Thursday, April 2, 2009

Safety Nets with Holes

MetroHealth System in Cleveland, Ohio is supposedly the safety net hospital of northeast Ohio. Or at least it was, before last summer's move to restrict the provision of free care to only those patients who have an address within the confines of Cuyahoga County. This excludes all the people in Lake and Geauga counties (population close to 400,000) without health insurance.

As a result we are starting to see more of the following:
1) 50 year old gentlemen with rectal cancer laid off from his factory job, without any insurance. He underwent neoadjuvant chemoradiation and then I did an abdominoperineal resection. HCAP (hospital care assurance program) will help him with his in-hospital costs but the medical oncologist, the radiation oncologist, and myself are not likely to be compensated. The burden of providing free care, because of the decision of Metrohealth, falls not on "society" but instead on individuals in the community who feel obligated to "do the right thing".

2)47 yo woman with melanoma who needs a wide excision and sentinel lymph node biopsy. She has no insurance. She lives alone, is unmarried, and has no family in the area. She showed up in my office for the initial consultation with some crumpled up dollar bills. It's heartbreaking. I tell her to put her money away and worry about getting well.

I don't know what the answers are. But I do know that safety net intitutions can be a valuable resource. Diminishing how wide that net gets cast for the sake of improving the county budget bottom line is borderline irresponsible. Someone has to take care of these people....


Anonymous said...

Buckeye Surgeon -

What part of metro's decision isn't sound logically? As a case med student, I trained there extensively. My understandign was that they do receive money from Cuyahoga County, but not from other counties in the area. Why should they provide free care to people from outside the area which pays for them? Shouldn't these areas either 1) create their own safety net hospital or 2) pay metrohealth to take care of these patients?

I always was confused why patients from anywhere could come to Cuyahoga county for free (good quality, I might add) health care.

Personally, much more needs to be done by the other huge institutions in NEO that have deep pockets and less deep consciences. Just my 2 cents.

Jeffrey Parks MD FACS said...

Logically, it makes sense but doesn't the ostensible raison d'etre of MetroHealth represent something entirely illogical anyway, i.e. giving free care to area citizens in need? Accepting an arbitrary line of demarcation as defined by the borders of Cuyahoga county is somewhat disengenuous; the greater Cleveland metro area certainly extends into surrounding Geauga and Lake counties. It's not like you encounter miles of desolate emptiness once you get to the Cuyahoga county line. It would be better to adopt a regionalist stance, where all the surrounding counties chip in with tax payer dollars.

But with the revelations of extensive Cleveland city council corruption ( and a subsequent federal investigation of the nefarious doings behind city hall, I find it less than redeeming that one of the first things Cleveland does is limit availability of care that can be obtained at MetroHealth.

We need more safety net hospitals. Call it a two-tiered system, whatever, but there has to be a network of healthcare facilities that serve as the "option of last resort" for the poor and disenfranchised in this country. Build more of them. Distribute them on a population basis. Waiting around for "Universal coverage" to save us all will just create a backlog of patients who delay treatment for cancer, diabetes, etc because they don't have anywhere to go.

The care patients receive at county/charity hospitals is top notch; it's just not as convenient. Maybe you have to wait 3 months to get your hernia repaired instead of later that week at the private hospital.

Anonymous said...

Shoot, Georgia's been doin that for years....what makes it even worse is Georgia has 159 Counties...

ER's Mom said...

I work at a hospital-owned clinic in a rural county not too terribly far from you. We get no county money, so we made the decision to do "free" care for only county residents.

We are the hospital for an 8 county region...but we are bleeding cash and the hospital can't afford it, especially with Strickland's brillant idea of taxing hospitals...

There is no good answer.

Anonymous said...

This problem comes from so many directions that it's mind numbing. First is Mark Moran, the current President, and his cronies from Bose Allen. They made the decision. They continue to make more bad decisions for public health.. One day they will walk out the door for their last time. Then Metro will go back to doing what they do - saving lives.

The next is the MetroHealth board. They made the decision on whao to name as president. We see where that got us. We need a couple of Metro doctors, a couple nurses, and a couple of patients added to the board. Only when the board isn't all business people will there be any understanding of the medical side of a hospital.

Then there's the county commisioners. They name Metro's board. I'm sure that one needs no further words.

The other counties. Metro cared for your residents. Just as Cuyahoga county hands money to it's county hospital, the other counties need to follow. If our county hospital cares for your residents, don't let them sink trying to care for all of us.

Our other "nonprofit" hospitals. 2% of revenues should not be enough for nonprofit taxes, both federal and property. The Cleveland Clinic saves roughly $90 million dollars on property taxes with charity exempt status , without counting their two newest buildings.
Funny, that $90 mil plus the newest building taxes just about equals the amount they spend on charity care of patients. All the while, they send EMS after EMS to Metro, because the patient is uninsured.