Uninsured patients bleeding dollars from ERs

[Guest guest]

" The system is totally broken for the working poor. The uninsured get

charged the full cost of health care, while people with insurance are

charged less. " -- Dr. Zyniewicz, chief medical officer at

Emergency Health Partners.

Uninsured patients bleeding dollars from ERs - MLive.com

As an emergency room physician, Dr. Zyniewicz works on the

front lines of a health-care system he says is " on the verge of collapse. "

America spends more money on health care than any nation in the world,

even outspending countries that provide universal health care to all

residents. The U.S. spent $2.3 trillion on health care in 2007, but 47

million Americans had no health insurance and the nation's overall

health status lagged behind many other countries, according to the

National Coalition on Health Care.

The fallout from America's health-care crisis is evident in hospital

emergency rooms. The ER has become the primary health-care provider

for increasing numbers of the working poor -- people who don't have

private medical insurance but earn too much money to receive

government-funded health care.

Many turn to emergency rooms for treatment of minor problems, such as

toothaches and headaches, which could be handled at far less cost by

family doctors and dentists. The situation is analogous to hunting a

mouse with a bazooka.

" The system is totally broken for the working poor, " said Zyniewicz,

chief medical officer at Emergency Health Partners, which runs the ER

at Mercy Health Partners' Mercy Campus. " The uninsured get charged the

full cost of health care, while people with insurance are charged less. "

Hospitals and clinics often charge insurance companies less for

medical services because insurers insist on paying discounted rates.

Health-care providers cannot offer the same discounts to uninsured

patients because it would be considered insurance fraud, according to

several local doctors.

In the end, the uninsured are charged more for medical services but

often pay less, or nothing, because they cannot afford the bills.

Caring for the uninsured and impoverished is taking a huge financial

toll on hospitals nationwide. Hospitals in the U.S. provide about $34

billion in uncompensated care annually, according to the National

Coalition on Health Care.

Last year, before Hackley Hospital and Mercy General Health Partners

merged to become Mercy Health Partners, the hospitals provided $26

million of uncompensated medical care. That figure has escalated in

recent years and will continue to increase unless the nation's

health-care system is overhauled, said Spoelman, CEO of Mercy

Health Partners.

" That loss means our (profit) margin is smaller than it could be or

should be, " Spoelman said. " The current system will collapse under its

own weight at some point unless there is some intervention. "

The rising cost of caring for the uninsured was one reason behind the

merger of Mercy General Health Partners and Hackley Hospital, said

Allore, Mercy Health Partners' chief financial officer. He said

the hospitals had to dramatically cut costs or possibly close one of

the facilities.

" We'd like to have a (profit) margin of 3 to 5 percent; right now

we're making about 1.5 percent with the combined systems, " Allore

said. " To survive in a health-care setting, you need to have a

3-percent margin; to really thrive you want to make closer to 5 percent. "

With three hospitals, two federally chartered medical clinics and

programs that provide free prescription medications, Muskegon County

has one of Michigan's most comprehensive health-care systems, said

Vondie Woodbury, executive director of the Muskegon Community Health

Project.

That's not a coincidence. Muskegon's health-care crisis is worse than

other parts of the country because of high levels of poverty, obesity

and chronic illnesses, according to government data.

Chronicle/Ken sNurse Mooney works at a computer in the

emergency room at Mercy Health Partners-Mercy campus. Technician Mark

Rundquist, right, and Health Unit Coordinator Shirley Veen, background

left, also are pictured.

Twenty percent of county residents are living in poverty, 10 percent

have no health insurance and two-thirds are overweight or obese. Worse

yet, the county exceeds state and national averages for deaths

attributed to heart disease, cancer, stroke, respiratory disease,

accidents, diabetes and Alzheimer's disease, according to government

health data.

" We're a very unhealthy community, " said Juarez, executive

director of Hackley Community Care Center.

Health-care providers blamed a number of factors on Muskegon County's

high incidence of medical issues, including: poverty; low education

levels; societal values that condone excessive eating, binge drinking

and cigarette smoking; a struggling economy; and an increasing number

of jobs that pay minimum wage and don't include medical benefits.

The end result: thousands of county residents who don't take care of

themselves, can't afford to see a doctor regularly and often go to

work sick just to keep food on the table, said Ken Kraus, director of

the Muskegon County Health Department.

" We've had more than one case where someone went to work sick because

they didn't have any other options (and) contaminated food in a

restaurant and made a number of other people sick, " Kraus said.

" They're trying to make a living just like the rest of us. "

Kraus said low-income workers showing up sick and inadvertently

spreading disease is one of the hidden costs of America's crippled

health-care system. He said the existing system places little value on

preventive medicine, focusing instead on costly procedures and

expensive medications -- many of which the working poor cannot afford

-- to resolve medical crises.

Juarez said it is common for low-income patients to come to her clinic

with 10 serious health problems.

" We call those people train wrecks, " Juarez said. " Usually in a

medical facility a doctor will identify three primary diagnoses -- we

often see patients with 10 diagnoses and we have to address them all.

The complexity of addressing that is pretty significant. "

Chronicle/Ken sEmergency room physician Dr. Duncan, left,

works as ez, a triage support specialist, pushes a

wheelchair in the emergency room at Mercy Health Partners-Mercy

campus. Hospitals in the U.S. provide about $34 billion in

uncompensated care annually, according to the National Coalition on

Health Care.

Dr. Maureen Street, medical director at Muskegon Family Care, said

being overweight has become the norm in Muskegon County, not the

exception. " It's acceptable and it's the norm for women here to weigh

200 pounds, " she said.

Every health-care provider The Chronicle interviewed for this article

said more needs to be done locally to encourage healthy lifestyles by

promoting exercise and better nutrition, particularly among children.

Several doctors and nurses said county residents need to engage in

more healthy activities that don't involve eating fried food or

drinking beer.

" For some reason, in Muskegon our idea of entertainment is to go out

and eat, " Woodbury said. " That just seems to be what we do for fun. "

Woodbury said eating fatty foods, drinking excessive amounts of

alcohol and smoking cigarettes is a recipe for a premature medical

crisis, such as diabetes, cancer or heart disease.

Juarez said it is harder for the poor to eat well because junk food

costs less than healthy food and there are few grocery stores offering

fresh fruit and vegetables in low-income areas.

Woodbury said many county residents are unaware of the medical

resources available to help them lead healthy lifestyles. That lack of

understanding leads many people to hospital ERs, which are required by

law to treat everyone -- regardless of their ability to pay.

Consider this: In 2007, Mercy's ER treated 692 patients for tooth

pain. The ER at Mercy's Hackley Campus treats about 100 patients

monthly for headaches, according to hospital official data.

Going to the emergency room for a toothache or headache costs more

than going to a dentist or family doctor because emergency rooms are

geared to deal with worst-case medical scenarios, around the clock,

every day of the year.

" We're the safety net ... people come to the ER when they have nowhere

else to go, " Zyniewicz said. " Forty percent of the patients we see are

uninsured or underinsured. "

Translation: Some of those patients will not pay their medical bills.

Allore said many of the unpaid medical bills that Mercy Health

Partners incurs come from the ER. But he said some of the largest

unpaid bills come from patients who were admitted for surgery or other

costly procedures.

Allore said he routinely sees cases in which uninsured patients have

racked up hospital bills of more than $100,000.

" I've seen some charity care cases that were significantly larger than

that, " Allore said. " It's kind of scary. "

Are those costs passed on to the rest of society through higher

health-care costs, higher taxes and more expensive insurance premiums?

" Ultimately, yes, " Allore said.

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