Sunday, September 10, 2000
Program may trim paperwork
Uninsured face red tape to get medical care
By Tim Bonfield
The Cincinnati Enquirer
People who don't have private health insurance still get medical care when they get sick, but proving they are poor enough to qualify for government or charity help often takes a blizzard of paperwork.
Neighborhood health clinics that offer sliding fee discounts want to see pay stubs or tax forms to document income. Ohio's Medicaid program for low-income people wants details on disability payments and child support checks.
Hospitals ask about rent payments, credit card bills and checking account balances. Hamilton County, which has a tax levy that repays Children's and University hospitals for indigent care, wants proof that patients actually live in the county.
Forms for uninsured patients routinely ask questions about U.S. citizenship, marital status, and for information about other household members. Then much of that information must be repeated as patients move among clinics, hospitals, diagnostic centers and specialists' offices to receive treat ment.
Cutting away some of that paperwork is a key goal of the Southwest Ohio Community Access Program, which won a nearly $900,000 federal grant Thursday. The money will pay to launch a three-county program intended to streamline care for the uninsured.
Right now, we have a patchwork system, said Randy Garland, president and chief executive of the Cincinnati Health Network, the leading organization in the program. On the patient side it's very demeaning to document your poverty level over and over again. On the provider side, all those application forms cost time and money to process.
Few realize the how expensive caring for the uninsured in Greater Cincinnati can be.
An estimated 110,000 to 173,000 people in Hamilton, Butler and Clermont counties spent at least part of 1999 without health insurance, according to the Community Access Program grant application.
Many sought medical care at vast expense to local government and charitable agencies.
The uninsured accounted for nearly 47 percent of visits to neighborhood health clinics and about 5 percent of all hospital discharges in 1999. The hospitals estimate they lost more than $100 million in uncompensated care.
In fiscal 1999 (ended June 30), the mental health and drug addiction boards of the three counties subsidized about $60 million in care to the uninsured. Meanwhile, the tax-supported Drake Center provides about 53,800 days per year of long-term nursing and rehabilitation care year to uninsured patients.
While local tax levies, a statewide hospital charity fund, and a variety of charities help pick up these costs, health care providers say many uninsured people probably qualify for government health programs like Medicaid and CHIP (an insurance program for children of uninsured working families).
The federal grant will pay for the people and equipment to build a regional registration system that will streamline financial applications and care for the uninsured.
By creating a central information bank, the Community Access Program also hopes to route more people to the benefits they qualify for, which in turn will help stretch local charity dollars, Mr. Garland said.
Meanwhile, doctors hope the program also will promote better disease management for uninsured people with chronic illnesses such as diabetes, asthma, depression and hypertension.
The idea is to get often competing medical organizations to agree on what tests, medications and preventive services to provide to patients with common, ongoing health problems, said Dr. T.J. Redington, medical director of the Cincinnati Health Network who also serves as director of community health for Health Alliance of Greater Cincinnati and medical director of Ohio's Medicaid program.
For example, providing more regular check-ups and education for diabetics can save money on emergency treatments for complications that occur when the disease is not well-controlled, Dr. Redington said.
While many private HMOs, doctor groups and hospital systems already use disease management programs, getting the far-flung array of organizations involved in uninsured care to start working together has required much more effort, Dr. Redington said.
Building the Southern Ohio Community Access Program was a massive job, Mr. Garland said. The grant application exceeded 140 pages. Assembling the plan required months of collaboration among 27 community agencies, 23 clinic sites and 18 hospitals.
With the money approved, some parts of the program will be launched within weeks, Mr. Garland said. But it still may take nine months for the paperwork changes to begin affecting uninsured patients, he said.
The following organizations have signed memos of understanding to participate in the Southwest Ohio Community Access Program. Many other organizations wrote letters to the federal government supporting the grant application:
Babies Milk Fund Pediatric Care.
Children's Hospital Medical Center.
Cincinnati Health Network.
Cincinnati Board of Health.
Health Alliance of Greater Cincinnati.
Legal Aid Society of Greater Cincinnati.
Mercy Health Partners.
Southern Ohio Health Services Network.
Source: Southwest Ohio Community Access Program
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