Issues in health care delivery in Hyde Park and Kenwood

Presented by Hyde Park-Kenwood Community Conference and its website www.hydepark.org

Visit our Helpline, Community Resources, and Persons with Disabilities pages for information on providers and accessing care.

Visit the Village page for its new board selected December 2012. Check out the new board of the Hyde Park Village in Village page.
Drop in at Augustana 1st and 3rd Wednesdays.

Meetings and seminars

Thursday, 11 am. Healthcare info- Medicaid and Marketplace signup. Thursdays at Blackstone Library, 4904 S. Lake Park. 312 747-0511.

July 19, Saturday and July 20, Sunday, 2-5 pm. Wellness and Politics series "China/Africa adn teh 21st Centerury" at Afrocentric Frontline Books, 5206 S. Harper Avenue. Free. 773 288-7718.

October 29, 2014. A large rally of those seeking a Trauma Center at UC was held beside the kickoff event for the University's $3.4 fund drive.

UNIVERSITY OF CHICAGO'S SIDE ON TRAUMA CENTER: http://www.uchospitals.edu/pdf/uch_028322.pdf

The UC Medical Center has been funded to conduct a study on advantages of the same physicians treating patients at risk of frequent hospitalization during both outpatient and inpatient phases, especially when time comes to consider end-of-life options.

The Medical Center has filed a Certificate of Need to shift almost all the remaining patient beds in Mitchell to the Center for Care and Discovery with an increase in intensive care and observation beds there. Mitchell will be converted (except the ER) for outpatient, research lab, and office space. A new expanded supplies dock and storage is under construction as part of the new garage north of 57th St.

UC Police response to trauma center demonstration, including arrests and alleged beatings, at new hospital pavilion January 26 2013 causes anger and shock, as does rigid "no" to any meeting on accommodations such as raising the age at the Comer children's trama center to 21. The matter since was complicated by practices of University Police, including presence of unannounced detectives among marchers.

A study by a Northwestern professor, reported by WBEZ, shows that there is a significant increase in mortality of gunshot victims brought more than 5 miles to a trauma center.

UC Medicine received an additional $23 million in July 2012 to speed research findings to bedside.

A very large march with many groups participating marched (6th march) to Northwestern Hospital was held May 12 2013, on the Trauma Center and issues. Opinions, expert and lay, on the issue range from this being an absolutely real need, to being just an expensive fix that would make little difference in saving lives for more than a few and would divert resources from other healthcare access and anti violence approaches.

Olivia Woolam is gathering signatures on a petition for a 3rd party survey of feasibility of a level 1 trauma center at U of C. Here is the site:
http://signon.org/sign/ucmc-run-a-feasibility?source=c.em.mt&r_by=516447

A recent study shows that the differences in neighborhood conditions strongly predict who will be healthy, who will be sick, and who will live longer, independent of income. The Washington, D.C.-based Joint Center for Political and Economic Study released Thursday a report that examines how social and economic conditions in Cook County are linked to poor health outcomes.

The report, “Place Matters for Health in Cook County: Ensuring Opportunities for Good Health for All,” is part of a series of reports supported by a grant from the National Institute on Minority Health and Health Disparities of the National Institutes of Health.

U of C MC will start training 27 percent of its nurses as sexual assault nurse examiners.

The Urban Health Initiative of U of C received in May 2012 $5.9 million Innovation Grant from the federal Health and Human Services Dept. to set up a Community RX system to assist South Side residents on Medicare, Mediate or Illinois assistance link to doctors and clinics and services near their homes. 90 jobs will be created and will build on the Database and Network created already. UHI's predecessor was established by Michelle Obama and is now headed by her friend Dr. Eric Whitaker. The new database will draw upon on a street and online survey of many south side neighborhoods trying to fill in the highly inadequate date of what's available to citizens and patients. One goal is to be able link patients immediately to the best ongoing treatment and prevention of recurrence.

How does widely preferred the model of directing patients to "homes" and away from hospitals work in practice? A preliminary study by U of C. Urban Health Institute indicates that hospitals are saving money but primary health centers and clinics' costs including per patient are rising, and overall costs are not going down.

The verdict seems to out as to whether the new model in the Affordable Care Act, really works. This is ACO or Accountable Care Organization that is wrap-around and aims to keep track of patients and patients on track so they are not repeat admissions to hospitals. The readmission rate at AdvocateCare seems to be lowering the readmission rate. But it took a lot of expense and work to set it up. Some critics say there is no empirical evidence of sustainable cost controls, and that they are trying to do four difficult things simultaneously--world-class quality, affordable care, coverage for all, and immediate availability. The next roll out is for Medicare patients.

Various rallies and letter-writing is underway to ask aldermen to block the closing of half the city's mental health clinics and privatize the health clinics. SOUL is one of the supporters. In the week of April 10 2012, dozens barricaded themselves in the Woodlawn Clinic and were eventually evicted. The city insists that there will be no diminishment of services or patient load, but the objectors say the remaining clinics will be overwhelmed, have to travel-- or won't go! to distant, unfamiliar clinics. After arrests (one charged) the group is "occupying" a space across the street in cooperation with STOP.

Message from Mental Health Movement.

A Mental Health Movement action: Presidential Pardon for Clinics on Death Row -- April 30 -- 11am, downtown

As you've probably seen on the news, we are in a down-to-the-wire battle with City Hall right now to stop our city clinics from closing on April 30th. We've appreciated all the solidarity we have seen from our allies during the clinic occupation and the subsequent 24/7 camp-out we are maintaining outside the Woodlawn Clinic at 6337 S. Woodlawn. The outpouring of support has been overwhelming, we have food around the clock for the most part and have had several great turnout events with lots of allies, most recently last Saturday at our People's Health Fair and Rally to #SaveOurClinics.

Next big steps:
We need your help in turning out as many people as possible for our April 30 march downtown. We all have a stake in Mayor Emanuel taking a defeat on this issue; the repercussions will extend far beyond saving the city's mental health clinics. Already the clinic occupation and ongoing camp-out have been called the "Birmingham and Stonewall of the Mental Health Movement" and is being watched nationally. Please get in touch with us to let us know if you can turn people out for the following:

1) Presidential Pardon for Clinics on Death Row - April 30 - 11am
Please join us at Obama Headquarters, 130 E. Randolph at 11am on Monday 4/30, the scheduled day for the closure of the remaining 4 mental health clinics, to ask President Obama to pardon our clinics and the people who use them from the death that closure will mean.

2) Town Hall 2nd Week of May
We don't have a day/time/place but in the second week of May we will host our own People's Hearing on the clinic closings (or victory celebration if we've won by then) at which we hope to have the majority of City Council in attendance at a large event downtown. Your organization's help in turning out any Alderman you have a relationship with would be much appreciated. (Also, please let us know ASAP events already taking place that week so we can schedule this event at a time that doesn't conflict.)
Please forward this message widely! If you can't come to the above events, consider sending food, water, juice, coffee, blankets, tarps, or other treats to us at the Woodlawn Clinic 6337 S. Woodlawn, we are there 24 hours a day, 7 days a week.

The University of Chicago Medical Center was investigating claims in May 2011 that it discriminated in terminating patients with disabilities after twelve weeks of leave. The University contests the claims. OECC has not decided whether to issue charges.

Institute for Excellence in Medicine, under direction of Dr. Mark Siegler received a large grant. Some will go to support medical students, some to support their mentoring and research faculty (up to 8) so they will not only develop best practices with dealing with patients (including communication and bedside) but carry it to the hospitals and schools where they serve.

In June 2012, Leapfrog gave the UC Medicine a score of 3.54, putting it, along with 8 other Chicago area hospitals in the top 10% nationally in six areas as measured by survey. It was flawless on safety processes and top marks for leadership structure, teamwork, nursing workforce despite the problems and leadership change and union change experienced during the timeframe measured. So on culture of safety it did very well. It did not do quite as well on measures from data from Centers for Medicaid and Medicare Services. It did better on conditions acquired during hospital stay than on preventable falls - flawless on preventing air embolisms and pressure ulcers and preventing foreign objects during surgery. It lagged other hospitals on death from serious treatable complications after surgery. UC and Advocate Trinity were the only Chicago hospitals to earn an A.

September 14, 2011, the Hyde Park Herald began a 5-part series on the South Side trauma center and healthcare delivery matter, "Range of Injury," under lead writer Sam Cholke. http://www.hpherald.com. There seems to be an impenetrable impasse and disagreement on how much a trauma center is needed or how much help it would be on the South Side, but one hard path includes addressing the violence and the disparities that help promote it. Find it in the Herald Archives.

Group insisting on a trauma center at UC in confrontation with police over tent city. More

It was unknown in late August 2011 whether UCMC would be effected by removal of non-profit status for three Illinois hospitals. (Decisions put on hold by the board.) Neither the state supreme court, legislature, nor governors office had set standards of what qualifies as charitable or community contribution or what percentage of income or outlays that should be.

Cuts in state meals, medicine cost assistance worry social monitors. The collapse Carl Bell's once huge mental health services is especially troubling.

Studies say Medicaid services save lives.

2011. More SRO's are closing partly due to their deterioration and code violations. This reduces the amount of housing of last resort, last barrier to homelessness. However, many think it is smarter and a better long-range solution to put monies into newer "supportive housing" which puts people in proximity to the services they need, supported by a mix of city, state, and federal housing programs and philanthropic funds. Renters pay about 30 percent of income.
Note that many especially with disabilities cannot afford a deposit plus one month's rent. Lumped with this, despite a recent major agreement signed by the Governor in conjunction with new state laws enabling people to move out of nursing homes to community based care, the hesitancy or refusal of many or most of the premium healthcare providers to sign up for the new Medicare program seems to be greatly disrupting the ability of many to keep their caregivers and services, in turn snowballing into housing problems.

The US Surgeon General has pointed to the impact of personal life and priority choices on "big problems" such as obesity-- one being that a major reason among women for skipping exercise is the time and expense they have "just" put into hair care.

The 3x / week walking (MWF) and 2x / week fitness class (MW) are still going strong. The free program is sponsored by University of Chicago Medical Center Community Affairs. Registration is required to get your badge that gains you entrance into the Museum and free parking in the garage. Here is the web site to visit for details and the contact information.
http://www.uchospitals.edu/programs/community/programs/fitness.html

2011 OWL National report on Health Care Act on elderly esp. women: http://www.owl-national.org/Mothers_Day_Reports.html.

2. Link to web video of January 25th , 2011 conference, sponsored by HMPRG, entitled “Implementing the Long Term Care Provisions of the Affordable Care Act in Illinois.” This is a really superb video, well worth watching.

http://hmprg.org/conference-materials-videos-from-forum-on-%E2%80%9Cimplementing-the-long-term-care-provisions-of-the-affordable-care-act-in-illinois%E2%80%9D/conference-videos-from-%E2%80%9Cimplementing-the-long-term-care-provisions-of-the-affordable-care-act-in-illinois%E2%80%9D/ <http://hmprg.org/conference-materials-videos-from-forum-on-%E2%80%9Cimplementing-the-long-term-care-provisions-of-the-affordable-care-act-in-illinois%E2%80%9D/conference-videos-from-%E2%80%9Cimplementing-the-long-term-care-provisions-of-the-affordable-care-act-in-illinois%E2%80%9D/>


OWL writes: Greetings to Hyde Park OWL Members and Friends,

Many of you are familiar with the Health & Medicine Policy Research Group (HMPRG), the organization founded by Hyde Park physician and former Cook County (Stroger) Hospital President Quentin Young.

On January 25, 2011, that organization sponsored an important conference on the Affordable Care Act (ACA), focusing on how the long-term care provisions of the Affordable Care Act could be implemented in the State of Illinois. The entire conference can now be viewed, on line, on your computer, if you control/click on the following link:

http://hmprg.org/conference-materials-videos-from-forum-on-%E2%80%9Cimplementing-the-long-term-care-provisions-of-the-affordable-care-act-in-illinois%E2%80%9D/conference-videos-from-%E2%80%9Cimplementing-the-long-term-care-provisions-of-the-affordable-care-act-in-illinois%E2%80%9D/ <http://hmprg.org/conference-materials-videos-from-forum-on-%E2%80%9Cimplementing-the-long-term-care-provisions-of-the-affordable-care-act-in-illinois%E2%80%9D/conference-videos-from-%E2%80%9Cimplementing-the-long-term-care-provisions-of-the-affordable-care-act-in-illinois%E2%80%9D/>

Move your mouse to anywhere on the link, hold down “Control” and then click with your mouse. You can see and hear the entire January 25th conference, including the five morning speakers and the afternoon interactive session with State of Illinois administrators who will be responsible for making ACA long-term care provisions work in this state. Audience questions and speaker answers are included.

 

Attn. to those who need to apply for insurance with a previous condition:

YouTube Video About Pre-Existing Condition Insurance Plan (PCIP)

This video from the Centers for Medicare & Medicaid Services presents an overview of the PCIP online application, information about what to expect, and what information you should have on hand when you are ready to apply online. PCIP makes health insurance available to people who have had a problem getting insurance due to a pre-existing condition. Find out if there's a PCIP in available in your state.
This information was recently added to Disability.gov. To learn more visit https://www.disability.gov/health/health_care/finding_health_care. (In par. near bottom of page)


Separate: Health care reform and law- what's in it.

Really want to see what it says? http://www.healthcare.gov/law/full/index.html. The Supreme Court says it can go into effect, but states cannot be coerced into expanding Medicare by withholding current federal match. Also, the law gives states a choice on setting up Exchanges. There are many options for persons and businesses.

Health Care Reform: Can We Work It Out in the Heat of August? | Illinois Humanities Council. More articles that they have links to are: An August Recess Health Care Reform Primer -- Politics Daily, & Health-Care Reform: How the Bills Stack Up, & Poll: Health Care Reform Foes More Likely To Give Voice To Views | The Plum Line, & $52 Million Has Been Spent So Far on Health-Care Reform Ads in What Could Be Record-Shattering Battle - washingtonpost.com.
Here is a highly recommended comparison chart from the Washington Post:
http://www.washingtonpost.com/wp-srv/special/nation/health/compare-health-plans-2009/?nav=most_emailed_emailafriend&referrer=emaillink
And this from the New York Times may be useful:
http://www.nytimes.com/2009/08/10/health/policy/10facts.html?em

A couple of breakdowns on the Supreme Court ruling on the Patient Protection and Affordable Care Act

A simple "what this means for me" calculator from the Washington Post:
http://www.washingtonpost.com/wp-srv/special/politics/what-health-bill-means-for-you/?hpid=z2

An interesting piece of some reporting doctors and companies will have to do as a part of the act from the Atlantic:
http://www.theatlantic.com/health/archive/2012/06/the-devils-in-the-details-for-doctor-transparency/259195/

For the administration's side, including a point summary of what it is and what it's not, visit http://www.WhiteHouse.gov/realitycheck.

The UC is still looking into whether to partner with Provident (with UC doctors, facility upgrade) and whether that would be as full service or outpatient, since it looks like Provident may be given the green light to not close. The expense both in capital and program would be enormous, but a first review said it could be a good investment for UC.

