Thread: Throwaway workers...unpaid bills squeeze US hospital's recou

THROWAWAY WORKERS

Unpaid bills squeeze U.S. hospitals'
By Bruce Japsen
Tribune staff reporter
Published October 22, 2006


When an illegal immigrant suffers a serious illness or injury, it can cost hospitals tens of thousands of dollars a day, compounding an already mounting pile of uncompensated- and charity-care expenses generated by the uninsured at U.S. facilities.

And when illegal immigrants have no family in the United States to take them in to convalesce, it's common for hospitals to spend $25,000 or more to fly them back to their home countries such as Mexico, Poland, the Ukraine or South America on medically equipped jetliners.

Hospitals can seek some relief through a $1 billion federal program that offers reimbursement for emergency room costs associated with undocumented immigrants, but inpatient and extended care are not covered, and those costs add up quickly and put a strain on hospitals.

"If you talk to any hospital executive and ask them what their problems are, the whole issue of uncompensated care is the first issue out of their mouths, and illegal immigrants are certainly a part of that," said Kevin Scanlan, president and chief executive of the Metropolitan Chicago Healthcare Council. "Any care you render illegal immigrants does become uncompensated care. It becomes bad debt if you cannot collect, and it is a growing problem."

Hospitals in neighborhoods with large populations of undocumented immigrants, such as Mt. Sinai Hospital on Chicago's West Side or trauma centers like Advocate Illinois Masonic Medical Center on the North Side, say it's common to have three or more undocumented immigrants in their facilities on any given day. That's more than 1,000 a year per hospital.

One patient, a 32-year-old Lithuanian construction worker who suffered a severe head injury when he was hit by a car, has run up a bill of more than $500,000 so far at Mt. Sinai, where he has been cared for since March 14.

Already, U.S. hospitals say they provide more than $26 billion in uncompensated care annually, or the equivalent of 5.6 percent of total hospital expenses, according to the latest figures provided by the American Hospital Association.

Uncompensated-care costs at U.S. hospitals soared more than 60 percent, or by $10 billion, from 1994 to 2004, the most recent year for which the hospital association has figures.

The association has not tallied the full extent of undocumented immigrants' impact on uncompensated-care costs, but representatives say they are certain it reaches into the billions of dollars annually, citing several regional studies completed in recent years. The association often quotes a 2002 study that put the annual cost of emergency hospital services and transportation costs at more than $200 million for hospitals along the border with Mexico.

The report commissioned by the U.S./Mexico Border Counties Coalition, which used cost data from 2000 for hospitals in just the 24 counties adjoining the Mexican border, represents a fraction of today's total spending. Even that data only represents patients who were facing medical emergencies, an expense for which hospitals can get some minor reimbursement through a federal program created three years ago under a Medicare reform bill.

The program pays for emergency care until the patient is stable, which hospitals say is usually two days. After that, hospitals say they must eat the costs for the balance of the patient's inpatient hospital stay.

Costs for uncompensated care are generally accrued by the nation's nearly 47 million uninsured Americans, or about 16 percent of the total U.S. population, a U.S. Census bureau report in September stated.

Some states, and even businesses, have begun to set up mechanisms to pay for health benefits or establish policies that let hospitals receive payment for uninsured U.S. citizens through extensions of state Medicaid health insurance programs for the poor.

But such a safety net does not exist for undocumented immigrants. Because they often do not have identification or do not want to reveal their identities, it is difficult for care providers to submit bills to the government or other special programs for the poor and uninsured to get reimbursed for services. About $97.5 million, or less than one-third of the money available in the first eight months of the emergency care program, was used by hospitals and other providers, the Centers for Medicare & Medicaid Services said.

Some hospitals are uneasy with the requirement that they document whether their patients are eligible for the federal money, and it can be difficult to convince illegal immigrants to share any identifying information, such as their passport or birth certificate.

"Almost all the time they do not want to give any information to help us try to get payment from Medicaid" or other programs, Scanlan said. "If they are totally unknown to us, then we have to assume they do not qualify for anything and then they become a cost and an expense for the hospital to provide."

