Uninsured Care: Denver Health May Cut Service as its Costs Soar - @ JEMS.com

Uninsured Care: Denver Health May Cut Service as its Costs Soar


Christopher N. Osher | | Wednesday, November 26, 2008

DENVER -- Denver Health Medical Center's costs to provide care for the uninsured next year are expected to come in $75 million higher than they did in 2007, forcing the hospital to consider cutting services.

Any cutbacks would come at a difficult time for indigent patients, who are using hospital services at a higher rate because of the downturn in the economy, health care officials said.

"If the safety net deteriorates, they're not going to have anyplace to go," said Dr. Patricia Gabow, chief executive officer for Denver Health.

She has been briefing U.S. Rep. Diana DeGette, D-Colo., and House Speaker Nancy Pelosi, D-Calif., on the issue. DeGette is pushing for an overhaul of how the federal government helps hospitals that end up shouldering a disproportionate share of such uninsured costs.

"I"ve been in Congress 12 years, and it's been underfunded virtually that whole time," DeGette said.

During a meeting with the editorial board of The Denver Post, Gabow added that the hospital is grappling with other challenges that also could significantly affect how health care is delivered in Denver.

Cuts elsewhere

Other hospitals in the metro area have eliminated emergency beds for the mentally ill, leaving Denver Health as virtually the only provider of such services, Gabow said.

Recently, University of Colorado Hospital announced that it was closing its 18 beds for psychiatric patients at the Anschutz Medical Campus in Aurora. Hospital officials complained that there was a lack of support from insurers and the government for maintaining those services.

The decline in emergency care for the mentally ill has forced the criminal justice system to absorb the overflow. Recent studies show that up to 17 percent of the 2,400 inmates at the Denver jails at any given time have serious mental illnesses, Gabow said.

Resisting tighter rules

Gabow also signaled that Denver Health may resist efforts to bring the hospital into compliance with National Fire Protection Association standards for paramedic response times.

Katherine Archuleta, a senior aide for Denver Mayor John Hickenlooper, recently told the City Council that the mayor expects a new contract to embody those standards, at a minimum.

The NFPA requires 90 percent of all calls requiring advanced life support to have a response on scene within nine minutes after a dispatcher answers an emergency call. Denver Health uses a different standard: 85 percent within eight minutes and 59 seconds starting at the time an ambulance becomes available to respond to the call, which sometimes is delayed from when a dispatcher receives a call.

Forcing the paramedic division to comply with the NFPA standards would increase costs at a difficult time for the hospital, Gabow said. She added that response times may not be the best way to measure paramedic service and encouraged instead a system that would track patient outcomes.

Archuleta did not return telephone messages seeking comment.

Hoping for federal aid

Gabow said she hopes Congress early next year will come up with new aid and formulas for how uninsured costs are calculated to provide some relief.

She said the hospital's costs for treating the uninsured added up to about $275 million last year. They are projected to jump to nearly $350 million next year, up from about $300 million this year.

The costs for treating the indigent and uninsured are also increasing at University Hospital, and officials there are still working on a plan to deal with the problem, said Jacque Montgomery, a hospital spokesman.

Early warning

"We're the canary in the mine shaft," Gabow said. "When something bad happens in the economy, we tend to see it on our doorstep."

Gabow said the actual numbers may even end up worse than projections. She said uninsured costs could jump even higher if Colorado sees as steep an economic downturn as other areas of the country are experiencing.

She added that she fears the possibility of further Medicaid cuts to hospitals, causing the hospital further financial pressure.

Gabow said that if Congress does not come up with the new formulas she is seeking, she will be forced to cut services to the uninsured. Federal programs help the hospital shoulder some of the costs of the uninsured, but there is an 18- month lag in when that money comes to the hospital, Gabow said.

Those federal formulas have not allowed for any inflationary cost increases since 1997. In past years, the hospital was able to have the federal government pay as much as 30 percent of the costs for the uninsured. In recent months, the costs have risen so much that the federal assistance is accounting for less than 20 percent of the cost these days, she said.

DeGette said she supports letting states like Colorado tap federal aid for the poor that goes unused in other states but would also like to see a new formula that would provide adjustments for inflation.

Lawmaker's plans

DeGette said Congress recently extended unemployment benefits to the jobless. Now, she said, it's time for Congress to start looking at finding a way to provide insurance for those who lose their jobs or for the uninsured working poor.

"It's a really serious problem," DeGette said. "I have hopes with the new administration and the increased (Democratic) majority in Congress that we will be able to do something to fix the problem."

Christopher N. Osher: 303-954-1747 or cosher@denverpost.com

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