Hospital pushes counties to pay for uninsured
Huge money savings!!!!! if only.....
Denver Health Medical Center provided $52 million in uncompensated care for residents outside the city last year, and the CEO says it's time for other counties to pay their share.
Chief executive Dr. Patti Gabow wrote letters to 14 county boards of commissioners last month breaking out how much uninsured treatment her organization gave to residents of each county and asking for money to cover the costs.
For Jefferson County, that number was $9.8 million in 2008. Uninsured residents in Adams County cost the hospital $11.3 million last year; and in Arapahoe County, the cost was $12 million.
"I'm a big believer that information is an important starting point for any discussion," Gabow said, noting she doesn't expect any checks to arrive in the mail soon. "And I'm a big data girl; you can't blame other counties if they don't even know."
Denver Health receives special tax dollars and benefits to care for the uninsured, Medicaid patients and kids on the state Children's Health Insurance Program. The organization runs federal health clinics in some of the city's poorest neighborhoods.
But according to state statute, the hospital is supposed to serve only uninsured Denver residents for non-emergency care. Federal law requires all hospitals to take emergency patients, no questions asked.
Denver Health has tried to reduce the number of out-of-city uninsured patients it sees by asking for for Xcel bills, leases or mortgage statements to prove Denver residency, though it legally can't ask about citizenship status.
Some out-of-town patients are best served at Denver Health, Gabow said.
"If you cut off your arm in one of those counties, it's appropriate, whether you're insured or uninsured," she said. "There's a good chance we can replace your arm."
But doctors say they are increasingly seeing more uninsured people from as far away as San Miguel County.
Melody Zwakenberg, a nurse practitioner working in the system's adult urgent-care clinic, said there has been a 30 percent jump in adult urgent care in the past year.
She sees out-of-county people who say they hear "word of mouth" that Denver Health takes anyone without insurance.
Counties have own issues
In 2008, the Denver hospital — supported by $95 million in city, state and federal tax dollars — did $318 million in uncompensated care, including people who live in Denver. The city devoted $27.9 million to the hospital last year to take care of its uninsured residents.
The counties that received a letter from Gabow, meanwhile, say they have financial problems of their own and are not likely to cut a check for Denver.
"We will not be contributing to the cost of anything at Denver Health," said Mark Tandberg, a division director at the Adams County Department of Human Services. "We don't believe it's a responsibility for county government to compensate hospitals for uninsured care. Adams County is not in the hospital business."
Jefferson County officials said they wonder how Denver Health arrived at its $9.8 million figure.
"They haven't shared the data and how they came up with the numbers," said Kathryn Heider, a Jefferson County spokeswoman.
Heider said the county has not asked Denver Health for more explanation. "I think we probably won't be pursuing it," she said.
The uncompensated-care numbers come out of Denver Health's computer system that counts charges for uninsured patients. The numbers don't include unpaid charges from Medicaid, Medicare or other insurance contracts.
Pete Leibig, chief executive of Clinica Family Health Services, which runs clinics in Adams and Boulder counties, said he would urge county governments to invest in local clinics and hospitals, rather than anywhere in Denver.
"Everyone is taking it in the shorts. We all have to find a way to make it better," said Leibig, who gets $95,000 from Adams County and $596,000 from Boulder County for services. "If the county's response is we want to step up and do something about the health care crisis, I would say do it locally."
Denver Health projects it will deliver another $360 million in uncompensated care in 2009.
To make up for that, Denver Health squeezes every efficiency it can out of its operation and paying patients. It depends on money its trauma center generates. And it has been marketing its money-maker programs — such as the eating-disorder center — to private insurers.
It also recently entered into an agreement with Metropolitan State College of Denver to get the students insured through the school as patients. And it opened a pediatric emergency room because, as chief financial officer Peg Burnette puts it, "children are more likely to be covered than adults."
Gabow, impassioned about the health care reform debate, told a congressional committee in June that everyone deserves the kind of care Denver Health provides.
She just can't afford to take care of everyone.
"As a doctor," she said, "where you live in America shouldn't determine if you live."
Allison Sherry: 303-954-1377 or email@example.com
Distortions and straw men
"It seems that free-floating fear of change is driving opposition to health reform. What people should fear is the consequences of doing nothing. Over 20,000 people die each year for lack of health insurance, and the number is climbing.
"Opponents to reform are preying on deep-seated anxieties of the American people for personal and political gain. They have people panicked over distorted details and straw men. We need to ignore them, pay heed to our 'better angels.' If we fail to act in this moment, the next life lost to our cruelly dysfunctional health care system could well be your own."
Costliest counties for Denver Health
Counties whose residents Denver Health Medical Center reports it spent the most on in 2008:
Many of those opponents are the insurance companies that have milked us, denied coverage when needed, and dropped many in their greatest time of need, after paying for years. If nothing else I would love to see healthcare reform to make them rethink their dishonest practices.
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