Thread: Hospital social workers 'get creative' for uninsured patient

Monday, 18 August 2008
Hospital social workers 'get creative' for uninsured patients Print E-mail
Ace Stryker - Daily Herald

Every week, the emergency room at Utah Valley Regional Medical Center sees illegal immigrants and other uninsured victims of trauma and sickness.
As part of the nonprofit group Intermountain Healthcare, the hospital treats everyone who walks through its doors. But many, after receiving immediate care, need follow-up attention in a skilled nursing or rehab facility or through home health care. In most cases, that's easy enough to arrange; but among patients without a means to pay the sometimes mountainous costs, it can get tricky to find services willing to take them. That's where UVRMC's team of 10 social workers comes in.

"There is sometimes difficulty when there's not insurance, no matter who they are," said Doug Huff, a discharge planner with the hospital's cardiac areas.

A trend that has been called "cold" and "disturbing" is growing from scattered hospitals across the United States: Required by federal rules to help arrange follow-up care, some health care facilities are deporting foreign nationals because there is nobody willing to accept them. The New York Times reports that dozens of victims are being forcefully repatriated each year from places like Phoenix, San Diego and Fort Lauderdale, Fla. But that has never happened in an Intermountain hospital, spokeswoman Janet Frank said -- although some hospitals have arranged transportation for patients from out of state when they are discharged.

"We never ask the status," she said. "We don't know if they're legal or not legal."

Kimball Anderson, chief operating officer at Mountain View Hospital in Payson, said his staff has never considered deporting an illegal immigrant after treatment.

"I think that's kind of cold," he said. "We've had to arrange transportation for patients that are indigent -- not necessarily illegal."

That recently included a family from Washington who needed medical attention after suffering a car crash. Mountain View bought the family bus tickets home, Anderson said.

At Mountain View, social workers are available to help uninsured patients after acute care, but employees more often provide patients with information and let them make their own choices, he said. If follow-up care can't be arranged, community clinics often help out.

"There has never been a situation, to my knowledge, where we have arranged transportation for someone out of this market or out of this state because we didn't want to take care of them," he said. "I don't think there's a hospital in the state of Utah that would do that."

There are a variety of possible solutions in "challenging" situations involving uninsured patients, Huff said -- but only some of them work, and only some of the time. One of the best solutions is to get these victims public assistance, although that's really only practical for some patients because it takes so long to secure it, he said.

"If a person's been involved in a trauma and they are disabled, we can begin the process of trying to get them Medicaid through the state, and maybe the right links to get them into the Social Security system," he said. "We look at those early on to see if we can kind of get the ball rolling."

Often, there is not enough notice. It then falls to the hospital to find services willing to take patients without guarantee of payment. The likelihood of success depends largely on the health of the patient, Huff said.

"Most of the skilled nursing facilities are willing to look at the case with the possibility that Medicaid isn't for certain yet, but it will probably come," he said.

Sometimes, though, when you've got to advocate for your patients, it comes down to simple begging.

"A lot of times you have to get creative, and you have to talk to facilities and get on bended knee and say, 'Hey, can you help us out?' " he said.

Failing that, there are several other nonprofit groups in the area that frequently help with home health care, Huff said. But if it gets to that point, it's not unheard of for the hospital to keep patients until they're healed -- Huff offered the example of a patient who stayed an extra six weeks for antibiotics.

"Many times, we just have no other options," he said. "We have to make sure that their antibiotics are taken care of."

Mountain View also participates in a program of the South County Health Coalition in which health care providers share the risk associated with uninsured patients, making it more manageable, Anderson said.

"They've come up with sort of a rotating plan where nobody's taking on an unnecessary burden," he said. "It's a good thing."

• Ace Stryker can be reached at 344-2556 or astryker@heraldextra.com.

http://www.heraldextra.com/content/view/277078/17/

This law about not asking immigration status has got to change. Sure, give the patient critically needed care but then send them home to where they came from before they climbed the fence or overstaying their visa.

"A lot of times you have to get creative, and you have to talk to facilities and get on bended knee and say, 'Hey, can you help us out?' " he said.

Facilities will sometimes help out in RARE cases, but not when presented with a tsunami of non-paying patients. Medicare will take care of the US citizen patients, illegal alien patients need to be deported.

Failing that, there are several other nonprofit groups in the area that frequently help with home health care, Huff said. But if it gets to that point, it's not unheard of for the hospital to keep patients until they're healed -- Huff offered the example of a patient who stayed an extra six weeks for antibiotics.

"Many times, we just have no other options," he said. "We have to make sure that their antibiotics are taken care of."

Six weeks hospital stay for antibiotics??? You could have bought the whole phamceutical co. for what that must have cost! Talk about excessive abuses!