Provident is set to start shutting its emergency room doors to ambulance runs starting c. February 14 2011. Ambulances would be sent to U of C, Jackson Park and other hospitals-- which are often on "bypass." All the south side hospitals are meeting the week of the 8th to figure out how to handle the situation.

February 15, 2011. Cook County to reduce service at 2 public hospitals
Source: ChicagoTribune.com

Cook County's plan to drastically shrink services at two public hospitals
shifted into higher gear Monday with the announcement that 138 hospital
nursing jobs will be eliminated.

Provident Hospital on Chicago's South Side will no longer accept ambulance
runs starting Tuesday and will see the elimination of 37 nursing positions.

Oak Forest Hospital in the south suburb of Oak Forest will see more than
100 nursing staff reductions as the county proceeds with plans to convert
the facility to a primary care center, pending a state board's approval.

Both hospitals are part of the Cook County Health and Hospitals System,
which is following a strategic plan to reduce costly inpatient services at
the hospitals to make room for more outpatient care. Some nursing cuts
will take effect by the end of the month and others will happen later this
year, said health system spokesman Lucio Guerrero.


Timetable for what goes into effect, when

Many of the provisions included in the healthcare reform legislation approved Sunday-and the bill that adds fixes to that measure that was sent to the Senate-would take place not immediately, but along a 10-year timeline through 2020. Here's a glimpse of how that timeline rolls out:

2010

Adults with pre-existing conditions who have been uninsured for at least six months can enroll in a temporary high risk health insurance pool and receive subsidized premiums--beginning three months after the bill's passage. (The pools expire when exchanges are implemented in 2014.)

All health insurance plans are to offer dependent coverage for children through age 26; insurers are prohibited from denying coverage to children because of pre existing health problems.

Insurance companies can no longer put lifetime dollar limits on coverage and cancel policies--except in cases of fraud.

Tax credits will be provided to help small businesses with 25 employees or fewer to get and keep coverage for these employees.

The Medicare "doughnut hole," in which beneficiaries had to pay full cost of their prescription drugs, begins narrowing by providing a $250 rebate this year to those in the gap, which starts this year after they have spent $2,830.

The doughnut hole fully closes by 2020.

Indoor tanning has a 10% sales tax.

2011

For Medicare beneficiaries reaching the Medicare doughnut hole, prescription coverage will be available with a 50% discount on brand name drugs.

A 10% Medicare bonus will be provided to primary care physicians and general surgeons practicing in underserved areas, such as inner cities and rural communities.

Medicare Advantage plans would begin to have their payments frozen-and then lowered in 2012. The plans would have to spend at least 85 cents out of every dollar on medical costs, while leaving 15 cents for plan

operations, including overhead and salaries. Reductions would be phased in over the next three to seven years.
A voluntary long term care insurance program would be made available to provide a modest cash benefit for assisting disabled individuals to stay in their homes or cover nursing home costs. Benefits would start five
years after people begin paying a fee for coverage.

Funding for community health centers would be increased to provide care for many low income and uninsured people.

Employers would be required to report the value of healthcare benefits

on employees' W 2 tax statements.

Pharmaceutical manufacturers will have a $2.3 billion annual fee that will increase over time.

2012

Nonprofit insurance co ops would be created to compete with commercial insurers.

Hospitals, physicians, and payers would be encouraged to band together in "accountable care organizations."

Hospitals with high rates of preventable readmissions would face reduced Medicare payments.

2013

Individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax of 2.35%-up from the current 1.45%. A new tax of 3.8% on unearned income, such as dividends and interest, is also added.

Medical expense contributions to tax sheltered flexible spending accounts (FSA's) are limited to $2,500 a year-indexed for inflation. In addition, the thresholds for claiming itemized tax deduction for medical expenses rise from 7.5% to 10% of income. People age 65 or older can still deduct medical expenses above 7.5% of income through 2016.

Medicare device makers would have a 2.3% sales tax on medical devices; devices such as eyeglasses, contact lenses, and hearing aids would be exempt.

2014

New state health insurance exchanges would be created. Income based tax credits will be available for many consumers in the exchanges. The sliding scale credits phase out for households that are four times above the federal poverty level (about $88,000 for a family of four).

Medicaid would be expanded to cover low income individuals up to 133% of the federal poverty level-about $28,300 for a family of four.

Insurers would be prohibited from denying coverage to people with pre-existing conditions, or charge higher rates to those with poor or chronic health conditions.

Premiums (with limitations) can only vary by age, place of residence, family size, and tobacco use.

Insurers will be required to cover maternity care as they do other medical procedures.

All legal residents would be required to have health insurance-except in cases of financial hardship-or pay a a fine to the IRS. The individual penalty starts at $95 each in 2014-"rising to $695 in 2016. Family
penalties are capped at $2,250; penalties will be indexed for inflation after 2016.

Employers with more than 50 workers would be penalized if any of their workers get coverage through the exchange and receive a tax credit. The penalty is $2,000 times the total number of workers employed at the company. However, employers get to deduct the first 30 workers.

2018

A tax would be imposed on employer sponsored health insurance worth more than $10,200 for individual coverage, and $27,500 for a family plan. The tax is 40% of the value of the plan above the thresholds, indexed for inflation.

2020

Doughnut hole coverage gap in Medicare prescription benefit is phased out.
Seniors continue to pay the standard 25% of their drug costs until they reach the threshold for Medicare catastrophic coverage.

From OWL National/ Alliance for Retired Americans- how it affects seniors and what's in it overall.

What's in the law for older adults? (Excellent summary by the Alliance for Retired Americans)

•Phases out the doughnut hole by providing a $250 rebate in 2010 for seniors who fall into the hole. Beginning in 2011, seniors will receive a 50% percent discount on their prescription drugs when they fall into the doughnut hole, and by 2020 the doughnut hole will be completely eliminated.

•Covers preventive services; in 2011, seniors in Medicare will receive free annual check-ups with no co-payments for mammograms, colonoscopies and other preventive screenings;
•Supports early retiree coverage, providing financial assistance to employer health plans that cover early retirees;
•Encourages doctors to coordinate care and improve quality, creating incentives for providers to work together and reduce wasteful care like repeated tests;
•Removes obstacles to changing Part D prescription drug plans, allowing Part D enrollees to make a mid-year change in their enrollment if their plan makes an unexpected change;
•Expands the Medicare Part D low-income subsidy, which will significantly help struggling seniors afford their health care costs;
•Enacts the CLASS Act, creating new long-term assistance for seniors and the disabled;
•Enacts the Elder Justice Act, authorizing new criminal background checks on long-term care workers who have access to residents or patients; and
•Eliminates wasteful overpayments to Medicare Advantage plans while creating incentives for coordinated, high quality care across the health care spectrum, extending the solvency of the Medicare Trust Fund by 9 years and improving Medicare for generations to come.

The basics of the law:
Summary by Anne Bollinger at OWL

•Estimated cost of $940 billion over ten years.
•Reduces the deficit by $143 billion over the first ten years and $1.2 trillion in the second decade after passage. That is an updated CBO estimate.
•Expands coverage to 32 million Americans who are currently uninsured.
•Requires U.S. citizens and legal residents to have qualifying health coverage. Those without coverage pay a tax penalty of $695 per year up to a maximum of three times that amount ($2,085) per family or 2.5% of household income.
•Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines applied to entire number of employees minus some allowances.
•Insurance companies must allow children to stay on their parent's insurance plans until age 26th.
•Expands Medicaid to all individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL based on modified adjusted gross income.
•Limit availability of premium credits and cost-sharing subsidies through the Exchanges to U.S. citizens and legal immigrants who meet income limits. Employees who are offered coverage by an employer are not eligible for premium credits unless the employer plan does not have an actuarial value of at least 60% or if the employee shares of the premium exceeds 9.5% of income.
•Establishing high-risk insurance pools: The Secretary of HHS is required to establish a high-risk pool within three months to provide insurance coverage to people with pre-existing conditions.

 

There are tons of documents on how health care reform might influence health for individuals localities and segments of the population, from AARP to OWL and lots others. One set from the Kaiser Foundation, now out of date:

The Kaiser Family Foundation today issued several new resources related to
the national debate about comprehensive health reform:

*Key-Comparison of evolving bills, as of recess August 5: http://www.kff.org/healthreform/sidebyside.cfm,

* How Might a Reform Plan Be Financed? examines the challenges of paying for
a major reform plan, including a look at some of the options under
consideration by Congressional leaders. The brief explains the various
approaches being discussed to finance the likely costs of the health reform
plans under consideration. It is part of the Foundation's series of
Explaining Health Care Reform briefs and can be found at
http://www.kff.org/healthreform/7947.cfm.

* Key Questions about Changes for Medicaid and Low-Income Individuals:
American's Affordable Health Choices Act of 2009 summarizes the Medicaid and
Children's Health Insurance Program provisions included in H.R.3200,
America's Affordable Health Choices Act, otherwise known as the
Tri-Committee bill. It also looks at some key questions about the
legislation's provisions affecting low-income individuals. It can be found
at http://www.kff.org/healthreform/7952.cfm.

* Summary of Key Medicare Provisions in H.R. 3200, America's Affordable
Health Choices Act of 2009 provides a detailed look at the provisions in the
House Tri-Committee bill that affect the Medicare program, including
breakouts of the savings and new spending included in the bill. It can be
found at http://www.kff.org/healthreform/7948.cfm.

In addition, the Foundation has updated its interactive side-by-side health
reform comparison tool, which can be found at
http://www.kff.org/healthreform/sidebyside.cfm, to reflect changes to the
Senate Health, Education, Labor and Pensions Committee proposal. The online
tool allows users to compare any of 11 different plans, including the House
Tri-Committee legislation and the Senate Finance Committee policy options.

All these resources are available through the Foundation's health reform
gateway page at http://healthreform.kff.org/, which provides a centralized
source for key information and analysis about national health reform efforts
now being considered by Congress. The gateway also includes original policy
and public-opinion research, columns from Kaiser President Drew Altman, and
relevant news summaries produced by Kaiser Health News, an editorially
independent health policy news service established by the Foundation.

For more information, please contact Craig Palosky at (202) 347-5270 or
cpalosky@kff.org.

Recommended: brief article and links about the Medical Center and UC Dental Clinic closure in James Withrow's blog, Hyde Park Urbanist- http://alwaysintransit.typepad.com/hyde_park_urbanist/ (scroll down the first page).

Coalitions opposing changes at UC: Southside Together Organizing for Power, 813 E.63rd Street, 2nd Floor, Chicago, Illinois 60637
773-753-9674
www.stopchicago.org, chartchicago@gmail.com listserve, stopgentrification@gmail.com.
See http://chartchicago.wordpress.com/ for more info on the CHART coalition, press reports, etc.- Coalition for Healthcare Access Responsibility and Transparency.

Throughout here, find University articles giving its side as well as media positions and coverage.
_____________________

Intro

NOTE-THE URBAN HEALTH INITIATIVE AND SUBSETS SUCH AS SSHVS AND SOUTHSIDEHEALTH.ORG MAPPING ARE CONNECTED TO THE UNIVERSITY OF CHICAGO BUT ARE FUNDED FROM OTHER SOURCES. THE UHI DOES NOT MAKE UC MEDICAL CENTER POLICY SUCH AS EMERGENCY ROOM, ETC.

So what does the UC Medicine spend on community and charitable care, in light of state changes?

After state board rulings that two Illinois hospitals do not spend enough on charity to qualify for tax exempt status, the governor declared a study and the legislature passed in spring 2012 new rules. These include that the hospital has to spend at least the equivalent of what its tax burden would be and spelled out (to some degree) what expenditures would qualify-- expanding the definition considerably to include such things as research, doctor training, and contributions to clinics et al.

The UC Medicine issued in spring 2012 its report on 2011. Community benefits and services $237.1M of $1.11B income (21.l4 percent. $14.4 was for charity care, a substantial increase over 2010. Additionally, $138.4M cover losses from Medicaid and Medicare treatment of which $100.7 was Medicaid. Research was flat at $23M and medical education went up by $9.4M to $44.9M. The medical center has made much progress in reducing its forgiven debt- $12.6M v. $51.8M in 2009. Gifts and in kind donations to community organizations wa s$773,441.

South Side Health and Vitality Studies (http://uhi.uchospitals.edu/about-uhi), an outshoot of the Urban Health Initiative and more, has been mapping all the resources on the South Side (in 34 neighborhoods) that do or could play a role in wellness and or healthcare, including businesses and faith and civic institutions. It received in February 2011 a half million infusion. Lead is Dr. Stacy Tessler Lindau. Making the information about what's our there is key. The study has also brought out what is missing, where. Volunteers including students have been fanning out, mapping, interviewing, and now going inside the multi-service buildings. Contributors include the Chicago Community Trust, National Institutes of Health Chicago Health and Aging Services Exchange and PepsiCo Global Nutrition group are contributing and people from the Hyde Park Village project.

Provident closed emergency care by ambulance That was the decision of Bill Foley and the Cook County Health and Hospitals system. Mid January Cook Co. Board President persuaded the Health board to delay this a month until Feb. 15 2011 to consider area hospitals' accommodation of this-- especially after UC Medical Center refused to accept the ambulances.

September 28 2010 STOP organized a march to University of Chicago Hospitals to demand a U of C trauma center. A year before, a youth shot near U of C was driven right past the UCMC to Northwestern. March starts at 61st cottage at 3:30, press conference 4 pm at 58th and Maryland.

________

UCMC doctors weighted in on student forum on healthcare disparities on the South Side, some calling living here a "death gap." They pointed out that disparities extend to many things that impinge on health and wellbeing- access to services, food and healthy food, transportation, and jobs. And the gaps exist within the South Side also: Life expectancy in Hyde Park is 84, in Washington Park 64. Many attendees called for radical new approaches to healthcare funding and priorities and delivery and reimagining of disparities and role of race and how healthcare relates to opportunity in America.

The Community Health Data Initiative is a collaborative effort among government and non-government partners to establish a network of suppliers and demanders of community health data, indicators, and interventions. Its purpose is to help Americans understand health and health care system performance in their communities, thereby sparking and facilitating action to improve performance and value. The HHS Health Indicators Warehouse serves as the federal data hub for the initiative.”

Links:

Community Health Data Initiative
http://www.hhs.gov/open/datasets/communityhealthdata.html

Community Health Data Interim Page
http://www.cdc.gov/nchs/data_access/chdi.htm

Health Indicators Warehouse
http://www.healthindicators.gov/

 

Contact us: flyleadingbytheyouth@gmail.com - www.stopchicago.org


For more info:

A Death sparks a demand for care - New York Times
(http://www.nytimes.com/2010/10/03/us/03cnchospitals.html)

Amid Violence, South Side Lacks Hospital for Victims - CBS 2
(http://www.youtube.com/watch?v=4UJtuvVfWRE)

Shooting Victim's Mom calls for more trauma centers - ABC 7
(http://abclocal.go.com/wls/story?section=news/local&id=7694491)

Activist's death sparks UCMC protests - Chicago Maroon
(http://www.chicagomaroon.com/2010/10/3/activist-s-death-sparks-ucmc-protests)

The "Big Hole" in Trauma Care - Hyde Park Herald
(http://cholke.com/blog/?p=412)

"Die In" calls for South Side trauma center - ABC 7
(http://abclocal.go.com/wls/story?section=news/local&id=7786457)

Teens Protest Lack of U of C Trauma Center - WBBM
(http://chicago.cbslocal.com/2010/11/12/teens-protest-lack-of-u-of-c-trauma-center/)

Die-in on quad protests UCMC - Chicago Maroon
(http://www.chicagomaroon.com/2010/11/16/die-in-on-quad-protests-ucmc)

Protesters demand trauma center - Hyde Park Herald
(http://hpherald.com/pg3.html)

Kenneth Polonsky in late 2010 returned to the Medical Center as President and CEO and Dean of the Biological Sciences Division and Pritzker School of Medicine.

