Doctors are concerned that Wishard Hospital’s new payment policy is a radical departure from the hospital’s mission to treat the indigent regardless of the ability to pay.
Dr. Betty Routledge, a physician at Wishard’s Westside Community Health Center, described the new policy as a “fundamental paradigm shift.”
While patients will always receive care in emergencies regardless of their ability to pay, patients will also be asked to undergo a financial screening. According to an executive summary, this will require Marion County residents who can pay for non-emergency health care to do so and require non-Marion County residents who cannot pay for their non-emergency health care to seek treatment in their county of residence. “Patients will be asked to have a financial screening to see if they can receive help through such programs as Medicare, Medicaid or Wishard Advantage,” wrote Dr. Robert B. Jones, medical director and chief executive officer, in a letter to Wishard patients. “Patients who have this screening will pay less for services, even if they are not eligible for an assistance program.” While Jones’ letter implies the screening is voluntary, an executive summary says the screening will be mandatory. “Wishard’s financial screening will determine whether the patient is eligible for an assistance program, such as Medicaid, and whether the patient is at 200 percent or below of the federal poverty level,” the summary reports. “Under the new policy, Wishard will require patients to consult with a Wishard financial counselor and/or provide point of service payments when the patients do not qualify financially for any form of subsidized healthcare (Medicare, Medicaid, Wishard Advantage) and do not have private health insurance.” “Wishard’s goal is to get as many patients as possible enrolled in financial assistance programs for which they qualify,” said Matt Gutwein, president and CEO of the Health and Hospital Corp of Marion County. “Doing so will result in a higher quality of overall healthcare for many of our patients long term because they will begin to receive routine primary care provided in healthcare centers located in their neighborhoods rather than through episodic visits to the emergency room.” Wishard Advantage provides subsidized care to Marion County residents who are at 200 percent or below the federal poverty level and do not qualify for healthcare assistance such as Medicare or Medicaid. According to Jones‘ letter, the program has grown 60 percent in just two years. The new payment policy is set to begin in October. According to Jones’ letter, the new policy will begin Oct. 1 for specialty care clinics and pharmacies, Oct. 15 for Midtown Community Mental Health Center sites and Nov. 1 for primary care, Community Health Centers, the emergency department and urgent visit centers. “Unless the care you need is for an emergency, you must pay the amount you owe,” Jones wrote. “If you cannot pay this amount, your appointment will be rescheduled until you can pay the fee … Patients will always receive care in emergency situations, regardless of their ability to pay.” Dr. Palmer MacKie, an internal medicine specialist at the Integrated Pain Center, said the new policy will be devastating to self-pay patients. “The bar is set so high as to preclude health care,” he said. “I couldn’t pay it at a physician’s salary.” Dr. Betty Routledge, a physician at Wishard’s Westside Community Health Center, described the new policy as a “fundamental paradigm shift.” “It’s not just an issue of being fiscally responsible,” she said. “It’s a frame shift for the hospital.” MacKie said he agreed. “To see this being whittled away is very sad,” he said. “I still have a fair amount of optimism, but it’s starting to erode.” Routledge said it is “very common and increasingly common” for fully employed people to have little or no health insurance. According to a report on the budget shortfall, the average cost of providing health insurance for one employee rose from $2,736 in 2001 to $3,156 in 2002. Costs are expected to rise 16 percent this year. As a result, many small and mid-sized employers cannot afford to provide health insurance as a benefit. An increase in the number of uninsured and underinsured patients seeking services, rising pharmaceutical costs, a nationwide shortage of medical personnel and the freezing of Medicaid and Medicare rates are all factors in Wishard’s $35 million budget shortfall. As a result, Wishard and Health and Hospital Corporation of Marion County have sought to attract additional revenues. While this is primarily by asking for more federal funding, Wishard has applied for $26 million in grants. The Richard M. Fairbanks Burn Center recently raised $5.7 million in a statewide fund-raising campaign. There is also a great deal of hope that Sen. Evan Bayh’s amendment to provide additional federal funding for Wishard will pass. “They basically put all their eggs into one basket,” MacKie said. “[It’s] over reliance on the federal pie in the sky.” In the meantime, Wishard strives to become more cost-efficient. While much depends on the federal government, the community’s role in easing the cutbacks is important. “What are we as a community willing to pay to ensure there is an adequate safety net there?” Routledge asked.