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Hospitals, Clinics Make Deal for Health; Crowded Emergency Rooms Get Relief, While Patients Get the Care They Need Close to Home

Posted on: Sunday, 4 December 2005, 15:00 CST

By GUY BOULTON

When Covenant Healthcare treats a Medicaid patient in one of its hospital emergency rooms, it generally loses money.

When Milwaukee Health Services Inc., a community health center, sees the same patient at one of its clinics, it makes money.

That economic fact rooted in the different fees each receives from Medicaid underlies an agreement that could increase health care services for the urban poor while saving Covenant money.

Covenant has pledged more than $250,000 to help Milwaukee Health Services open a clinic in northwest Milwaukee.

The goal is that it would take patients who currently seek basic health care and reduce the number of patients at the emergency departments of Covenant's two hospitals in that area, St. Michael Hospital and St. Joseph Regional Medical Center.

Covenant estimates that 78% to 83% of patients at St. Michael's and St. Joseph's emergency departments could be treated by primary care physicians.

"People aren't getting the care they need in the community," said Bob Speer, Covenant's regional director of community partnerships.

Changing that could help stanch Covenant's losses at St. Michael Hospital. The hospital has lost nearly $75 million in the past four years, including $23 million in its most recent fiscal year ended June 30.

"We know that we cannot meet all the needs by ourselves, so it made sense for us to think about whom we can best partner with," Speer said.

Caring for basics

The agreement between Covenant and Milwaukee Health Services is an outgrowth of the growing recognition of community health centers' roles in the health care system. It also is an outgrowth of the growing burden on inner-city hospitals that treat a disproportionate share of people who are uninsured or who get health care through Medicaid and Milwaukee County's General Assistance Medical Program.

Medicaid is the state-and-federal health program for poor families with children and for people who are disabled or elderly and impoverished. General Assistance care provides health care to people who are indigent and not eligible for other public health programs.

By law, community health centers must be located in rural and urban areas with high rates of poverty and a shortage of doctors. They receive federal grants to offset the cost of providing health care to the uninsured, who pay a fee based on their income. They also receive higher payments from Medicaid.

The four community health centers in the Milwaukee area will treat about 57,000 patients this year. And health care systems, such as Covenant, know that were it not for the community health centers, many of those patients would end up in hospital emergency departments.

Aurora Health Care, for instance, now gives $120,000 a year to Milwaukee Health Services to offer longer hours at the Martin Luther King Jr. Heritage Health Center near downtown Milwaukee.

The hope was that the expanded hours would reduce the number of patients who seek care at the emergency department of Aurora Sinai Medical Center a hospital that has lost $72.1 million in the past four years.

Aurora has similar relationships with other city clinics. So, too, do other health care systems.

The Sixteenth Street Community Health Center has had a longstanding collaboration with Columbia St. Mary's, while the Westside Healthcare Association has had a similar relationship with Froedtert & Community Health and the Medical College of Wisconsin.

"We all have relationships with hospitals and health systems," said Jenni Sevenich, executive director and chief executive of Westside Healthcare.

Clinical collaboration

Covenant also helps supports several clinics, including the Angel of Hope Clinic of Health Care for the Homeless of Milwaukee. But it now is taking an active role in helping a community health center expand to an area largely served by two of its hospitals.

"It makes sense for all concerned," said C.C. Henderson, president and chief executive officer of Milwaukee Health Services.

The collaboration would enable Milwaukee Health Services and Covenant to benefit from the higher rates, mandated by the federal government, that Medicaid pays community health centers.

$108 vs. $150

Medicaid pays Covenant $108 to treat a patient at one of its emergency departments who is not admitted to a hospital, said Anne Ballentine, a Covenant spokeswoman. That fee doesn't change no matter how many tests are done. In most cases, the hospital loses money.

In contrast, Medicaid pays Milwaukee Health Services more than $150 to treat a patient.

And, in most cases, the community health center makes money.

But Covenant's Speer said, "This is not only a good business decision this is good for patients."

At a hospital emergency department, a patient is treated and sent home. At a community health center, a patient typically is assigned to a doctor who can provide continuous care.

One specializes in emergencies, the other in primary care, including early intervention and prevention.

Milwaukee Health Services, for example, has done 352 Pap smears, 292 breast cancer screenings, and 2,400 childhood immunizations so far in its fiscal year ending Jan. 31.

24,000 patients this year

In all, Milwaukee Health Services will treat close to 24,000 patients this year up from slightly more than 16,000 in 2001.

The community health center, which has an annual budget of about $12 million, operates two clinics: Martin Luther King Jr. Heritage Health Center, at 2555 N. King Drive, and Isaac Coggs Health Connection at 2770 N. 5th St.

More than half of its patients get health care through Medicaid, and more than a fifth get health care through the General Assistance Medical Program.

About 10% of its patients don't have health insurance though Henderson said the figure would be much higher without General Assistance care.

Convenience and efficiency

Milwaukee Health Services hopes to open a clinic in the vicinity of Capitol Drive and 55th St.

The expansion which would cost about $10 million is still in the early planning stages. But under the tentative plan, Milwaukee Health Services would close its Isaac Coggs clinic, which is near its main clinic.

"It makes very little sense to have two centers within three or four blocks of each other," Henderson said.

At the same time, it would expand the Martin Luther King Jr. Heritage Health Center, and open the new clinic in northwest Milwaukee.

That's an area where low-income residents have migrated in recent years.

To finance the expansion, Milwaukee Health Services is talking to investors who potentially would buy a building for the new clinic, Henderson said.

Investors can get tax credits

The investors would benefit from federal tax credits designed to encourage investment in depressed areas. The details still need to be worked out.

Henderson hopes to have an agreement in place in three to six months. If everything comes together, the new clinic could open late next year.

For its part, Covenant has agreed to provide $100,000 to help with the planning, including hiring consultants. It also will help recruit physicians, subsidizing their salaries, and provide additional services, such as staff training.

Covenant knows there is no guarantee that the planned expansion will happen.

"It's a tall order," Speer said. "But we've seen good leadership at that organization, and we have faith they will be able to pull it off."

Copyright 2005, Journal Sentinel Inc. All rights reserved. (Note: This notice does not apply to those news items already copyrighted and received through wire services or other media.)

Source: Milwaukee Journal Sentinel

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