UC ER use goes through occasional cycles of extremely heavy use during which it on bypass most of the time. The most recent was in February into March 2011.
There is controversy between the National Nurses United and UC over scheduling and staffing/assignment among other issues. The former drew back at the end of March from potential withdrawal from contract and strike.

A group formed to hold the fast food giants accountable through Corporate Accountability, Inc. re childhood obesity and other possible contributions to health problems, and the role that corporations play. At 4815 S. Kenwood. Contact Dr. Alfred Klinger at alfredpopdoc@aol.com.

Older Women's League often has discussions on healthcare issues at its 1st Saturday meetings, 1 pm at 1st Unitarian, 5650 S. Woodlawn.

This page, as part of the Conference's concern about a sense of erosion in social, services, and small institutional/organizational capital in the neighborhood in the wake of the fall or feared fall of major bastions of community support, will address concerns and prospects for access to health care for local residents. Note that the UCMC has now changed its policy of treating then counseling patients at the ER with less than life threatening conditions to one of triaging and sending elsewhere.
(As of mid March, the University was re-evaluating its policy- see below.

This page is sparked by comments to us and in blogs and newspapers that while efforts are being made to shore up providers in the near/mid south in general, people have to go further and that residents here may be increasingly unable to have fast and close access to various primary care facilities. (This site has not noted a drop in the number of private physicians, dentists etc. health and nutrition stores, or pharmacies. But lose of these are a growing concern nationwide --"Where have all the doctors gone," asks AARP in its September 2008 publication, and concerns of advocates for a better, non-rationing healthcare system in America and over erosion and non delivered promises for healthcare in Illinois. And Hyde Parkers ask whether we will also lose our veterinarian with the redevelopment of Harper Court.

The issues were discussed at the HPKCC March board meeting.

From the 1970s forward the area lost: Woodlawn Hospital, Chicago Osteopathic Hospital, Illinois Central/Doctors Hospital, the primary care HMO facility under various aegis in Village Center, and soon the closure of Michael Reese Hospital to the north-- whose HMO had already become less convenient to reach via bus. Recently the University of Chicago transferred its Windermere Seniors facilities to South Shore and is reported to be limiting new unaffiliated patients in the Primary Care and other clinics in the Center for Advanced Medicine. (On the other hand, the complex of medical services in the Windermere has increased , including dental groups and imaging.)

We have to start taking consideration of "health" parameters in neighborhoods to a higher plane- Studies in the past have found that the non-healthcare infrastructure of a community, like kinds of restaurants, grocery stores and gyms, have more of an impact on people's health than health care providers. So inventories and directories are being made by the UC and others and should be disseminated like other kinds of "asset" and "help available" directories and databases.

In addition, it appears from a Tribune report April 2009 that hospitals throughout Chicagoland frequently refer less-than-emergency patients or those for whom specialists are not available to Stroger County Hospital, which is overwhelmed. Also, that in an August 2008 decision, the Illinois Appellate Court ruled that a downstate hospital's nonprofit status remain revoked for an insufficient amount spent on charity cases-- spending has to liberal. Most nonprofits, according to the article, spend little more than for-profit hospitals on charity cases and in fact only 10% of the benefit of their status. Hospitals assert the measurements are unfair, inaccurate and grossly non-inclusive. Note, Resurrection in Chicago was cited in the article as having over a year ago adopted the policy for which the U of C has been criticized (and is now on hold).

Another problem is on again-off again threats to shut down four mental health clinics on the South Side including that at 63rd and Woodlawn.

Yet, aspects of the small private health providers sector remain strong-- physicians, dentists, podiatrists, holistic, physical and occupational therapy. A new physical therapy and recreation provider is AthletiCo, at 1644 E. 53rd St. Includes for sports and performing arts health, injuries, and problems-- including for major teams and dance theaters such as Hubbard Street.

To find out the hospitals association side of matters: "Thank you for your continuing participation in your Regional Healthcare Council (RHC). As a community leader working to address issues impacting access to care throughout the metropolitan Chicago region, I wanted to alert you about a new Web site launched by MCHC - www.SupportOurHospitals.com. The site hosts an online video that outlines the great things hospitals do for their communities while addressing several of the critical issues hospitals are facing. Please visit the site, watch the video and sign an online petition showing your support for hospitals. The call to action at the end of the video provides MCHC the ability to capture and create a new audience of supporters through social media channels. MCHC also urges you to forward the link (www.SupportOurHospitals.com) to your supporter lists and encourage their involvement in our ongoing advocacy efforts."

 

The aging of our population in an age of medical specialization.

Owl says- March 2009 (from an online article): Currently, those 65+ make up approximately 13% of the population. As the baby boomers enter this demographic, this number is expected to nearly double, rising to 25%. Furthermore, between now and 2050, the population of Americans 85+ is expected to quadruple. OWL has long been aware of the importance and necessity of high quality health care - now in our efforts towards reform, we want to stress the importance of family practice physicians and geriatricians, which are seemingly becoming extinct over the years.

The issue isn't that there is a shortage of medical students or doctors, it is that the majority of physicians are now specializing their practices which results in too many referrals, and patients bouncing around from one physician to another. Medical costs exponentially multiply, as the most expensive part of a check-up often comes from walking through the door....

On January 14th, the Retooling the Health Care Work Force for an Aging America Act was introduced by Senators Herb Kohl (D-WI), Blanche Lincoln (D-AR), and Bob Casey (D-PA). This legislation directly addresses the current shortages in personnel and resources available for caring for older adults and a few pieces of the legislation directly related to improving home health in America are as follows:

Expand other geriatrics programs under Title VII and Title VIII of the Public Health Service Act to be more inclusive of allied health professions.
Establish tuition stipends for direct care workers (nurse aides, home health aides and person or home-care aides) in the long-term care sector to advance into nursing.
Establish programs to develop the opportunities for high school and college students studying in various allied healthcare disciplines to work with low-income seniors.
Establish a national demonstration program to develop and evaluate core training competencies for personal and home care aides as well as additional training content, and supplement current federal requirements, for home health aides and nurse aides.
Provide better integration of services and information to meet of the needs of family caregivers.

And Martha Holstein told OWL in April 2009 that from an ethical perspective, we don't approach the needs of the elderly, or anyone needing long-term care, from the right direction-- dealing from the PERSPECTIVES AND NEEDS OF CARE RECEIVERS- AND GIVERS (co dependency). Is "rebalancing" always the right answer? And what good is it if it doesn't pay attention to real OUT OF POCKET COSTS AND IS TOP-DOWN (BY FORMULAS). WHAT ABOUT QUALITY OF LIFE?


State Rep. Will Burns and Sen. Kwame Raoul said also they want the state to reimburse on time state capital money for affordable housing, early childhood education and health care including underutilized Provident Hospital. "Provident is a building that's being underutilized." If the hospital gets investment in non-critical care infrastructure, it can become more of an asset in communities that lack health care options. "The less you have quality options for people to turn to, the less you're solving the problem."

The main controversy, which seems to have good argument on both sides, is the growth of the University of Chicago's Urban Health Initiative of which one component is to encourage both emergency and non emergency patients to seek care out of area.

February 24 2009 Maroon called for the U C should compensate for its withdrawal of services and inherent disincentive for clinics to locate near its medical center by promoting clinics in house or in the area-- to fulfil its goal of making Hyde Park more appealing and fulfilling its obligation to society for subsidizing its tax exempt status.

The Tribune article below discusses only some of the issues, but it opens discussion.

 

Quick news - see next section

Patients in Medicare- and Medicaid-participating hospitals now have the right to choose their own visitors during a hospital stay,
regardless of whether or not the visitors are family members.

According to new guidance from the Centers for Medicare and Medicaid Services,
hospitals can’t discriminate on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.

Patients will also be allowed to name a person of their choice, including a same-sex partner,
to make medical decisions on their behalf if they are medically unable to do so.

The new guidance updates the Conditions of Participation, which are standards that apply to all Medicare- and Medicaid-participating hospitals,
critical access hospitals, and patients in those hospitals even if they aren’t on Medicaid or Medicare.

Hospitals will need to have written policies that explain visitation rights, as well as clear guidance on when
hospitals may restrict access based on reasonable clinical needs.

Is departure of dialysis, other UC health/social/employment services part of a pattern of dispersal of Hyde Park resources making for longer commutes to services and maybe dispersing resources rather than building up in deprived communities? It's really hard to tell, but there is more in the mix on that. The privatized dialysis center is also having trouble convincing the businesses at Wabash and 50th that they are a good fit. More in Healthcare Delivery.
DeVita dialysis clinics (Total Renal Care) is closing its 3 Hyde Park locations leased from the U of C and will build a new facility in Grand Boulevard. Experts say that will leave the South Side even shorter of slots, even after built and open. There is concern that rather than building resources in underserved areas, they are are taken from those locals that have some and spread around the area.
The clinic bought the UC clinics in 2010 with understanding that the premises would be vacated by a certain time-- so there will be a gap in services.

Herald, July 27, 2011. By Sam Cholke

The state last week approved moving a dialysis center from Hyde park to Grand Boulevard. DaVita, Inc., operated locally as Total Renal Care, plans to build a new center for its dialysis patients at 5838 S. Martin Luther King Drive. Davita purchases its current facility at 1164 E. 55th St. as part of a $27.8 million buyout of the University of Chicago Medical Center's three dialysis centers in 2010.

The Illinois Health Facilities and Services Review Board reviewed the plan and voted five to three on July 21 to approve the project. The plan needed five votes to pass. One member was absent.

In a report, the Illinois Department of Public Health determined that the new dialysis center complies with state statutes. The report took issue with the temporary discontinuation of the dialysis services while the new center is built. Of the 44 dialysis center within a 30-minute drive from the current Hyde Park location, 21 are operating over capacity. The Hyde Park location started a fourth shift to handle all its patients, according to the report.

The state report identified a need for 53 dialysis stations in the area. The new center would add 11 stations, but it will quickly be overwhelmed, the state suggested. "The referring physician for teh proposed facility, Dr. Mary Hammes, estimates referring 156 patients to the new facility. Of this 156 patients, 135 are from the current Woodlawn facility," the report says. "This, and other supporting data suggests the proposed facility would be operating at 82.8 percent capacity by the end of the second year of operation, which surpasses the state minimum capacity fo 80 percent."

The dialysis center is moving because the University of Chicago is not renewing the lease on the current location. The lease ends Dec. 31. Though the state approved the move, residents and business owners oppose the new center. "We have all those lots and almost any of them would be a better use," said Bernard Loyd last month. Loyd is developing retail and restaurants a block away. He called the plan "short sighted." The 51st Street Business Association also unanimously rejected the proposal, saying it "would not fit as proposed into the scope of retail development that is being considered in this location and would be a detriment to the character of the King drive residential boulevard" in a letter tot he state.

According to documents filed with the state, DaVita originally considered a property at 4648 S. Drexel ave., but could not secure the necessary zoning. [That is in the 4th Ward.]

July 2010 the Illinois Supreme Court ruled Provena Hospital not entitled to tax exempt status as a charitable care hospital. Here is an article about it. http://www.abanet.org/health/esource/Volume6/08/Wehl.html.

U of C Medical Center will be selling its dialysis center to DaVita, with some consolidation and moving. Meanwhile, Comer Children's Hospital has opened a new kid-friendly clinic .

Dean and Medical Center CEO James Madara resigned in mid August 2009. Whether this will have any inpact on directions or the Medical Center and the Urban Health Initiative is uncertain. Madara presided over unprecedented expansion and integration of the biological research and medical facilities and program.

A U of C Health Vitality study and greater area initiative rolled out at April 24 Outreach Forum.

Herald April 29: Lipinski also introduced local doctors and educators who are leading programs that aim to build bridges between the university and its neighbors. The Medical Center is shortly to launch the Center for Community Health and Vitality, said its inaugural director, Dr. Doriane Miller. The new center's mission is to make the South Side a "healthy, vibrant and stable place to grow up," she said. Some programs under consideration include expanding "Project health" family help desks, creating more and better online health information, and forging partnerships with the city's public schools and colleges.

It will make use of data collected through the South Side Health and Vitality Studies, said Stacy Tessler Lindau, an assistant professor of Obstetrics an Gynecology and Medicine (Geriatrics) at the Medical Center, who is leading the research effort. the studies, shortly to get underway, will focus on how to forge a stronger health safety net across the swath of the South Side running from Western Avenue to the lake and from 35th to 130th street.

A Cook County Commissioner is proposing taxing hospitals because of questions about whether they are really providing charity care. Here is what UC Medical Center says about it:

Cook County Commissioner Roberto Maldonado is preparing to introduce the so-called "Cook County Healthcare Access Protection" ordinance, which would impose an arbitrary charity care benchmark; a tax on local hospitals; and a new bureaucracy for Cook County government. Private hospitals in Cook County already provide more than $2 billion annually in charitable community benefits, including free care for those who cannot pay their bills. These hospitals are already taxed under state law to support medical care provided to Medicaid patients, the poor and the uninsured. Ultimately, the proposed ordinance could negatively impact access to health care for Cook County residents.

Please click here to urge the Cook County Board of Commissioners to oppose Commissioner Maldonado's proposed ordinance and instead encourage them to join the national efforts to develop a bipartisan solution to ensure that every person has access to high quality, affordable health care coverage.

The University of Chicago Medical Center announced in January 2009 that it is cutting its budget 7.5 percent (100 million). Cuts (and layoffs in the hundreds) start at the top with President David Hefner, Community Relations VP Michelle Obama (whose duties will be assumed by Eric Whitaker) and other vice presidents. CEO and Dean James Madara says the new hospital pavilion and Urban Health Initiatives and quality healthcare will continue, and many consolidations with the Biological Sciences Division and Medical School are underway. This is not the only medical center to cut back drastically. The jobs impact will be serious. One reason cited was the failure of the state and federal government to pay the medicare and medicaid. It is true ,though, the the UCMC was cutting back and consolidating already for the sake of the new facilities. Despite the review in process at the Medical Center, geriatric patients judged to be not requiring the University's advanced equipment will be sent to Holy Cross or Mercy hospitals (with limited access).

Their latest cut is elimination of the Woman's clinic at 47th and Woodlawn, which serves almost exclusively Medicaid and Medicare patients with specialty care. More below.

Dr. Whitaker of the UCMC says it is still hard to turn people from the rational decision to prefer a major center like UCMC over local clinics. One solution is put in facilities that remove stigmas from visiting the local clinic (e.g. add a barber shop). Another is UC's inclusion of more of its doctors, etc. in the clinics. Still, he said, most people will go to where there are more options and perception of quality. The third might be to reach an arrangement with Provident Hospital.

