University of Chicago's Emergency Room Send Uninsured Non-Emergency Patients to Other Facilities

Posted by Damozel | Having been to more than my share of emergency rooms, this actually makes sense to me:

Sen. Barack Obama's wife and three close advisers have been involved with a program at the University of Chicago Medical Center that steers patients who don't have private insurance -- primarily poor, black people -- to other health care facilities....[T]he program, which aims to find neighborhood doctors for low-income people who were flooding the emergency room for basic treatment. Hospital officials say such patients hinder their ability to focus on more critically ill patients in need of specialized care, such as cancer treatment and organ transplants.  (Chicago sun-Times)

I am going to assume---naively?---that they are extremely careful to filter only patients with non-urgent problems.  While far from an ideal solution, it at least strikes me as pragmatic to that extent.   

A lot of people who can't afford doctors and have no insurance use the ER as a sort of primary care provider.   So saith the campaign. 

Medical center officials and Obama's presidential campaign staff say the Urban Health Initiative -- along with a three-year-old companion program called the South Side Health Collaborative -- will dramatically improve health care for thousands of South Side residents. They say that, rather than having to wait hours at U. of C.'s emergency room, those patients get seen sooner and at less expense at neighborhood clinics and other hospitals. U. of C. even offers them a ride on a shuttle bus to other centers and sometimes provides the doctors at those facilities.  (Chicago sun-Times)

So it's not like those hospitals in Sicko that just turns them out on the street, hospital gowns and all.  Okay.  What bothers me is the implication that the policy is different for people who have insurance and can afford to pay.  I am not sure whether it should bother me----people with insurance often don't have a choice where to go if they can't pay.

I'm sure what I think about this bit:

At the same time, the Urban Health Initiative is improving the university's finances. Fewer poor patients are showing up at the U. of C. emergency room for basic medical treatment and are no longer admitted to the hospital. That frees beds for transplants, cancer care and other more-profitable medical procedures that the university prides itself on.  (Chicago sun-Times)

But is a pity that David Axelrod "co-owns the firm, ASK Public Strategies, that was hired by the hospital last year to sell the program -- called the Urban Health Initiative -- to the community as a better alternative for poor patients." (Chicago sun-Times)   

Maybe it is.  I've certainly experienced the flooded emergency room problem.  Axelrod further says:

The collapse of the health care system was driving more and more people to the emergency room," Axelrod said. "The trend line was and is a disastrous one from the standpoint of maintaining the hospital. Their goal was to find an answer."

The reality is that if we get universal heath coverage, or really any comprehensive heath care reform,  people's choices about where to go for care are going to be somewhat circumscribed.  I don't see this as a huge drawback----under my fairly generous insurance plan, my choices already are. 

In any event, perhaps this is a reasonable interim solution.  Someone with a broken wrist could wait 12 hours to be seen if the ER is dealing with a real life-threatening crisis. 

Hmmm.

At Memeorandum, you can see some pretty funny concern-trolling on the right over the poor black citizens who get "turned away." 

I think the real question is whether being sent elsewhere means they get faster/more efficient care. 

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Comments

[freadom]

That's good news. I just thought it would be a good idea to allow me the option to risk my soc. sec dollars so I could make more money annd have that money left for my kids when I die, instead of it going to the gov.

I don't rely on soc. sec. for retirement, but if it's there still I'll take it as a bonus. By not relying on soc. sec., I can retire at 58, instead of waiting till when the gove says I can retire -- say 62-70.

That's my view of social security. Just a thought to ponder.

[katie]

That Sun-Times article pissed me off, and this is the comment I left there:

I worked at the UofC--I will be very upfront about that because I have nothing to hide. My position entitled me to no special privileges, and I don't speak on behalf of an institution unless I truly believe that what they are doing is right and moral. I was a writer for the Medical Center's magazine, Medicine on the Midway, and I did a story about the Southside Health Collaborative for the magazine and for the Biological Sciences Division's annual report. In the Sun-Time's op-ed response to this article (http://www.suntimes.com/news/commentary/1129160,CST-EDT-edit27.article), the writers even pulled a quote from the annual report, "'Michelle Obama, speaking of the clinics in a hospital report, said it herself: "The world is seeping in, and our salvation will be the success of our partners.'" So I know those writers were at least doing their research.

The Michelle Obama I knew at the hospital was very down-to-earth and candid about the things we talked about. I could call her any day of the week to set up an appointment to talk with her. In those conversations, she explained to me what her goal was for the UofC's ER. Patients wait there, sometimes for 24 hours or more, just to be seen because they have a sore throat. Those patients don't know where else to go. They don’t have primary care doctors because they can’t afford them, and because historically, they’re not used to getting regular physical check-ups. They see the UofC in advertisements as a cutting edge facility, and they trust it. They don't realize that they have other hospitals, good hospitals such as Mercy and Michael Reese, sometimes closer than the UofC. It's the same situation with clinics.

No patient is turned down or "shunned" from care when they arrive at the UofC ER. Insured or uninsured, the wait is the same. And it's long. I know how it works because for my articles--and I try to be an honest, moral, and unbiased journalist in what I report--I sat in the ER waiting room for hours at a time and talked with patients. I went with them behind curtains when they were finally admitted to wait once again for a physician--one step closer. I picked the patients I spoke to—almost a dozen of them—randomly, and then followed them through this process. So here's how it works:

When a patient arrives in the ER, they fill out a form at the desk about their illness or pain. They provide their address as well, and perhaps who their insurance carrier is (that I don't remember for certain, but I think that was part of it).

Next, one of the three or four people stationed in the ER called Patient Advocates looks at that paperwork. If they find someone they think could be a candidate for another hospital or clinic, they go sit down with that person and talk. The advocate asks where the patient lives, and consults a clipboard right in front of the patient that holds a map and list of about 20 other clinics and hospitals in the area. The advocate checks to see if any of those institutions are within the vicinity of the person’s address. If they are, the advocate offers to call the clinic or hospital to set up a future, follow-up appointment. Sometimes a clinic is only two blocks from a patient’s home or near where they pick their kids up from school, BUT THEY NEVER EVEN REALIZE THAT OPTION EXISTED.

The UofC doesn’t turn down these patients, and it’s the patient’s prerogative to return to the UofC or go on to the institution that the advocate told them about. If they choose the latter, the advocate keeps track. A week or so after the appointment, the advocate calls that patient to see how it went. Were there any problems? Did the doctor see you on time? Do you have any complaints or praise?

The people from Michelle Obama’s office—Community and External Affairs—visited these clinics and hospitals to see for themselves with whom they were working. If the clinic was in desperate need of new carpeting or a new paint job, Michelle’s office would see that they got funding for it. Michelle was very open in her discussions with me about the partner institutions. She said that the UofC didn’t always cooperate with them in the past, but that we are in such desperate times, that we needed to change. Michelle also said that healthcare in this country is in such dire straits, that the UofC need to do something. She alone couldn’t change the healthcare system immediately to universal coverage, but she could work to improve the system we’re in currently. And that was Michelle’s—and her team’s—goal.

In 2006, the UofC adult ER admitted more than 60,000 patients. Roughly a quarter of them—15,000 visits—were people who used the ER as their only form of medical attention. These are people who had no primary care physician or “medical home.” Michelle and her staff, and now Eric Whitaker and his staff, are simply trying to help them find one.

Read my previous articles about the SSHC and Urban Health Initiative here: http://katiescarlettbrandt.com/artwork/348635.html
http://katiescarlettbrandt.com/artwork/348673.html