Hospitals tackle insurance issues

By Brittany Abeijon

During Carle Hospital’s annual Foundation Day event last week, Dr. Ben Gerber, UIC assistant professor of medicine practicing general internal medicine and health promotion research, was among the guest speakers who came from all over the state to address current and potential challenges for hospitals, medical staffs and patients.

Gerber addressed the “patient of the future” and focused on the Internet age and the unique technological resources available to improve the patient-physician relationship.

“Although the provider may have some skills of evaluating the quality of information, they may not have the time or motivation to sift through large amounts of information, like the patient has,” Gerber said. “But (patient and doctor) putting some effort into it is probably a good thing.”

Hospitals in the Urbana-Champaign area are working to better prepare their staff for future challenges within the health care system, but some have realized that more immediate problems affecting the community should come first.

Approximately 40 percent of Champaign County residents have Medicaid insurance or are uninsured, according to Champaign County Health Care Consumers, a self-described citizen’s advocacy group for improving local health care.

In March 2003, Carle Clinic stopped taking new patients who are on Medicaid insurance. Christie Clinic also stopped around that time, according to the consumers’ organization. But 90 percent of physicians in Champaign County are employed by these two clinics as of April 2007.

Jennifer Hendricks Kaufmann, manager of public relations and communications at Carle Clinic, said the clinic has worked to make changes since 2003.

A new program called Illinois health connect program began to assist people in Illinois with health care access and Carle Clinic has been encouraging all physicians to participate. Hendricks said since August 2007, they have enrolled approximately 6,000 to 7,000 people in the program.

“We are accepting new patients enrolled in that program, and we are pleased with how that is going,” Hendricks said.

In June 2007, Illinois Attorney General Lisa Madigan’s office filed an anti-trust lawsuit against Christie and Carle clinics, charging they had allegedly agreed to stop accepting new Medicaid-eligible patients seeking primary medical care. The clinics are fighting to have the charges dismissed.

Carle responded in a public statement on June 14 that defended their decision as necessary for future expansion to serve the needs of the community. In 2006, Carle Clinic had a patient population of more than 31,000 Medicaid patients from 84 counties, according to the statement.

“The state’s accusations against Carle Clinic highlight the need to fix the reimbursement model in the health care delivery system in this state so providers and patients are given the resources they need to maintain the health of its citizens. With physician shortages, increasing costs of providing care and escalating demand, the health care system is in crisis, not only in central Illinois, but throughout the nation,” the statement read.

A representative from Christie Clinic was unable to comment on the pending lawsuit.

“A healthy community is one where everyone has an equal opportunity to health care,” said Megan McClaire, the consumer health hotline coordinator for the county health care consumers. “We see that resolutions do exist, and we are targeting clinics and working against discriminatory policies, regardless of insurance or medical debt.”

Gregory Alford, regional director of marketing and public relations at Provena, said both locally and regionally the biggest challenge in the local health care market is access to care.

“One of the issues that we face in the community and nation is making health care available to everyone who needs it,” Alford said. “Provena’s position is universal insurance. We believe no one should go without medical care and our hospital doors are open to anyone who needs service.”

Another challenge in surrounding communities is funding for health care, and often hospitals are underfunded at both state and federal levels.

“The state is slow in paying Medicaid bills,” Alford said. “We can wait months before we receive payment for services from the state, and often reimbursements are less than the amount of care.”

Alford added that Provena works to maintain balance between making sure that care is provided to everyone in need and still invest in technology and grow with the community.

“We are not trying to make gobs and gobs of money,” Alford said. “We are reinvesting 4 to 5 percent, which is a really tiny profit margin.”