In February the Center cut its (first?) 450 jobs across all sectors. A hiring freeze is also in effect for 18 months, and 30 inpatient beds have been cut, elimination of doctors' offices on Greenwood and on 47th (Ballys's, supposedly with services moved to DCAM), increased ER wait time (in addition to telling lesser cases to go elsewhere), and shorter surgical hours on Saturday through Tuesday.

The University shut Windermere Seniors Center and is now reported closing the clinic at Bally's Fitness in April (itself both in troubled and criticized for cuts).

For more on the UC and allegations of a health desert, see hydeparkprogress.blogspot.com. And keep an eye on always_in_transit.typepad.com/Hyde_Park_Urbanist/.

As of mid-March 2009, the University was re-evaluating its ER policy or its implementation, but largely went ahead.

Hyde Park Herald, March 18, 2009. By Sam Cholke

The University of Chicago Medical Center will delay implementation of a news patient triage system that would have referred more patients from the emergency room to surrounding clinics. "It's still being discussed," said John Easton, a spokesman for the medical center. The new system was slated to be implemented in early April. The plan would place more responsibilities on a physician to diagnose which patients in the emergency room would be better served by a neighboring clinic. No patients would have been forced to leave the emergency room, and the decision would not be influenced by insurance coverage.

The plan came under intense scrutiny in the media and by emergency room doctors' organizations after a Feb. 13 Chicago Tribune story, "University of Chicago ER sends kid mauled by a pit bull home," which described how 12-year-old Dontae Adams was treated with Tylenol, morphine and antibiotics after he was attacked by a dog. The article contends that Adams required surgery for the wound.

The instance brought a harsh rebuke from the American College of Emergency Physicians and the American Academy of Emergency Medicine. "If anything, these are times that demand the most from our hospitals and our emergency departments, because these are the times when our patients need more care, not less. My heart breaks for Mrs. Adams and Dontae and the night of hell they surely endured just to get Dontae the care he needed and deserved," Dr. Nick Jourile, president of ACEP said in a prepared statement.

In its own press release, the University of Chicago Medical Center called Jourile's comments "reckless and uniformed and based on hearsay." The medical center contends that the treatment given to Adams was the care recommended by the ACEP. The ACEP made a call for Congressional hearings "about the problems facing emergency patients."

Easton said it's "hard to say" whether outside pressure played a part in the decision to reconsider the new triage system. The University of Chicago Medical Center has experienced a changing of the guard over the last month. Everett E. Vokes was appointed chairman of the department of medicine at the University of Chicago Medical Center, effective March 9. Also this month, Andrew Alper was elected to replace Thomas Crown as chairman of the University of Chicago board of trustees . Easton said the decision to reconsider changes in the emergency room came from the new leadership after consultation with university president Robert Zimmer.

the decision to delay changes in the emergency room could affect budget cuts at the University of Chicago Medical Center. Reducing costs related to the 40 percent of patients who visit the emergency room who do not require emergency medical attention was a considerable part of the 7 percent the medical center is cutting from its budget.

On Feb. 9, the medical center laid off about 5 percent of its work force, 450 workers. The medical center has also cut 15 executive positions and about 20 nurse administrator positions. No practicing nurses will be laid off, Easton said. "I think we have found a way to keep all direct care giver nurses," Easton said. The university employs about 1000 nurse, according to Easton. Easton said he could not say if more layoffs were coming, but said the medical center was "through the bulk of that. To continuation and more.

_____

In a Maroon interview April 28 2009, President Zimmer said that he played little role in the halt and reevaluation, and that it is being done within the Medical Center and they are responsible.

 

MCHC is encouraging the Congress to ensure the "stimulus" package adequately funds the federal portion of Medicare, Medicaid et al:

Congress is now considering an economic stimulus proposal, and we are grateful that the "American Recovery and Reinvestment Act" includes an increase to the federal share of the costs of state Medicaid programs, known as the FMAP. We also urge Congress to include a strong "maintenance of effort" provision to require states to maintain their current Medicaid programs - including eligibility, benefits and provider rates. Similarly, we urge Congress to increase allotments for the disproportionate share hospital (DSH) program to accommodate an FMAP increase. The Medicaid DSH program, which helps reimburse providers for the care provided to the uninsured, has essentially been frozen since 2004.

Deal with Provident, others, offers hope for amelioration of concerns about UCMC. But will Provident be there?

A Cook County health and hospitals services restructuring committee led by COO Bill Foley and Warren Batts, chair, agreed to take reform ideas back to the drawing board after more than 200 residents and stakeholders including Provident physicians at as October 28 hearing vociferously objected to plans to phase out inpatient care at Provident and Oak Forest and institute other reductions and consolidations. In the plan other places were to have absorbed patients, but, other than ambulancing to County, only U of C stepped forward, and it's reducing service to the uninsured and routine patients. Commissioner Butler said cuts are coming regardless, esp. if the sales tax is repealed.

Raising great concern has been decisions by the University regarding what kind of clientele it believes it should serve, closure of outlying clinics, and efficacy of the Urban Health Initiative including whether other providers can with quality pick up the slack.
In an interesting partial balancing, the State of Illinois and the University of Chicago are funding upgraded and additional facilities at Provident Hospital, Friend Center and other facilities in Chicago to address these needs including access to quality professionals. :

Updates on Provident deal

June 2010, according to the Herald, things are looking promising as specifics are put "on the table"

By Sam Cholke, June 23: Plans for the restructuring of the Cook County Health and Hospital System are back on the table and in plans presented May 27, limited inpatient care would remain at Provident Hospital. Key to the plan is an agreement being mulled over between the hospital and the University of Chicago.

In the last iteration of the plan, Provident Hospital, 500 E. 51st St., would have all of its inpatient services cut and would serve as an emergency room and outpatient clinic. The elimination of inpatient care was fiercely contested at public hearings and was withdrawn by the hospital system's oversight board. The board has come back with a revised plan that tentatively would keep inpatient care at the hospital, but cut some services such as obstetrics. The hospital would "downsize inpatient beds to serve the emergency room patients," said Bill Foley, president of the hospital system at the May 27 board meeting.

Provident currently has staff for 85 of its 200 patient beds. Current proposed cuts would reduce the hospital to 36 beds. Foley was clear that the future arrangements at Provident were highly dependent on partnership negotiations with the University of Chicago. An initial study of a partnership between the two healthcare providers completed last month says Provident would need to retain inpatient services and make substantial infrastructure improvements to be a valuable partner to the University of Chicago Medical Center.

The board was expected to authorize the second phase of the study this month, but deferred approval until at least next month. A successful partnership.... released $10 million for infrastructure improvements. The university will put up $5 million, which the state will match, if a partnership deal can be hammered out. If no deal can be reached, the money is off the table. The future of services at Provident hinge on the second study and the board has been explicit that without a successful partnership with the university, Provident would face cuts eliminating many of the current services.

Cuts remain more prominent at Oak Forest Hospital, where inpatient services are expected to be eliminated completely in part to finance the infrastructure improvements at Provident and to rebuild the Fantus Clinic, 1901 w. harrison St. "That we're going to have the funds to keep a large number of services open for a small number of patients is not realistic," said Warren Batts, chair of the hospital system's oversight board. the Cook County Board of Commissioners voted June 1 to make the Cook County Health and Hospitals System Board permanent.

 

Considering alternatives- Herald commentary by Dr. Joseph Pulvirenti, Infectious Diseases, Provident.

I read with dismay the plan of the hired consultant to the board of the Cook County Health and Hospital System regarding closing inpatient services at Oak Forest Hospital, reducing the already reduced Provident Hospital inpatient unit to a 20-bed, short-stay unit with an emergency department and converting both faculties into outpatient venues. The crux of teh argument is that there is a need for more outpatient services and the shift from inpatient services wil save money by reducing staff.

The plan fails to take into account the long lines of patients seeking inpatient care at Stroger Hospital of Cook County. It fails to mention that most inpatient medical services at Stroger reach their maximum admission quota even before starting their workday. It fails to mention that at Provident and Oak Forest, light usage is directly related to teh 2007 budgetary cutbacks that have crippled their ability to provide vital services to their patients. If fails to mention that in the aftermath of the enactment of this plan, critically overstrained medical facilities will be strained beyond the breaking point.

With the drastic cuts in 2007, Provident closed 10 intensive-care unit beds and limited inpatient beds to 60 medical-surgical beds. As a result of these cuts and subsequent moves, Provident no longer has orthopedic and vascular surgery and has sparse, intermittent resources in other critical areas (general surgery, gastrointestinal, hematology and rheumatology, to name a few). Many patients admitted to Provident are transferred to Stroger because of a lack of these services. This further diminishes Provident and burdens the already crowded Stroger Hospital. Obviously, this situation will be further exacerbated if the number of beds at Provident is cut further.

The new plan also removes all intensive-care beds at Provident. Patients who come to the hospital with severe diseases or who develop severe circulation problems while in the short-stay unit will be transferred to another critical care unit. Where will that be? have the hospitals in the area committed to taking in non or poorly insured patients and if so, at what cost to the county? Or is the plan to transfer these patients in a mad dash down the Dan Ryan to Stroger Hospital? Would you want you or your loved ones to be admitted to a hospital where they lack basic resources for critically ill patients only to wind up in a headlong dash down the expressway to an already overcrowed hospital?

During the 2007 cutbacks,the family practice department was moved to Provident. Since teh move, it has been a much-needed academic shot in the arm for Provident and has greatly improved the care of patients. What wil happen to this program if inpatient services are scrapped?

Provident sits in an area that is in desperate need of a good community hospital. Although the University of Chicago Medical Center sits on the South Side of Chicago, its interest in the community is limited. Problems of diabetes, hypertension, heart disease, strokes, asthma and chronic obstructive pulmonary disease and HIV have ravaged this community, leading to multiple hospitalizations, early debility adn death. Many people who should be working and paying taxes are now disables and unable to work. Providing good medical care makes economic as well as good ethical sense.

in the 1990s, when plans for the new and smaller Stroger Hospital were made, we were told that Oak Forest and Provident would make up for the smaller bed space. What has changed since then? In the 1990s we were in an economic boom. We are in anything but that at the moment. We require more rather than fewer hospital beds .

In an effort to raise money, the county has now started to bill patients. This is fine for patients who have third-party payers who can defray most of the cost. However, if you have no insurance or high co-pay medical insurance and little or no income, getting large bills in the mail with the threat of sending these bills to collection agencies if not paid acts as a strong deterrent to seeking medical care. As a result, many people stay home knowing that if they seek care, they wil have to make the choice between feeding their family and caring for their illness.

Although the goal to improve outpatient services is laudable, I am dubious of its achievement in the short run. I base this on long experience with the county system and its inability to enact sweeping changes in a timely or meaningful way. In the past sweeping changes got bogged down in politics -- with different groups protecting their constituents without thinking of the main goal of providing good medical care. Patient care deteriorates as a result.

What should be done? First, re-establish Provident as a community hospital on the South Side of chicago with full community hospital services, including orthopedic and vascular surgery and critical medical services, build an endoscopy suite to off-load the incredible backload of patients in the county system. have staff at Provident immerse themselves in the community by regularly attending neighborhood groups and speaking to medical problems plaguing the community. Make Provident a center of excellence for diseases that most impact its community.

Next, bill in a humanitarian fashion; bill the third-party payers and so limit-of-liability billing for those who are un-insured or who are insured and have a high co-pay. Bill for pharmaceutical services.

Finally, encourage grant writing to take advantage of federal government programs that may offset some of the cost of care.

In short, I find the new county plan to be short sighted and potentially disastrous for our patients. By closing inpatient bed space, it makes an already critical situation worse. By billing patients in a non-caring way, it drives patients away from seeking out care until they require hospitalization at a much higher cost, become debilitated or die. If the new plan is truly to care for these people, the board should seriously consider some of the issues raised above.

Top

Provident Hospital gains $10 M. Herald, June 24 2009. By Sam Cholke

Provident Hospital wil get a much-needed injection of infrastructure dollars from the state capital budget and the University of Chicago Medical Center. "If we make this investment in Provident Hospital it will be somewhere you can go that you can have confidence that you will receive the best of healthcare," said state Sen. Kwame Raoul (D-13), who lobbied the governor to include funds for the 500 E. 51st St. hospital and other South Side facilities.

The state wil put up more than $5 million, which the University of Chicago Medical Center will match. The funds wil be use to expand Provident's clinic, specialty care and urgent care. Funds will also go towards obstetrics care. "We'll be able to take some additional patients for urgent care," said Marcel Bright, a spokesman for the Cook County Department of Medicine. Urgent care centers treat patients whose condition requires immediate treatment but is not life threatening.

Bright said Cook County has increased its efforts to improve the underutilized hospital. As part of a reorganization of the county healthcare system, Provident will better utilize its surgery suites to handle a greater number of patients who require outpatient surgery and routine surgeries, while more complicated surgeries will be performed at John H. Stroger Hospital, 1900 W. Polk St., according to Bright.

Raoul said the investment in Provident Hospital could go a long way to improving both patients' and physicians' negative perceptions of the facility. "Medical professionals want to go where they can practice on state-of-the-art equipment in a state-of-the-art facility, so it makes it easier to attract that personnel," Raoul said.

Though the state funds have yet to be released by the governor, Raoul said he was confident the money would not be negatively affected by the state's budget woes.

the capital budget also has funds scheduled for South Shore Hospital, 8012 S. Crandon Ave.; St. Bernard Hospital adn Health Cary Center, 326 W. 64th St.; Friend Family Health Center, 800 E. 55th street; and other South Side clinics.


Provident continuing to struggle according to the Herald May 4 2011. By Sam Cholke, citing Cook County's chief operating officer and Provident's interim head. They want to keep it open. Critically ill services, inpatient care, and maternity are out, items like podiatry are in, in an effort to trim almost $20 million in costs. As an example of its problems, it cost $4 million in an $87m budget to deliver less than 1 baby a day-- doctors say this is because the staffing was cut to the bone. A SEIU report from 2010 also says staff has been cut beyond viability, and adding in mismanagement, people stopped coming.

Without the ambulances, the er patients aren't as likely to need inpatient care and can be moved to Stroger. Inpatient at Provident may reopen but with only 25 or so beds. They still plan to invest $30 million in capital including $12 m for outpatient.

Top

Rallies continue to be held by CHART, STOP and other coalitions opposed to changes in UC policies.

Opportunities, Meetings

From STOP and CHART

August 7, 2009: Friends of STOP:

We had an excellent spirited action today, bringing the fight of the Coalition for Healthcare Access Responsibility and Transparency to the Gold Coast, where the U of C just opened up a clinic as they close down the south side women's clinic. Please see the ChiTown Daily News Article about the action and also if you haven't seen it don't miss the excellent Labor Beat video U of C Puts Profit Over Women's Health [http://blip.tv/file/2390021] with excellent coverage of our last action.

From the ChiTown Daily News:

A new University of Chicago clinic in Streeterville became a flash point this afternoon in the controversy over the school's plans to refocus its medical services -- a move that some South Side residents say is an effort to ditch poor patients in favor of wealthier ones.