And when immigrants put off medical care for fear of being detected, it creates a situation that often festers for the immigrants and the hospitals, public health officials say.

As medical conditions worsen, the sick eventually return to the hospital with more complex and costly medical problems--problems that have no one to pay for them.

"When you are too sick, you show up at the emergency room because they do not ask too many questions," said Edward Mensah, associate professor of health economics at the University of Illinois at Chicago School of Public Health. "Usually, they will end up in the emergency room, and the cost of treatment in the emergency room for even simple problems is very expensive."

Mt. Sinai, at California Avenue and 15th Street on Chicago's West Side, reported that between 5 percent and 25 percent of its patients are uninsured.

"What it does to the system is it takes resources from other patients, and there is a cost associated with it," said Larry Volkmar, Mt. Sinai president and chief executive officer. "We have two to three patients that are undocumented on any given day."



Getting home not easy

Mt. Sinai officials are still trying to find a home for Sergej Jakolev, whose head injuries have left him unable to walk since being hit by a car near 24th Street and Western Avenue in March.

The nature of the injuries left him unconscious and made it difficult for Sinai staff to even identify him. The hospital turned to Russian radio stations to help find friends or family when they initially thought he was Russian or Polish. As his condition improved, hospital officials were able to learn that he was Lithuanian, and they are working with the Lithuanian Embassy in the United States to get him home and admitted to a facility in that country.

While functioning "like a low-level brain injury patient," he will need special transportation by an air ambulance to get him back to Lithuania and admitted to a long-term care facility. Costs for such trips run $25,000 or more, hospitals say.

"The reality is, we cannot get him placed anywhere," Volkmar said. "We might have three people in the hospital who do not have that same story, but there are two or three patients that are undocumented that are difficult to place somewhere."

In the Lithuanian patient's case, the driver who hit him had insurance, but the driver's policy had a $25,000 cap on bodily injury coverage, Volkmar said. "That is a drop in the bucket."

Sinai officials say the Lithuanian Embassy in the U.S. has contacted the man's mother, and officials hope they can get him home soon.

Similar stories are playing out elsewhere. At Advocate Illinois Masonic, the hospital estimates at least 6 of about 100 patients who come through the emergency room each day are undocumented. Beyond the emergency room, there is no reimbursement for the three of those six patients that end up being admitted and staying for at least one night and likely longer, the hospital said.

"Not all patients recover to the point where they can return home independently," said Kenneth Laube, director of care management service at Advocate Illinois Masonic, one of eight hospitals operated by Oak Brook-based Advocate Health Care.



Transportation costs thousands

If the patient is returned to his or her home country, Advocate said the cost of transportation can vary from a medically-equipped air ambulance at more than $25,000 to a commercial flight that costs $2,000 plus the cost of a health-care worker the hospital must send along with the patient.

Earlier this year, Masonic discharged a Ukrainian construction worker who had two neurological surgeries and had been in the hospital for 103 days. He was able to walk out of the hospital, said Advocate officials, who described him as in his mid 40s but would not name him, citing federal privacy laws.

"We arranged for a commercial flight back," said Alberto Godinez, a social worker at the hospital. "We also sent an employee who spoke the language and was able to help him."

Because undocumented immigrants do not have health coverage, they often have to be sent home--even when they have loved ones in the United States--if relatives cannot afford to take them in, hospitals say.

Jeff Welch, a social worker at Advocate, said a Mexican restaurant worker in his mid-40s had a stroke and was bedridden for several weeks, but his daily rehabilitation needs were too much for his support network outside the hospital to handle.

"He had a wealth of support here, but because of the extent of his needs, his friends here could not meet his needs," Welch said.

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bjapsen@tribune.com

http://www.chicagotribune.com/business/ ... erline-411

If you get injured in Mexico and can't pay up they will just leave you on the street!

If you get injured in Mexico and can't pay up they will just leave you on the street!

They will probably give you a chance to call someone to come and get you, THEN throw you on the street!