added.

“I could say ‘ditto’ (to everyone),” Pryor noted. “What’s different about Ingalls is we are a not-for-profit independent health system. We have only our board and the community to answer to.”

The system is profitable as family care centers in Tinley Park, Calumet City and Flossmoor have dramatically increased Ingalls’ outpatient volume.

“This will be another huge challenge as we go forward,” he said.

The Company with 100 Percent Wellness Participation

The secrets about how one employer attained mythical success with its wellness program.

By KEVIN HERMAN, director of worksite wellness for the The Horton Group

Workplace wellness programs often provide employers with positive results, such as happier employees, reduced absenteeism and a strong return on investment. As a rule, the third year of a well-constructed wellness program is when employers often see the true results of their efforts. Employers generally witness significant positive cultural changes in the way health and wellness are viewed within the workplace.
However, without modifications and additions after the first year, it is common for organizations to lose their initial enthusiasm and begin to feel like their program has stagnated. Or they fail to see the results they originally hoped to achieve.

Likewise, employers who focus only on cost control and do not give employees access to positive interventions, may see declines in program participation. Oftentimes, these organizations fail to communicate intentions to employees or fail to make the interventions both fun and interesting. Many organizations also fail to make the small investments needed in incentives in order to help employees choose to participate more often. It is also important when starting to have clear metrics to track improvements so you can see successes.

Robinson Engineering, a premier civil engineering firm that provides diversified municipal engineering expertise throughout the Midwest, is not one of the companies experiencing a loss of interest. Nearly three years after implementing its wellness program, Robinson has seen incredible results and is reaching new heights in program participation.

In June 2007, Horton Health Initiatives helped Robinson implement its wellness program in order to educate employees about choosing healthier options and leading healthier lifestyles.

INVOLVE EVERYONE

Robinson implemented its wellness program with the support and involvement of senior management, which are vital to the success of wellness initiatives. Management needs to recognize wellness as a worthwhile endeavor that is valuable to employees in order to invest the time and funds needed to advance the program.

“Often, an investment in wellness does not need to include a huge dollar figure to see great results. If you think of the investment in relation to the cost of the health plan, 1 percent to 2 percent of that cost will go a long way,” says Mike Wojcik, senior vice president at Horton.

But management was not the only party involved. This past year, 100 percent of Robinson employees (about 100 people in total) participated in the biometric screenings and Health Risk Assessments. Robinson was able to score a perfect participation rate because of a mix of a high financial incentive, a strong communication campaign to inform employees of why they were implementing the incentive and a positive employment culture that facilitated an early trust in the employer’s motives for screening.

When 100 percent of employees participate in health initiatives, it’s possible for employers to recognize and address everyone’s health issues.

Because of Robinson’s companywide support and success, the employer was recognized by its health management vendor, Interactive Health Solutions (IHS), as “one of the healthiest companies in America”–an award only given to approximately 100 out of 2,000 employers screened by IHS for their employees’ overall heart and stoke health.

START STRONG AND ORGANIZED

How has Robinson been able to maintain momentum and improve employee health? The success results from a combination of factors, beginning with the company’s solid plan. To launch the program, Horton helped Robinson survey employees, asking them about their interests and wellness ideas.

From there, the company’s wellness committee compiled the results and built activities surrounding those interests. Members of the wellness committee are volunteers from all divisions of the company who help to implement and expand the program. The company adopted a wellness committee logo that incorporated the company culture and image. Robinson also communicates wellness results with pride and continues to reward employee efforts.

Since there are so many wellness topics and events introduced at Robinson, each employee is likely to find something that appeals to him or her. Programs include health club subsidies, healthy potluck lunches, on-site educational seminars and other activities with creative incentives, such as raffle prizes, healthy snacks and cash from walking competitions.

During the company’s weight-loss contest, participants lost an average of seven pounds each. In 2009, Horton began providing on-site body composition analysis and educational counseling regarding the results. Wellness education information is readily available to employees on Robinson’s Intranet site. These materials are located in a section dedicated to wellness topics and houses the monthly wellness newsletters distributed to employees.

RESULTS

Today, the Robinson wellness program has proven to be a great success. Proof is in the results, as shown by Robinson’s current return of investment of almost 10 to one.

The data from the biometric screenings and health risk assessments showed that 88 percent of employees who were diagnosed as pre-diabetic in 2008 improved their status by 2009 from pre-diabetic levels to normal glucose levels.

Also, 75 percent of employees with high cholesterol in 2008 improved by 2009. None of Robinson’s employees were rated as “high risk” in 2009 in terms of the major risk factors for preventable cardiovascular disease.

The employees at Robinson Engineering have become healthier since the company implemented its wellness program in 2007 with the help of Horton. The program is an important part of the company culture, and will continue to develop based on employee goals and ideas, allowing for even healthier results moving forward.

By recognizing the potential for a healthy improvement, getting everyone on board, and starting strong and organized, all organizations will begin to see results and successes as Robinson has.

November 1, 2009

Copyright 2009© LRP Publications