About 30 protesters gathered outside the clinic, 150 E. Huron, this afternoon, singing protest songs and chanting. They say the clinic epitomizes UCMC’s abandonment of the South Side, as it reorganizes to incorporate more high-tech research and procedures.

The clinic, just off the Magnificent Mile, offers everything from cardiology and endocrinology to sleep medicine and dermatology.

Protester Wardell Lavender says he came because his South Side neighborhood needs access to health facilities.

"I don't think the University of Chicago has compassion for poor people," he says.

The university's marketing efforts for the clinic have angered some of the protesters. A video explaining the clinic pitches "personalized" medicine for busy people in the downtown area. In it, one doctor promises that "We are now treating patients as individuals, not as a disease”

"My first thought was how much they spent on that video," says Matthew Gisnberg-Jaeckle, a spokesman for Southside Together Organizing for Power, which organized the demonstration.

The U of C has said some service cutbacks were caused by budget concerns.

Medical Center spokesman John Easton says several physicians from the hospital see patients at the downtown clinic a few days a week. Meanwhile, he says, the university has invested more than $12 million in creating a network of community health care providers across the South Side. Those clinics also draw on university physicians.

Easton says the Streeterville clinic's focus on personalized medicine doesn't mean there is different care offered downtown than at the main campus in Hyde Park.

“Rather, it is an example of positive trends in medical care more generally. The combination of different specialties at one office means that patients can get a complete, personalized assessment in a timely way, bringing the high quality of our Hype Park hospital to a smaller downtown setting," he says.

Former U of C professor Mel Rothenberg says the service at the Streeterville clinic was different.

When he needed to see a cardiologist, he was told it would be a three-month wait to book an appointment at the university's Hyde Park campus.

But the Streeterville clinic offerend him an immediate appointment.

Rothenberg signed up, and didn’t even have time to crack open a book before his number was called.

“It was wonderful. It was Rolls-Royce,” he says. “The doctor spent about 40 minutes talking with me about my condition. I’ve never gotten that type of treatment here at Hyde Park.”

While Rothenberg was happily surprised by the treatment he received at the Gold Coast clinic, which bills itself on a Web site as a place where “we can now take the time to actually describe to you what the risk is,” he worries that it’s emblematic of trend where the university abandons the South Side.

“I’m upset by it because I think that it means they are less interested in serving the South Side of Chicago, even the Hyde Park community,” he says. “They’re more interested about reaching out to wealthier (communities) on the North Side.”

November 10 UC Student Government held a panel and forum on the trauma center issue. Featured were Dr. Dallad Liu, Surgeon-in Chief and head of Comer ER and trauma center (since a deceased hero), Dr. Stephen Weber, Chief Medical Officer of UCMC, and activists including Student Health Equity. This was the first official-setting dialogue on the matter. Questions focused on need versus practicality and a perceived disparity between what the UC thinks is best (including for the community) and what members of the community think is best. FLY (Fearless Leading by the Youth) asked for an unbiased third party feasibility study. The University would not commit to that but would continue the dialogue.


_____

http://tinyurl.com/kvox5l

In response to this attempt to do away with the clinics while nobody's looking, STOP and their allies are organizing a prayer vigil outside the Woodlawn clinch for this Friday, July 24th, at 5pm. The most important thing right now is for us to draw attention to the fact that the clinics are being threatened again, and to show the city that we're not going to let them go without a fight. Needless to say, although this is a prayer vigil, there will be people of all faiths and none in attendance - we just need as many people there as possible to stand in solidarity with our neighbors.

There will be a group walking from the Reynolds Club at 4.30pm - I'll be there, and I'll try to remember to have my cell phone switched on: (773) 595 1862. If you think you can make it, email me back at this address so we're expecting you. If you want to make your own way down, the clinic is at Woodlawn and 63rd. Obviously this is very short notice, but if you can make it, your presence will really make a difference.

For the background on the campaign, here's a couple of older articles:

http://tinyurl.com/mp5mo3 (Sun-Times on the successful sit-in)

http://tinyurl.com/cwxglo (Chi-Town Daily News on how the City's own billing problems led to the crisis in the first place)

http://tinyurl.com/nvuq7g (NPR's Eight Forty Eight on how the cutbacks would affect vulnerable people in minority communities)

Our demands are:
1) Stop the closure of the 47th st Women's Health Center and restore all services
2) Immediate moratorium on clinic closures, staff cuts and bed cuts
3) Restore and expand transportation from the community to the hospital
4) Expand beds and staff in the E.R. and General Medicine
5) Open the hospital to new patients looking for a doctor, regardless of insurance
6) Living wage jobs with good benefits for all employees

We are making progress. After our direct action and community forum coupled with pressure from doctors, the U of C halted its plan for further in-patient ER bed cuts. The issue of the women's health center has received good media coverage. Congressman Bobby Rush is calling for a Congressional investigation into patient dumping by the U of C Medical Center and Commissioner Maldonado is introducing an anti-patient dumping ordinance.

But we have a long way to go. The above are merely our initial demands to ask President Zimmer to show good faith as a first step in completely revising U of C Medical Center policies to ensue it becomes part of the solution, not part of the problem, in addressing the community and the country's health care crisis.

--
Southside Together Organizing for Power
813 E.63rd Street, 2nd Floor
Chicago, Illinois 60637
773-753-9674
www.stopchicago.org, chartchicago@gmail.com listserve, stopgentrification@gmail.com

See http://chartchicago.wordpress.com/ for more info on the CHART coalition, press reports, etc.

cheers

mark


---------- Forwarded message ----------
From: Ebonee Stevenson <ebonee.stevenson@gmail.com>
Date: Mon, Jun 29, 2009 at 2:52 PM
Subject: Join Us! Save the 47th Street Women's Health Center!
To: ebonee.stevenson@gmail.com


Friends & Colleagues,

This Tuesday, June 30th is the scheduled closure day for the University of Chicago's Women's Health Center. The Women's Health Center is an extremely important health care asset that serves thousands of underprivileged women (often women of color) on the Southside of Chicago. Many of the women treated at the clinic often have serious conditions. In December 2008 at the age of 27, I was treated for a 15lb tumor attached to my uterus. As a poor young woman without private insurance, I was devastated. Without access to the experienced, and caring staff at the University of Chicago Hospital, and Women's Health Center; I don't know where I would be today.

If the University of Chicago closes this clinic, poor women of color on the Southside will be disproportionately affected. For the University of Chicago to be at the "forefront of medicine" and then turn its back on poor underprivileged women on the Southside is a unacceptable. We need your support for this important day of action. Below is a list of things you can do to show solidarity in this fight!

Please forward around this email and the attached flier and join us on Tuesday:

3pm - 5801 S. Ellis - Rally + Press Conference
Join the Coalition for Healthcare Access Responsibility & Transparency (CHART) as we present our demands to the President of University of Chicago Robert J. Zimmer.

5pm - 59th and University - Free BBQ and Peaceful Picket Line
Join us across the street from President Zimmer's house for BBQ and a spirited picket line.

Our demands are:
1) Stop the closure of the 47th st Women's Health Center and restore all services
2) Immediate moratorium on clinic closures, staff cuts and bed cuts
3) Restore and expand transportation from the community to the hospital
4) Expand beds and staff in the E.R. and General Medicine
5) Open the hospital to new patients looking for a doctor, regardless of insurance
6) Living wage jobs with good benefits for all employees


Call and Email President Zimmer 773-702-8001, rzimmer@uchicago.edu
1) Demand that President Zimmer immediately STOP the closure of the Women's Health Center and restore all services, and
2) Meet with the CHART COALITION.

Thank you for your support!

Ebonee Stevenson
Southside Together Organizing for Power (STOP)
773-543-4538
ebonee.stevenson@gmail.com

 

Seed Grant Funding to Community-Academic Partnerships to Improve Community Health- LOI due Feb 2.
The Alliance for Research in Chicagoland Communities (ARCC), the community-based participatory research program of the Community-Engaged Research Center at Northwestern University Clinical and Translational Sciences Institute, is seeking proposals for the second round of their seed grant program. The program aims to build the capacity of communities and Northwestern University academic partners to engage in authentic collaborative research partnerships through two types of grants, Partnership Building grants and Community-Based Participatory Research Implementation grants.

Proposals must be submitted by a team that includes the participation of at least one community-based organization and at least one NU faculty member (regular or adjunct), fellow, or full-time graduate student. Community and academic partners are encouraged to contact ARCC staff to discuss the fit and feasibility of potential proposal ideas and/or for assistance in identifying and connecting with potential partners.
Required letters of intent are due February 2. Invited full proposals will be due March 5.
ARCC is offering a technical assistance workshop on January 20 from 10 am – 12 pm. To RSVP for this session, email cerc@northwestern.edu.
To access the full Request for Proposals and Application instructions, see the attached document or visit http://www.nucats.northwestern.edu/centers/cerc/CBPR/cbpr-seed-grants.html.

Questions: Jen Kauper-Brown. ARCC Co-Director j-kauper-brown@northwestern.edu, Phone: 312-503-2942.

Alliance for Research in Chicagoland Communities Community-Engaged Research Center, Northwestern University Clinical and Translational Sciences Institute 750 N. Lake Shore Drive, 11th Floor Chicago, IL 60611, http://www.nucats.northwestern.edu/centers/cerc/.

The Alliance for Research in Chicagoland Communities (ARCC) is the new name for Northwestern University’s Community-Based Participatory Research Program. Our mission is growing equitable and collaborative partnerships between Chicago area communities and Northwestern University for research that leads to measurable improvement in community health.

Hyde Park, south side residents too far from a trauma center?- twice as far as on the north side

Hyde Park Herald October 6 2010. By Sam Cholke. More than 150 demonstrators marche to the complex of the University of Chicago Medical Center, 5800 S. Cottage grove Ave. lasts Tuesday, sept. 24, to demand the university open a level one trauma unit that would serice severely injured area residents.

At 12:08 a.m. August 15 [2009], Damien Turner was shot in the back. Ten minutes later he was hurtling up South Lake Shore Drive in the back of an ambulance to Northwestern Memorial Hospital, where he died 10 miles from where he was shot at the corner of East 61st street and south Cottage Grove Avenue -- less than four blocks away from the University of Chicago's hospital.

"I'm not going to bury my head and let his memory die away," said his mother, Sheila Rush, at a rally Sept. 28 in front of the university's hospital, vowing to work toward opening a trauma center on the SouthSide that could have treated her 18-year-old son.

Rush was surrounded by dozens of supporter from the community organization her son founded, Fearless Leadership by the Youth, called on the university to reopen its long-shuttered trauma center. Since 1989 when the university and Michael Reese Hospital closed their trauma centers, residents of the south Side, including Hyde Park, live in the only neighborhoods in Chicago to be 20 miles or more from a hospital that can treat victims of gunshot wounds, stabbings or car accidents -- such as the motorist who crashed a car which then burst into flames on South Lake shore Drive at East 51st Street on Sept. 25.

All residents of the North and West sides of the city live less than five miles from a trauma center.

Turners' ambulance tore up the empty Lake Shore Drive at close to 50 miles per hour on a clear, calm August night, reaching Northwestern Hospital in 10 minutes--the fastest an ambulance can get to a trauma center from the South side, according to Larry Langford, a spokesman for the fire department. Langford declined to estimate average travel times, but said traffic and weather can slow down an ambulance considerably. In the poorest served parts of the city, the state estimates ambulance travel times can approach an hour, about equal to the most isolated rural parts of the state.

"You don't have a lot of options to go to. The fire department would like more options on the South Side," Langford said. "It's a big hole, but I don't know what to do about it."

The South Side wasn't always a big hole. For the first two decades of trauma care in Chicago, only a handful of residents around Lake Calumet were farther than five miles from a trauma care hospital. "That's how ist was supposed to be," said Dr. David Boyd, who invented the trauma center classification for hospitals and set up the county's first trauma care network in Chicago in 1971. "What we did was we said we know we need coverage on the South Side and we need the university involved because they have a the organization and training," Boyd said. "You can't justify these guys coming 30 miles in the middle of the night with a bullet in their belly."

According to Boyd, it was difficult to convince the university to commit to a trauma center and it was given broad leeway, including a smaller area to serve and an agreement from the state to not put up signs directing people to the trauma center. "It was a nervous situation because they didn't want to become the county hospital on the South Side," he said. The university was only intended to be in the network until the smaller community hospitals could build their own trauma care centers, according to Boyd.

The community hospitals on the South Side never opened trauma centers [and many closed altogether] and the the university closed its center in 1988, telling the Herald at the time it was losing more than $100,000 a month because of trauma care. Michael Reese Hospital['s?] closed the next yer, citing millions in yearly losses. "We, for a while, were the busiest in the city," said John Easton, a spokesman for the university who has been at the hospital through the opening and closing of the trauma center. "You get a lot of patients that happen to unfortunately be very expensive and can't pay."

Cash for trauma centers is few and far between -- often subsidized -- by routine patients with private insurance. The state operates the Trauma Center Fund, which collects about $2-$4 million a year in fees from drunk driving convictions. Half of the fund is distributed to hospitals across the state based on how many patients they treat in trauma centers that can't pay, according to Sam Gaines, the state director of emergency medical services. The fund is a small and unreliable source of funding because the governor can chose to empty it into the general coffers at any time, the said. The state receives some funds for emergency rooms from the federal government, but the money cannot be used for trauma centers, according to Gaines. "The state would love to have trauma centers in the area; the problem is we can't mandate it and we can't fund it," Gaines said. The trauma center designation has always been optional for hospitals and the state is only now reviewing to option make all hospitals apply.

To increase funding for trauma centers, a committee at the Illinois Department of Public Health last month recommended new fees on the sale of guns, ammunition and fireworks. The source of the funds, which would largely come from downstate, could make it politically difficult to spend on expanding South Side trauma centers and hiring the always-on-call staff needed to run them.

City and state officials all agreed that without increased funding, the city would unlikely expand beyond its four current trauma centers, Northwestern Memorial Hospital, the county's John Stroger Hospital, Mount Sinai Hospital, and Advocate Illinois Masonic and the south suburban Advocate Christ Medical Center. Together, the five hospitals threat more than 6,500 trauma victims a year. Stroger and Mount Sinai hospitals treat more than 60 percent of trauma cases.

"Too many young people in our area have lost their lives, some of which could have been saved but they were driven by this hospital that does not have a trauma center, that refuses to serve our community" sid Rev. Andre Smith in a prayer at the Sept. 28 rally at the university. "The blood trailed all the way to Northwestern is on their hands."

 

_______________________________

 

U. of C. medical practices drawing critical eye

And protests at UC calling for a South Side trauma center continue, some becoming confrontational.

By late 2009 the UC Emergency Room was undergoing reforms, which came under fire (Dean Madara later resigned).

A pilot Discharge Lounge was one of several changes being inaugurated after review under head Dr. Everett Vokes. Lots of interviewing and reviews went into the various changes. staff positions were added to transfer lower risk patients to other servers, and streamlined admissions and waiting room policies including a surge plan for high volume times. Wait times have already decreased 65 percent. The discharge lounge is for patients waiting to be picked up, Mon-Fri 10 am-8 pm. And it creates more space by not having patients just wait in beds because family or friends haven't come yet to take them home. Patients will have boxed lunches, water, and a handicap bathroom, and an aide who will assist with phone calls, help, and wheeling them out to the street.

