[Marxism] Milwaukee: "Treat fewer poor people, " hospital tells docs

Lou Paulsen loupaulsen at sbcglobal.net
Tue Aug 3 15:05:09 MDT 2004

A little update on "the greatest healthcare system in the world":
"People don't realize how close to collapse the health care system is."
(By the way, this is an example of "faith-based" care, not a for-profit - but in a capitalist market, everybody and everything has to act like a capitalist)
>From the Milwaukee Journal-Sentinel:


Aurora Sinai Medical Center is urging its doctors to treat fewer poor patients.

The hospital, 945 N. 12th St., serves primarily low-income people whose care is covered by government insurance programs. Aurora Sinai has reduced admissions by almost 16%, about 1,000 patients, since the year's beginning.

Even with staff cutbacks, clinic and ward closures and tougher restrictions on care in Sinai's emergency department, the hospital still projects a loss this year of $14 million. That is in addition to a loss of $24 million last year.

"We are cutting back generally on the population that hurts us the most," said Paul Nannis, Aurora Health Care corporate spokesman.



That population consists of the people enrolled in the county's general assistance medical program, or GAMP, a $38.4 million program that pays for medical care ranging from hospitalizations to primary care, laboratory tests and pharmacy services. It is available to poor people who do not qualify for any other type of government help and meet income limits.

"What we have done is try to restrict the number of patients on the front end so physicians see fewer GAMP patients," said Nannis. "If physicians see fewer patients, we see fewer patients."

Many Aurora physicians are unhappy with efforts to cut care, said Barbara Horner-Ibler, an assistant professor at the University of Wisconsin Medical School who teaches at Aurora Sinai.

"We are here to serve the population," she said. "We understand the need to be profitable, but we feel what's happening is unethical."

The hospital still treats people who come to its emergency room with genuine emergencies, such as serious wounds or life-threatening conditions, but it does not treat those who have a condition that may be better served by a primary care facility, such as a cold. The hospital will also try to refer those it cannot treat somewhere else, but there is no guarantee that those patients seek out the help they need.

Horner-Ibler is also medical director of the Bread of Healing Clinic, a free clinic set up in Cross Lutheran Church, 1821 N. 16th St., and sponsored by the UW Department of Medicine.

She sees "an absolute, desperate need for more primary care in Milwaukee. Free clinics can only care for so many. There is no awareness of this. People don't realize how close to collapse the health care system is."
Where are they now?
Where Aurora Sinai's former patients now go for care is a mystery.

"Clearly, these folks are going somewhere else," said Rob Henken, acting director of the Milwaukee County Department of Health and Human Services, which oversees GAMP. 

[Clearly!!  They must be!!  At least, their dead bodies have not yet piled up in the streets! - LP]


"To the extent that one of the GAMP hospital providers is making a decision to try to limit admissions, that will have an impact on the three other systems," he said.

Covenant Healthcare System Inc., the area's second-largest hospital system after Aurora, is the most likely place patients would gravitate to, health officials said.

Covenant's hospitals, which include St. Joseph Regional Medical Center, 5000 W. Chambers St., and St. Michael Hospital, 2400 W. Villard Ave., continue to see an increase in poor patients, a spokeswoman said. But Covenant cannot determine if the influx of poor patients formerly sought care at Sinai or are just more poor people needing care.

The $3.3 million that GAMP pays Sinai to care for poor patients ran out at the end of June, Nannis said.

"We have not summarily discontinued services to GAMP patients. We have asked the county to reassign them to other providers. We are slowing the number of GAMP patients we see," he said.

Of the hospital's patients - more than 5,000 have been admitted so far this year - about 80% are covered by government insurance or have no insurance at all.

"We have to push that number down if we are going to stem the loss of money at Aurora Sinai," he said. The hospital provided $31 million in charity care last year when revenue was $190.2 million.

Aurora Sinai wants "to reinvent itself as a downtown destination hospital. We want a healthy mix of commercial and neighborhood patients," Nannis said, adding that Sinai needs more commercial patients to survive. Commercial patients have medical insurance, generally provided by their employer.
'Broken' health system
"There are a couple of big problems here," said Darcy Haber, health care campaign director of Wisconsin Citizen Action, a consumer advocacy group. "As a not-for-profit entity with a mission to serve underserved populations, Aurora has a lot of explaining to do when they claim they can't afford to serve the residents of the inner city in Milwaukee but they have $85 million to build another hospital in Waukesha County, three miles away from Oconomowoc Memorial."

Aurora Health Care is seeking governmental approvals to build an 88-bed hospital in the Town of Summit in the Pabst Farms development.

"But the even bigger issue here is that our health care system is broken, and relying on charity care is a weak patch to put on the system. We need political leadership in Milwaukee County and in this state to overhaul our health care system," she said.

Aurora Sinai's downtown location is the reason it serves so many poor people, said John Whitcomb, director of Sinai's ER department.

"We are the last ones standing downtown. Someone please help us," he said. "The real villain here is an inadequate health care system."

Many hospital admissions are the result of poor patients not receiving primary care, said Bevan Baker, Milwaukee health commissioner. As they get sicker with conditions that could be managed in a primary care setting, they require expensive hospitalization, he said.

"The solutions are not wrapped around Aurora but around an understanding that care should be assessed through the primary care route," Baker said.

The city, hospitals, clinics and health care groups are working to get a $4 million federal grant that would expand primary care services in Milwaukee, Baker said.



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