In the world of healthcare, unfortunately, there are patients who can’t pay, putting a strain on the network of care. Providers say that even with Mississippi’s high number of residents on the federal programs of Medicaid and Medicare, there are still a large number of patients without the means to cover the costs of care. It may be partly due to the large number of self-employed residents and those who work for small businesses without insurance plans.
“Sure there’s still a problem. We run into that every day,” said Tim Alford, M.D., of Kosciusko. “According to the American Medical Association, there are 56 million uninsured people in this country.”
He says his practice, Kosciusko Clinic with nine physicians and three nurse practitioners, is sometimes a safety net in the community. He often sees the uninsured in crisis format at the emergency room for a condition that could have been treated earlier in the clinic. He and other physicians point out that emergency room visits are more costly than office visits, passing along additional unpaid care.
“I would like to say those costs don’t get passed along to paying patients, but they do,” Alford said. “We fight real hard to keep our overhead down, but medical care is more labor intensive than it used to be.”
His clinic now has 80 employees, and a lot of them work with paperwork for all the different forms of payment providers must deal with.
Randy Easterling, M.D., of Vicksburg, says the uninsured population is growing. “A lot of people think the uninsured don’t work, but they are the working poor,” he said. “Among the uninsured, 80% have a paycheck or are connected to a paycheck.”
He, too, explains that cost-shifting spreads uncompensated care among those who do pay. However, that does not apply in a lot of cases to fixed costs that physicians have.
“Our reimbursement for Medicare and Medicaid has not changed substantially for 11 years while all costs are going up, including nurses’ salaries, energy and other overhead.”
That’s why fewer physicians are seeing these patients, and with an additional 75 million people destined to be on the Medicare rolls in 10 years, that’s the making of a perfect storm, Easterling says.
“A lot will end up in emergency rooms and sicker,” he said. “Sicker patients cost more. It’s foolish of the government not to raise the reimbursement for physicians. It will cost more in the long run.”
Dwaila South, M.D., of Ripley points out that one in five Mississippians has no form of health coverage. “Some of them (particularly the young who still see themselves as immortal) simply elect not to purchase it,” she said. “Most of those who don’t have it state that they can’t afford it.
“With the economy the way it is, I foresee that number rising. Many of the people who do have insurance have such high deductibles that they neglect having preventive medicine screening or simply don’t go to the doctor for early warning signs and symptoms until their disease process is too far advanced to be cured. In primary care, we see this very often.”
In South’s area, the largest employer, Benchcraft/Berkline, recently closed its doors on 2,500 employees, which she feels will add to the number of patients who can’t pay. Someone remarked that South has a recession-proof job as there will always be sick people. “I told him that this notion of his was unfounded because my work goes on, sickness doesn’t take a layoff, but the patients don’t have the money to pay their bills,” she said. “But our costs of caring for patients continues an inexorable rise.”
Easterling, president-elect of the Mississippi State Medical Association, agrees that the number of uninsured patients will rise as the economy worsens and other industries, including automotive, have layoffs.
In step with the slowing economy, Hancock Medical Center in Bay St. Louis is seeing a rise in the number of patients who can’t pay.
“In the months of April, May and June, approximately 35% of the patients who came to the emergency department were private pay patients who do not have health insurance of any kind,” spokesman Tom Carlton said. “Throughout 2008, about 18% to 22% of all patients seeking healthcare services have been uninsured. The hospital is absorbing millions of dollars in bad debt.”
He adds that the area’s continuing recovery from Hurricane Katrina also plays a role. “A lot of the jobs that are available in our current economy dealing with recovery are jobs that do not typically offer health benefits,” he said. “In Hancock County and all across the Coast, people are working hard rebuilding, but many are working hard with no health insurance.”
The situation has led the county-owned facility to change its emergency department policy, effective July 1, as most hospitals, according to Carlton, are now doing. The new policy clearly states that many patients seen in the emergency department were not true medical emergencies and could have received appropriate care in a clinic setting at a lower cost.
Now patients will be screened to determine if a true emergency condition exists. Those with no significant high-risk factors may continue the process but will be required to make a $120 deposit to proceed with treatment. Or they may choose to seek treatment with a local physician or clinic. A list of physicians and clinics will be made available.
The physicians also observe that patients are not coming in for treatment as the economy worsens. In the rural area surrounding Kosciusko, Alford says the cost of gasoline is a big factor.
South says many of her patients are burning up the phone lines trying to get treated without paying for an office visit.
“Often, it is hard to refuse when they flatly state they can’t afford to come in for their re-check and ‘could you please just renew my prescriptions without seeing me?” she said. “What are you to do for the severely hypertensive patient who asks you this question? Some days I feel that both my patients and I are in the middle of one big crap shoot.”
Easterling says the American Medical Association has a good plan to cover uninsured people. He encourages Congress and business people to look at it to break the stalemate that he believes exists.
Contact MBJ contributing writer Lynn Lofton at firstname.lastname@example.org.