Chicago Tribune, September 8, 2008. By Bruce Japsen

A University of Chicago Medical Center strategy to steer poor and uninsured patients with less serious injuries to other facilities to focus on treating the most challenging cases is making the South Side hospital more money--and attracting growing criticism.

In the last three years, the medical center has expanded an effort to educate the uninsured on how to get proper medical care without showing up in its expensive emergency room.

For all its successes, though, the initiative has prompted questions from a wide array of skeptics, including a prominent Republican senator, a local alderman an some of the hospital's doctors. They all strike a similar chord, which Sen. Charles Grassley (R-Iowa) summed up this way: The medical center appears to be "culling the least profitable patients from its emergency room."

Grassley, the ranking Republican on the Senate Finance Committee, recently requested documents concerning the medical center's Urban Health Initiative as part of his larger inquiry into whether non-profit organizations such as the center are "losing sight of the public service that comes with tax-exempt status."

The issue is politically sensitive because Michelle Obama played a central role in creating the health initiative before taking leave to join her husband's presidential campaign. Barack Obama, the Democratic nominee for president,has made a major issue out of the ailing healthcare system and the nation's 45 million uninsured citizens. Michelle Obama, as vice president of external and community affairs, led a team that worked with physicians, including emergency-room doctors, administrators and clinics to link patients with primary-care medical providers elsewhere on the South Side. The effort, called the South Side Health Collaborative, has evolved into the Urban Health Initiative.

As part of the inquiry, Grassley is asking for information on executive salaries, including Obama's; how she and others were hired; and the process used in making these decisions.

Asked to comment on Grassley's inquiry, a spokesman for the Obama campaign directed the Tribune to a statement from Sen. Dick Durbin (D-Ill). "The fact that Sen. Grassley is questioning the work of the University of Chicago Medical Center--especially those programs aimed at reducing emergency department overcrowding and promoting preventative health-- is troubling and shows that he simply doesn't understand the problems facing our hospitals today," Durbin wrote. But a Grassley staffer said this inquiry is similar to others he has undertaken to determine whether non-profit hospitals are earning their tax-exempt status and benefiting the community.

The medical center says it's trying to focus more of its resources on providing specialized care, training doctors and conducting cutting-edge research. Medical center officials say that any increased profits go toward those three missions and that the Urban Health Initiative is "not about making money," said Dr. James Madara, chief executive of the medical center.

The Urban Health Initiative has sent poor patients to other hospitals and about 20 clinics on the South Side, including the Access Community Health Network. There are two major financial incentives for patient to be moved from the U. of C. to other places of treatment. Under federal reimbursement rules for facilities that operate in certain neighborhoods, the government pays more money to treat Medicaid and other poor patients than if th U. of C. treated them. Also, the University's costs tend to be about 60 percent higher because, as a teaching institution, its expenses include training doctors and conducting research. Though the university says the initiative involves transferring patients covered by commercial and higher-paying Medicare plans for the elderly, nearly two in five of the medical center's patients are uninsured or covered by the Medicaid program for the poor, which is notorious for its low payments to hospitals. The U. of C. says this percentage of Medicaid patients is higher that that of other teaching hospitals nationwide.

The University would not provide a specific number of patients referred to other facilities or how their care is paid for. University officials say they have heard concerns from some physicians and community leaders but say this is understandable given the program is new and innovative. "Anything that's a major change stimulates some anxiety," Madara said.

Some U. of C. doctors and physicians at places where patients are being referred say they did not want to speak publicly, fearful of being critical of the university as well as of the Obamas.

But Ald. Toni Preckwinkle, who represents the neighboring 4th Ward, said she ha heard from some of her constituents who feel short-changed when referred to community hospitals and clinics. "What about dignity?" asked Preckwinkle, who was an Obama delegate at the Democratic National Convention but has publicly criticized him, and separately the U. of C., in the past. "What's the message to people when they say you can't get treatment at a place that is on television [with its ads] every hour? If you are going to send people who have mundane or chronic illnesses to surrounding institutions for care and treatment, you have to be supportive of those institutions, including financial support," Preckwinkle added. She wonders whether medical center executives are doing something that makes good business sense or are simply "gaming the system" to make more money.

The program helped the medical center achieve a 5.2 percent operating profit margin through the first 11 months of its fiscal 2008, ended June 30. A Moody's Investors Service report said the program to steer patients with less complex conditions to "a more appropriate and cost-effective setting" was among several actions that helped "bring expense growth under control." By comparison, one in three U.S. hospitals has a "negative operating margin," according to the American Hospital Association.

And medical center officials say they are providing millions of dollars in grants, staff time and doctors to the places where patients are being referred. Those facilities also benefit. At Mercy Hospital and Medical Center, for example, U. of C. referrals help fill its beds for low-risk baby deliveries, routine heart bypass surgeries and other procedures, Mercy executives said. "It's just a wiser use of resources," Madara said. "We want to make sure the right treatment, at the right time in the right place is given for the best outcome."


University of Chicago and Medical Center state their case

University of Chicago Chronicle, September 25, 2008. Urban Health Initiative: Building a 'medical home' for all. Whitaker leads initiative to build 'medical home' on city's South Side. By Steve Kloehn

For patients, the expansion of the Grand Boulevard Family Health Center will mean shorter waits to see a doctor and more regular treatment for chronic conditions such as asthma and diabetes.

For the Medical Center, which helped the clinic double in size with a $350,000 grant, the expansion represents a new chapter in the Urban Health Initiative, and ambitious effort to reshape health care on Chicago's South Side.

On Friday, officials of the University and Access Community Health Network, which operates the 16-room clinic at 5401 S. Wentworth Ave., will gather to celebrate their growing partnership. Together with other South Side providers, they are promoting a model for health care focused on giving every patient a "medical home."

The medical home model has gathered momentum nationally, with Congress embracing many of its core ideas and Medicare recently adopting a new demonstration program based on its concept.

Under the Urban Health Initiative, a South Side resident might find a medical home at the Grand Boulevard Family Health Center, getting care for routine or chronic conditions that is more appropriate, less costly and more convenient than along wait in an emergency room -- the only alternative for some. At the clinic, they might see Access staff or one of 11 University specialty care physicians, who serve patients there. The medical home model also helps smaller health providers to use their full capacities, while allowing the University Medical Center to focus on the complex medical care that is unique to an academic center.

"We want to create a cooperative system of independent health care providers who can deliver the right patient service, at the right time, in the right setting," said James Madara, Dean of the Division of Biological Sciences, Vice President for Medical Affairs and Chief Executive Officer of the Medical Center. "We are trying to develop a national model for serving a vulnerable population, with all the special challenges that entails."

In 2005, as part of a federal grant, the Medical Center launched the Healthy Communications Access Program, an effort to match UCMC emergency room patients seeking routine care with a primary physician. That led to the creation of a network, known as the South Side Health Collaborative, that now includes local doctors, nurses, 19 community clinics and two other area hospitals, Mercy Hospital and Medical Center and Mount Sinai Hospital.

those efforts were soon incorporated into UHI, a more comprehensive effort that adds scholarship, teaching and policy advocacy to the clinical initiatives. UHI features a $23 million research program seeking better ways to provide community health care and offers student loan assistance to Pritzker Medical School graduates who pursue careers in underserved areas of the South Side.

Eric Whitaker (M.D. '93) a nationally known public health expert who grew up on the South Side, joined the Medical Center last fall as Executive Vice President for Strategic Affiliations and Associate Dean for Community-Based Research to help shepherd the Urban Health Initiative. Whitaker had seen the challenges from many angle -- as head of the Illinois Department of Public Health, as senior attending physician at Cook County Hospital and as the creator of an unusual grass-roots effort, which built a barbershop inside a South Side community health center to encourage African-American men to seek care.

Whitaker knew better than most that Chicago's South Side is one of the least healthy communities in the state, with high rates of chronic disease. he felt that the only way to address those deeply rooted problems was to bring all the community's resources to bear. "Our current system is disjointed, which leads to the duplication of efforts," Whitaker said. "We need to create a rational system for serving patients, and we need to support it with our intellectual, political and financial capital."

One hundred UCMC doctors and 4o administrative staff are now working in UHI partner institutions. The University also has provided more than $2 million in the last year to help support partner institutions such as the grant to the Grand Boulevard Family Health Center -- part of an $8 million investment in the Initiative so far. "The University of Chicago Medical Center and Access Community Health Network share a common objective: to build a partnership that increases access to a continuum of high-quality primary and specialty care services for South Side residents," said Donna Thompson, chief executive officer of Access Community Health Network. "Our strategic partnership with the Medical Center is focused on expanding patient care resources as well as on broadening teaching and research opportunity."

As election-year scrutiny put a spotlight on Michelle Obama -- on leave from her position as UCMC's vice President of Community and External Relations, where she helped launch the South Side Health Collaborative -- the Urban Health Initiative also received national news coverage this summer. That prompted U.S. Sen. Charles Grassley (R-Iowa), to ask the Medical Center to explain UHI, as part of Grassley's ongoing examination of the public benefits provided by tax-exempt institutions, including hospitals and universities.

UCMC officials say they welcome the opportunity to discuss the initiative and demonstrate the hospital's commitment to providing high-quality care for all patients, whatever their circumstances. Currently 36 percent of the Medical Center's patients qualify for Medicaid, roughly three times the average of other large hospitals around Chicago. Just as the UCMC is seeking medical homes for all emergency-room patients without a primary physician, regardless of their insurance or income, it wants to make its highly specialized care available to all patients who need it -- something they say is not possible if the Medical Center becomes crowded with routine cases, while other providers are underutilized.

Early results look promising. UCMC data show that 67 percent of patients who were referred through UHI in its first six months have since had a general physical exam, something they could not previously get because they did not have a primary physician. Thirty-eight percent had seen UHI doctors two or more times.

Officials say the program is also helping preventative and chronic care, two constant challenges. Seventy-nine percent of patients with hypertension were taking regular medication, according to UHI data, while 46 percent of those identified as smokers had enrolled in smoking-cessation programs.

"This is a new way of doing things, and that can make people uncomfortable," said Whitaker. "But we are getting a lot of good feedback, from patients and doctors, because they see how this will improve health across the community."

Top

[Suggestion: an in between solution might be to continue and expand what UCMC is doing plus have an additional DCAM with outside clinics/practitioners in it as well as UC that would give for sub-emergency conditions: initial treatment, regimens etc. and referral for ongoing care to various providers including UCMC with preference to close-to-home and depending on what kind of ongoing treatment, primary or preventive care is decided by a team using consistent and fair standards. This would still serve the purpose needs (including research and training) of the Medical Center as well as expanding community service. It would require more fundraising and better collections and payments including from government, which is all too slow and pinch-penny from all levels and programs. Perhaps the alderman's experience related below is one of general approach and problems within emergency rooms and policy respecting this hospital rather than with the program?]

Chicago Maroon, November 18, 2008. By Christina Schwartz. Iowa senator presses Medical Center on level of community care- Grassley: Hospitals appear to be culling the least profitable patients from its ER

The U of C Medical Center (UCMC) sent a final response on Friday to Senator Chuck Grassley's (R-IA) investigation into its finances, which probed whether regulations for non-profit tax-exempt status should be amended to exclude hospitals who are neglecting their communities. The UCMC's response elaborates on an initial response of over 1,000 pages, sent in mid-October.

Grassley's criticism of the UCMC focuses on a controversial program launched by then-vice president of community and external relations Michelle Obama in 205. The program directs emergency room patients with noncritical conditions to seek medical care closer to home. The ranking member of the Senate Finance Committee, Grassley has been examining the hospital's charity care policy as part of a larger investigation evaluating whether the Internal Revenue Service (IRS) should reinstate quantitative rules for what constitutes charity care when hospitals apply for tax exempt status. Currently, qualification for tax-exempt status is based on "community benefit," rather than on the amount spent on charity care.

"The IRS regulations were pretty much watered down to nothing," said Jill Kozney, Grassley's director of communications. According to Kozney, the IRS determined in 1969 that there was less need for charity care after the introduction of Medicare and Medicaid because the government would handle payments for the care of the uninsured. According to documents prepared by Grassley, the community benefit standard requires an emergency room open to all, an open medical staff policy, a board of directors drawn from the community, treatment of patients on Medicaid and Medicare, use of surplus funds to improve patient care, and the provision of medical training, education and research.

The UCMC program Grassley has attacked, the South Side Health Collaborative, helps UCMC emergency room patients with non-emergency conditions find medical care near their home. the program also helps eligible patients register for Medicaid or Medicare and aims to inform them of their health care options.

"The emergency room is not a great place to get anything other than emergency care. You don't get primary care, and you don't get preventive services like screening for HIV or breast cancer," said Eric Whitaker, UCMC executive vice president for strategic affiliations and associate dean for community-based research. "Given the scarce resources of the health system, we cannot afford to spend an enormous amount on people who get care in an inappropriate setting."

But this program has its skeptics, who have criticized this program since September. "It is pushing routine or chronic illnesses into community hospitals around the University and is keeping the unusual and interesting cases for the hospital," said Toni Preckwinkle, alderman for the the fourth ward, which contains parts of Hyde Park. "I don't know that it is always in the best interest of the communities that I serve." Preckwinkle told the story of her daughter-in-law's younger sister, who took her son to the emergency room in an ambulance. He was vomiting and could not stand up or walk. "They spent the entire time in the emergency room trying to discourage him form entering and telling her to take him home," Preckwinkle said. "This has been very discouraging to me."

Grassley has made similar characterizations of the program. "The hospital appears to be culling the least profitable patients from its emergency room," Grassley said in a September statement.

But hospital administrators contend that the program benefits the community by saving uninsured patients from the hospitals high costs. Whitaker said that as a teaching hospital, UCMC's operating expenses are up to 60 percent higher than a community hospital. Also, UCMC is the only hospital on the South Side to perform certain complex medical procedures. "People would come here for their general pneumonia, and we ended up not being able to be of service for those who needed sub-specialized services which only we can provide," Whitaker said. "This meant for our partner hospitals that we actually took business away from them as a consequence of us taking on general care."

A year ago, the need for empty beds caused the hospital to turn away half of its prospective patients in need of special care, according to Whitaker. With the program diverting a greater number of non-emergency cases toward community hospitals, the hospital can take 90 percent of the complex transfer patients. Another of UCMC's defenses is that the hospital provides grant money to clinics and hospitals on the South Side.

Despite intense criticism, the UCMC will not be making any changes to the program. "The fact is that what we are doing is good public policy," Whitaker said. "We have not had to change or adapt what we are doing because we believe that we did the right thing in the first place, and we have no need to adapt."

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From the UCMC Forefront, October 2008: Grand Boulevard Expansion Provides Community-Based Specialty Care

UC gave a $350,000 grant to Grand Boulevard Family Health Center enabled additional specialty cares staff, currently 15. VP Erik Whitaker was quoted, "People who live in our community suffer extraordinarily high rates of chronic diseases -- suffering that is amplified by the lack of connections to care. Collaboration.. is beginning to meet the critical challenge of providing quality, accessible health care in a community setting." 60 Medical Center doctors work in partner institutions and the MC gave over $2 million in the last year to partners-- $8 million to date. CEO James Madara said, "Our collaboration.. helps solidify an expanding, cooperative system of independent health care providers in our community." "These....help us serve a vulnerable population." Dr. Kenneth Silver: " ...we still have millions of children without access to primary and specialty health care. This partnership shows that we can provide high quality care that makes a positive, long term impact in this community."

Chronicle of February 19, 2009 seeks to put changes in context- BioMedicine restructuring focuses on coherence, by John Easton, UCMC

[to] advance... missions while lowering overall costs and allowing for a strong and focused response to the economic downturn. The changes continue the work begun in 2006, when the University unified all of its activities in patient care, biomedical research and education, and community outreach into a single structure, now called Chicago BioMedicine.

Medical Center CEO James Madara said the current restructuring will increase the connections between different parts of the organization and put it in a better position to meet today's financial challenges. In December, when financial pressures created by the economic downturn began to accelerate changes already under way, CBM leaders identified the need to cut $100 million from the annual budget. Among the first actions was a reduction of about 15 positions in senior management, announced in early January. A process was created, in consultation with representatives across Chicago BioMedicine, to reassess the contributions of every part of the organization to core missions.

In a letter to the XCBM community (http://www.uchospitals.edu/news/2009/20090209-reorganization.html), Madara wrote, "Our decisions have been directed by our continuing commitment to high-quality, compassionate care for patients with the most challenging diseases; the creation of new knowledge; producing the next generation of leaders; partnering with community-based providers through the Urban Health Initiative; and protecting our high-technology platform for complex patient care and leading-edge research on the South Side of Chicago."

The decisions are designed to make the organization somewhat smaller, but more focuses on activities for which it is uniquely suited. Unfortunately, that also requires a workforce reduction across all parts of the enterprise, which will decrease through a balanced combination of attrition and layoffs. Beginning Monday, Feb. 9, about 450 employees--about 5 percent of the CBM workforce-- were notified that their positions were being eliminated. "We deeply regret the loss of so many talented employees..."

The major principal of enhancing the Medical Center's focus on providing complex care has guided the institution's decisions in the area of patient care. The Medical Center has long led the way in complex care, often providing intricate lifesaving procedures that few other institutions could match--such as multiple organ transplants, innovative cardiac surgery and cutting-edge clinical trials for cancer. Some of the reductions are based on how units fit within the mission of providing the highest level of complex care; other decisions stem more directly from declines in patient volume as a result of the national and local economic downturn.

Overall, inpatient capacity will decrease by more than 30 beds, including reductions in general medicine and intensive care units, along with staff reductions in those areas. This difficult decision was based partly on the fact that some patients can be treated at other institutions, without the high-technology platform that Chicago BioMedicine provides.

As part of the reorganization, two offsite doctors' offices will be closed adn most of their services relocated to the Duchossois Center for Advanced Medicine. A surgical unit will reduce weekend services and staffing, while clinical operations also will cut back on outside consultants and standardize supplies in some areas. Housecleaning staff will be reduced for non-patient areas or clinical units affected by the decrease in patient beds. Patient units that remain open will preserve high standards of safety and quality by retaining current staffing ratios and contact hours between patients adn nursing staff.

The emergency department will be reorganized, with more up-front medical assessment to identify patients with urgent conditions. The institution will strengthen transfer agreements with other hospitals and clinics, as it begins to redirect patients who do not require emergency care to physician's offices and other facilities. Madara noted that over time these changes should reduce patient volume in emergency care and help redistribute demand among a broader set of appropriate providers, Madara said.

In addition, the Medical Center is opening a specialized intake unit to improve the quality of care for patients who already receive specialty or complex care or who develop urgent complications. Madara noted that as these plans are implemented, they will also be refined in consultation with clinical faculty and nursing staff.

In the basic sciences, some staff reductions will come from consolidating administrative duties...[and] a pause in hiring new faculty.

the largest source of savings from institutional support comes from the reduction in senior management positions made in January. Additional administrative reductions will come from financial personnel and facility design and construction. Reductions in budgets for areas such as marketing will be made, and capital spending for construction and renovation will be reduced.

Madara emphasized that construction of the New Hospital Pavilion, scheduled for completion in 2012, wil go forward, and the Medical Center wil continue to strengthen the community health care network on Chicago's South Side through its Urban Health Initiative (http://www.uchospitals.edu/news/uhi/index.html).

"Even as we look for ways to reduce costs and become more efficient, we must continue to invest in cutting-edge technologies, modern facilities and strategic initiatives in order to ensure that Chicago BioMedicine can achieve its core missions," Madara said. "Such investments are necessary if we are to continue to provide medical care of the highest quality and safety, conduct agenda-setting research, educate the nation's finest doctors and scholars, and lead the way in biomedicine."

Related links:

Reorganization FAQ: http://www.uchospitals.edu/news/highlight26.html.

Statement on emergency room care: http://www.uchospitals.edu/news/highlight12.html.

UC News Office release September 23, 2009:


UHI advocates connect patients to medical homes on Chicago’s South Side- September 23, 2009


The patient is a 25-year-old African American male who came to the Bernard Mitchell Hospital emergency room for chest pain. He straightens his slouched posture and looks hopeful when Wanda Trice, an Urban Health Initiative patient advocate, pulls the curtain back and inquires about his medical home.

He doesn’t have one, he tells her. In fact, the only time he sees a doctor is in the emergency room, even though he has health insurance. When Trice offers to arrange a visit to a University of Chicago-affiliated health clinic near his home, he eagerly asks to leave and go there, since he has been in the ER for hours.

“No, you can’t leave,” Trice tells him. Clearly disappointed, he sighs and slouches again. “But you can go there for follow-up care. Let me make you an appointment.”

Patient advocates like Trice can play a vital role in helping patients find a medical home for routine care. Patients without medical homes often delay treatment for non-urgent medical conditions until the symptoms worsen and warrant a trip to the ER, where they may wait several hours to be treated.

One goal of the Urban Health Initiative is to change that pattern, connecting patients with medical homes through the South Side Healthcare Collaborative—UHI’s network of community health centers.

About 74,000 patients pass through the Bernard Mitchell ER for adults and the pediatric ER at Comer Children’s Hospital each year.

Each patient is screened by a triage nurse and later by a physician to determine the acuteness of the patient’s condition. After triage, if a patient has a condition with low acuity, and he or she reports having no medical home, advocates like Trice begin the process of connecting the patient with a primary care physician at one of the health centers.

Eligible, low acuity patients who want to bypass the wait in the ER may be offered to receive care that same day at Friend Family Health Center, located three blocks north of the Medical Center. High acuity patients with no medical home are approached upon discharge after they have been thoroughly treated.

Recent data suggest that this approach is working. In early 2008, 40 percent of visits to the adult ER were classified as low-acuity, or non-life threatening. That number has dropped to 30 percent, according to data for fiscal year 2009.

“I try to let them know that in the emergency room, you’ll only be treated for your complaint that day, not for your overall health,” explained Trice, who has been a patient advocate for four years. She has seen many patients come in for one condition and leave diagnosed with another that requires regular care. “I try to let them know that [at a medical home] it’s more personable. There will be time for questions and certain tests that just won’t happen in the ER.”

Through the South Side Healthcare Collaborative, the University of Chicago Medical Center has ties to more than 25 federally qualified community health centers throughout the city. Trice called the one closest to the young man’s home, but the earliest available appointment conflicted with his work schedule. After more back-and forth-discussion, she scheduled an appointment for the young man one week later at Access Booker Family Health Center.

Advocates routinely follow-up with patients to check that they were satisfied with the clinic visit. The UCMC estimates that in both emergency rooms about 80 successful links are made each week, regardless of a patient’s ability to pay. If a patient has challenges paying for services, the community health centers work with them by offering an income-based, sliding scale fee.

“We don’t leave our patients out there with no leads, and we don’t want them to go clinic shopping,” said Semeca Johnson, a patient advocate at Comer Children’s Hospital. “We do all the homework for patients to find them somewhere where they’ll be comfortable.”

Since helping to launch the patient advocate program at Comer, Johnson has seen more than 3,000 patients in two years. A large part of her job, she said, is educating parents. Johnson explains a child’s medical condition and how it can best be managed at the doctor’s office, rather than in the emergency room, and she explains the costs covered by insurance.

Patients often are able to get a quicker follow-up appointment at an affiliated clinic in the community, where many UCMC doctors attend patients. By helping patients find those options, advocates also help keep the ER available for patients who truly need emergency care.

“Our goal is to get patients where they need to be, and a lot of times, that’s not in the ER,” Johnson said.

By Kadesha Thomas


Perspective on the Hospitals in March 12 2009 Chicago Weekly

Medical Emergency. The University of Chicago Hospitals face a crisis of conscience. By Sarah Farr

As the issue of national health care becomes the focus of an increasingly heated debate in the national political arena, the issue is equally important here on the South Side, with the University of Chicago's medical center generating a lot of talk in recent weeks. First, the UCMC announced its plans to lay off 540 employees and to cut up to an additional 500 jobs through attrition. Then criticisms began to surface regarding its treatment of Medicaid, Medicare, adn uninsured patients. While restructuring plans within the emergency room are in the works, in-patient capacity is being reduce through the elimination of more than thirty beds.

All of this is related to the UCMC's transition to become Chicago BioMedicine. the transition will bing organizational change, but, most importantly, Chicago BioMedicine represents a total reconfiguration of priorities, with a growing emphasis placed on lucrative, high-tech specialty medicine and less attention on primary care service and general medicine. The University's stance is that the restructuring will allow the hospitals to focus their energies on the areas of "specialized care," in which they excel, allowing other to focus on the less glamorous side of medicine.

Then, of course, there is the Urban Health Initiative, or UHI, which has garnered a lot of criticism recently, such as accusations that it comes "dangerously close" to the illegal practice of "patient dumping." Additionally, the emergency room structure that it will leave in its wake will likely result in a decline in the quality of care provided to Medicaid, Medicare, and uninsured patients. But what exactly is the Urban Health Initiative, and why is it so controversial?

In 1986, the U.S. Congress enacted the Emergency Medical Treatment and Active Labor Act (EMTALA) to remedy the practice of "patient dumping," the act of turning away Medicare, Medicaid, and uninsured patients from emergency rooms in order to save hospitals money. EMTALA requires that any hospital receiving government assistance provide treatment for all individuals seeking care for emergency medical conditions, regardless of their insurance status or ability to pay. Virtually all hospitals in the United States receive some form of government assistance and are thus subject to EMTALA, and the UCMC is no exception.

With the UCMC estimating that approximately forty percent of cases treated in its emergency room would be better treated by primary care physicians and that twenty-five percent of patients arriving at it ER do not have a regular primary care physician, receiving patients without primary care doctors is a serious problem. This is where the Urban Health Initiative comes into the picture: the initiative is supposed to provide patients with the opportunity to find permanent and appropriate "medical homes" by transferring patients who arrive at the ER with non-urgent cases to community clinics and nearby hospitals. This is where some of the controversy arises: according to the American College of Emergency Physicians, the country's largest group of emergency doctors, these transfer practices come "dangerously close" to breaking the federal guidelines outlined in EMTALA.

The UHI is essentially a two-step process's whereby patients classified as non-urgent and low-complexity are removed from the ER and then directed to the "medical homes" they deserve. While the UCMC has been very successful in accomplishing the first part, its execution of the second step leaves much to be desired. The truth is, there aren't many available statistics about the success of the UHI at helping these patients find "medical homes." Even the statistics published by the University are unimpressive-- only thirty-eight percent of patients referred to clinics by the UHI had seen a primary physician more than once. While the UCMC boasts of its commitment to supporting health care alternatives within the South Side community, its actual contributions to improving this infrastructure are mediocre at best. The University claims it has invested $8 million towards these programs since the UHI's inception four years ago. Where has this $8 million gone? Aside from the $650,000 it says it has given to assist renovations and support medical programs at community clinics and a $40,000 financial aid program to encourage UCMC graduates to practice on the South Side, your guess is as good as mine. And considering that the UCMC paid over $6 million to its five top-salaried employees in 2006 alone and that it wil spend $700 million on its new pavilion, this figure seems suddenly much less impressive.

Even doctors and medical students within the University have expressed concern over the new direction of the UCMC adn UHI, although fear of reprisals has kept many from making public statements. One University of Chicago medical student who chose to remain anonymous described several policies currently being debated among the hospital leadership that could lead to a "segregated, two-tier hospital in which patients with private insurance receive distinct treatment from those on Medicaid, Medicare, or without insurance." Two prominent doctors at the UCMC recently resigned their leadership posts as a result of disagreements over these proposals. The medical student also criticized UCMC CEO James Madara's reasoning that the UCMC must decide between "health care at the cutting edge or treating the poor," holding the conviction that "a medical facility located in an urban center must do both." The student also worried that "the values that attracted people to the UCMC--patient care, education, and dedication to the community-- were being lost.

while the University might like us to think that the recent plans to restructure the UCMC have arisen out of necessity in light of the recent financial crisis, the decision to place priority on high-tech specialty care at the cost of primary care and general medicine has been a long time coming. In 2005, Madara published an article in the Journal of the American Medical Association outlining a vision for the future of academic medical centers such as the UCMC. In the article, Madara observes that many academic hospitals are located in "economically marginalized" communities and argues that expecting such a medical center to be the primary health care provider for the community is "overly simplistic." Madara suggests that academic medical centers redefine the term "community" to reflect the population that such a high-caliber institute could best serve--patients requiring "highly specialized and complex care" --instead of the geographically adjacent population. Madara is careful to add that this new understanding of "community" would not be defined by a patient's insurance status or income level. He does not address, however, the fact that the application of such a redefinition would effectively result in a priority shift toward privately insured adn non-local patients, intentionality aside.

Additionally, Madara argues that the presence of as large, academic hospital could drive community clinics out of business due to competition. Questions have been raised, however, over whether community clinics on the South Side of Chicago even have the capacity to adequately meet the increased demand that will come as the UCMC begins to send non-urgent cases elsewhere. In a plan released on February 9 of the year, the UCMC announced the closure of a University of Chicago-supported community health center. The clinic will now be housed in the UCMC Duchossois Center fro Advanced Medicine, which is home to most of the UCMC's adult primary care services. The catch? According to a story published by the Huffington Post, the Duchossois Center is not currently accepting new patients. It appears that even as the UCMC places limits on who can access care at its ER, it is also cutting back on alternate health services in the community.

Under Madara's leadership, Chicago's BioMedicine will completely redefine the role of the UofC hospitals within the South Side community. As the UCMC becomes increasingly closed to the local community, it is time to reevaluate the moral obligations of the University of Chicago. As an institution with its fair share of baggage when it comes to community relations, it finds itself at a critical crossroads: what kind of neighbor will the University of Chicago choose to be?

 

A response by HPKCC president George Rumsey to a March 20 Tribune piece Mr. Rumsey calls "fawning". This was posted in the Tribune Online.

ER troubles worse than you think
Tribune staff reporter
March 24, 2009
Surely you realize you need to do more than mention Michelle Obama to "justify" an editorial ("Trouble in the ER," Editorial, March 20).

The U of C Medical Center "wants to clear its ER of non-urgent injuries and illnesses." It intends to become "a magnet for research dollars." You don't see a bit of a conflict with "health care" here?

You refer to the community clinics the UCMC now "redirects" patients to. I live two blocks from the U of C hospital and cannot get an appointment to see a doctor, though I've gone there for 30 years. I'm now referred to clinics that are run by the UCMC and are soon-to-be-closed. See the Hyde Park Progress blog (hydeparkprogress.blogspot.com) on the health care desert in Hyde Park and the surrounding South Side. I've also been directed to call other clinics, which tell me they aren't accepting new patients for a number of years.

A major hospital needs to serve its community. The U of C Medical Center is beginning to fail in that responsibility. The Tribune needs to do a more thorough examination of the patient.

--George W. Rumsey

President, Hyde Park-Kenwood Community

As of mid-March 2009, the University was re-evaluating its ER policy or its implementation. Perhaps in part due to federal allegation (see next item)

Hyde Park Herald, March 18, 2009. By Sam Cholke

The University of Chicago Medical Center will delay implementation of a news patient triage system that would have referred more patients from the emergency room to surrounding clinics. "It's still being discussed," said John Easton, a spokesman for the medical center. The new system was slated to be implemented in early April. The plan would place more responsibilities on a physician to diagnose which patients in the emergency room would be better served by a neighboring clinic. No patients would have been forced to leave the emergency room, and the decision would not be influenced by insurance coverage.

The plan came under intense scrutiny in the media and by emergency room doctors' organizations after a Feb. 13 Chicago Tribune story, "University of Chicago ER sends kid mauled by a pit bull home," which described how 12-year-old Dontae Adams was treated with Tylenol, morphine and antibiotics after he was attacked by a dog. The article contends that Adams required surgery for the wound.

The instance brought a harsh rebuke from the American College of Emergency Physicians and the American Academy of Emergency Medicine. "If anything, these are times that demand the most from our hospitals and our emergency departments, because these are the times when our patients need more care, not less. My heart breaks for Mrs. Adams and Dontae and the night of hell they surely endured just to get Dontae the care he needed and deserved," Dr. Nick Jourile, president of ACEP said in a prepared statement.

In its own press release, the University of Chicago Medical Center called Jourile's comments "reckless and uniformed and based on hearsay." The medical center contends that the treatment given to Adams was the care recommended by the ACEP. The ACEP made a call for Congressional hearings "about the problems facing emergency patients."

Easton said it's "hard to say" whether outside pressure played a part in the decision to reconsider the new triage system. The University of Chicago Medical Center has experienced a changing of the guard over the last month. Everett E. Vokes was appointed chairman of the department of medicine at the University of Chicago Medical Center, effective March 9. Also this month, Andrew Alper was elected to replace Thomas Crown as chairman of the University of Chicago board of trustees . Easton said the decision to reconsider changes in the emergency room came from the new leadership after consultation with university president Robert Zimmer.

the decision to delay changes in the emergency room could affect budget cuts at the University of Chicago Medical Center. Reducing costs related to the 40 percent of patients who visit the emergency room who do not require emergency medical attention was a considerable part of the 7 percent the medical center is cutting from its budget.

On Feb. 9, the medical center laid off about 5 percent of its work force, 450 workers. The medical center has also cut 15 executive positions and about 20 nurse administrator positions. No practicing nurses will be laid off, Easton said. "I think we have found a way to keep all direct care giver nurses," Easton said. The university employs about 1000 nurse, according to Easton. Easton said he could not say if more layoffs were coming, but said the medical center was "through the bulk of that.

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U. of C. violated ER law, U.S. alleges. Hospital protocol wasn't followed in man's visit, death.

Chicago Tribune, March 28, 2009. By Bruce Jepsen

The University of Chicago Medical Center violated federal law by not providing a medical screening exam to a 78-year-old man who died last month in its emergency room, federal health officials say. The Feb. 3 death of the man led to violations of the federal Emergency Medical Treatment and Active Labor Act, according to the Centers for Medicare and Medicaid Services. Such violations, if not corrected to the agency's satisfaction, could lead to a loss of federal health insurance program for the elderly, a financial lifeline for hospitals.

The Center for Medicare and Medicaid Services on Friday said it cannot comment on the case until the U. of C. has submitted a corrective action plan. The agency's allegations were outlined in a March 17 letter to the hospital provided by the U. of C. Medical Center to the Tribune on Friday.

In addition, The Joint Commission, the major accreditor of U.S. Hospitals, on Friday said it was investigating the incident. The Joint Commission is empowered by Congress to accredit hospitals so they can get Medicare reimbursement. The Illinois Department of Health, which conducts compliance investigations lon behalf of the Centers for Medicare and Medicaid Services, surveyed the hospital Feb. 18.

The hospital said Friday that its investigation found proper policies and procedures were in place but that staff members may not have followed the protocol. Appropriate disciplinary actions are being taken, the hospital said in a statement. "Emergency department physicians and nurses have met with the patient's family to explain the event and express their sympathy," the U. of C. said in a statement.

The federal allegations come amid a plan, put on hold two weeks ago by U. of C. President Robert Zimmer, to reorganize the emergency room and send triage patients with less serious illnesses elsewhere.

Under the federal act a hospital needs to ensure that appropriate medical screenings are provided to everyone who comes to the emergency department. For every person found to have an emergency medical condition, a hospital must provide "Stabilizing treatment" or appropriate transfer to another hospital if the facility lacks the capability to care for the patient, according to the Centers for Medicare and Medicaid Services. But in the letter to U. of C. Medical Center President David Hefner, the agency said the hospital failed to "maintain a central emergency services log" and "provide a medical screening exam." The Joint Commission described the actions of U. of C. personnel as a "sentinel event," an incident that could lead to death or serious injury.

"This means that the organization must submit a root cause analysis and a plan for taking corrective action," Joint Commission spokesman Ken Powers said. "This is then reviewed by Joint Commission. After a plan is accepted, the organization must submit evidence that the plan is working and that changers have been implemented."


Maroon, April 3 2009. U of C to revisit EDR changes amid controversies. By Alison Sider

Public backlash surrounding the University of Chicago Medical Center emergency room policies and standards of care have escalated in the last two weeks as the Center announced it wil reevaluate its plans to reorganize the emergency room, and a unrelated February incident in the ER could jeopardize its ability to serve Medicare patients.

In a memo to faculty and residents last month, President Robert Zimmer announced plans to create a committee to revisit the ER's policies, which include transferring patients in less urgent condition to other area facilities. Everett vokes, the newly appointed chair of the medical department, wil head the committee and coordinate any shifts in policy. "Faculty in the Department of Medicine, under the leadership of new chair Dr. Everett Vokes, have been asked specifically to review and refine plans related to changes in the operation of the Emergency Department and the planned reduction of beds in general medicine and in intensive care. As a result of this review, it is likely that the proposed changes will occur in phases and implementation of some changes -- though not all -- will be delayed slightly," said University spokeswoman JUlie Peterson in an e-mail interview. Hospital spokesman John Easton has said that early plans to cut 10 of the 31 ER beds have also been shelved.

Discussion about potential reorganization of the emergency room began in the fall, but they took on new importance as the Medical Center faced $100 million in budget cuts this winter, according to Easton. "So many different but inter-related things were changing so rapidly. The economic downturn forced people to accelerate the pace of change," he said. But Easton said that Zimmer's announcement developed out of "a belief that maybe we should slow down and reevaluate."

The financial constraints are hard to ignore. Compared to peer institutions , the Medical center relies heavily on Medicaid payments, which Illinois has been slow to provide. This has left it without a "cushion" to fall back on in hard times, according to Willard Manning, a professor in the Harris School of Public Policy and the Biological Sciences Division, who focuses on health economics.

Two national physicians' organizations publicly criticized the Medical Center's policy of diverting patients from the emergency room to other area facilities. The American College of Emergency physicians compared the policy to the illegal practice of "patient dumping," and expressed concern that the hospital was attempting to jettison its least profitable patients in order to focus don profitable specialty care. A group o nearly 200 faculty members and residents signed a letter to the administration criticizing the policy.

But hospital administrators contend that in addition to cutting costs, the plan will increase community access to healthcare and streamline the ER by encouraging patients to find a more appropriate "medical home" for primary care and non-urgent concerns. According to the Medical Center's website, about one-third of the patients visiting the ER do so instead of seeing a primary care physician. These visits are costly and contribute to long wait times for urgent cases.

It is not only patients who might be denied care at the Medical Center who have raised concerns. Federal authorities investigated the death of a patient in the emergency waiting area, and subsequently threatened to revoke the Centers' Medicare certification. On February 3, a 78 year old patient died in the ER waiting areas, having waited there for hours without receiving a medical examination or even being checked in. After receiving a complaint, the Centers for Medicare and Medicaid launched an investigation. An unannounced survey conducted by the Illinois Department of Public Health on February 18 determined that the hospital failed to maintain a central emergencies service log, and cited the hospital for failure to provide medical examinations. The inspectors also found additional deficiencies in medical record services and emergency services, according to Medicare spokeswoman Cinthia Michel.

Medical Center Chief Operating Officer Carolyn Wilson said that the incident was not the result of the EDR's organization, but with the way employees followed protocol. "Our EDR, like all big-city emergency rooms, is crowded, but proper policies and procedures were in place and staff members may not have followed them," Wilson said. "Appropriate disciplinary actions are being taken."

Medical authorities are currently reviewing a plan of correction, a process that could take a few weeks or longer. The review will be followed by another unauthorized inspection. Wilson said that the Center's proposed corrections are "robust," and should be more than sufficient to maintain Medicare Certification. Losing Medicare Certification would be highly costly, a over 35 percent of the hospital's payments come from Medicare. Manning said that while it is not uncommon for hospitals to be cited or inspected by federal authorities, it is unlikely that the hospital would allow the loss of its Medicare certification. "The consequences are relatively severe-- we would lose a lot of money. Clearly the university can't afford to do that. Very few institutions walk away from Medicare," Manning said.

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Referral to primary care doctors and clinics- succeeding? failing? mixed bag?

From the Tribune Aug. 2010 by way of UC News releases:

U. of C.'s Urban Health Initiative growing
Program is linking thousands to primary care but officials say more work is to be done
July 29, 2010|By Bruce Japsen, Tribune reporter. An initiative designed to transform health care on Chicago's South Side that was once led by first lady Michelle Obama has linked 5,600 people to a "medical home" since 2005, University of Chicago executives said Thursday.

Five years after the Urban Health Initiative was launched as a way to educate patients on the best use of the emergency room, the program has grown into a network of 25 community-based clinics and other medical care providers on a budget of more than $6 million a year. It is now poised to escalate research initiatives and teaching opportunities for physicians in hopes of becoming a national model for medical care in urban areas.

While medical center executives point to the successes of the Urban Health Initiative, they also acknowledge that these patients are not consistently maintaining a relationship with a doctor after they are guided by U. of C. to its vast network of primary care providers.

From Hyde Park Herald August 4 2010. By Sam Cholke

The University of Chicago's Urban Health Initiative is making incremental progress in convincing patients to find a primary care physician and not use the emergency room as a first option for health care.

The Urban Health Initiative was started in 2005 as a program to set up appointments at local clinics for patients who seek treatment in the emergency room for minor health concerns. Appointments are now being kept by more than a third of patients referred by the medical center, a modest rise over previous years. "We're trying to change social norms and that's hard," said Dr. Eric Whitaker, the lead on the initiative and associate dean of community-based research. Whitaker said the no-show rates for appointments are approaching the levels at the university's primary care and specialty clinics.

Patients referred to clinics by the university after being treated in the emergency room are still missing appointments about twice as often as those who go straight to one of the partner community clinics. Less than a third of patients are missing appointments at the Chicago Family Health Center, 9119 S. Exchange Ave., according to Warren Brodine, CEO of the clinic.

The university faced criticism last year when activists accused the Urban Health Initiative of plotting to deny care to uninsured and Medicaid patients in the university's emergency room. Whitaker said teh program still faces misconceptions in the community. Patients are referred to community clinics only after being treated at the medical center's emergency room and often see University of Chicago doctors who practice in the partner clinics. whitaker said the program is driven by the desire to provide the best care to patients in their community.

Few patients who find a home at the partner clinics return to the University of Chicago Medical Center when they develop a condition that requires hospitalization. Dr. Sara-Anne Schumann, a University of Chicago doctor who practices at the Chicago family Health Center, said she usually refers Medicaid and uninsured patients to Advocate Trinity Hospital or the Cook County's Stroger Hospital and refers insured patients to Trinity or sometimes the university.

Schumann and Whitaker said this is the unpleasant reality of health care in Chicago and across the state. The government offers large financial incentives to nonprofit hospitals like Trinity to admit Medicaid adn uninsured patients, while discouraging academic hospitals like the university by compensating at a vastly lower late. Trinity and community clinics are reimbursed by the government at a rate up to three-times higher than the university for treating the same patient. University officials said the medical center is rarely paid enough by the governmental to cover the costs of treating Medicaid and uninsured patients.

Brodine said there are patients at the Chicago Family Health Center who are taking risks with their health to make sure they get to choose where they are treated. Pregnant patients would sometimes tell me, 'I intend to present myself at the University of Chicago emergency room when my water breaks,'" Brodine said. Pregnant women are rarely referred to the University of Chicago unless there are medical complications, according to interviews with directors of several clinics involved in the Urban Health Initiative. Brodine said it was still unclear how the federal health care reform efforts would affect care on the South Side. Health care reform will add thousands of uninsured patients to the Medicaid rolls and double budgets at clinics like the Chicago Family Heath Center; Friend Family Health Clinic, 800 E. 55th St.; and other clinics that are registered as federally qualified health centers, according to Bodine.

Whitaker said he is pushing for expanded care at the county's Provident Hospital, 5900 E. 51st St., to care for many of the patients that will b newly eligible for Medicaid. He said th e university does not have the capacity to handle the influx of new patients. Provident Hospital, like Stroger Hospital, is reimbursed at a higher rate for treating Medicaid patients than the university. The board overseeing the county hospital system has said Provident will have to aggressively pursue Medicaid patients in the future to remain financially stable.

The university is currently in partnership negotiations with the county on expanding care at Provident. If successful, the university would provide doctors to staff the hospital, training for teh expanded specialty care services and invest $5 million in upgrading infrastructure in the hospital. "Provident is a critical piece to what we're doing," Whitaker said. "If we have Provident or if we don't, we will continue to build a network on the south side. "

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University starts South Side health providers survey so it can better refer

Herald, July 15, 2009. By Sam Cholke

The University of Chicago launched a study last week that will give South Siders a full listing of all health resources in their community by fall. The Resource Mapping Project will provide a database of every business in the South Side's 32 neighborhoods that relates to health - from hospitals and clinics to gyms and farmers markets.

Studies in the past have found that the non-healthcare infrastructure of a community, like grocery stores and gyms, have more of an impact on people's health than health care providers, said Colleen Grogan, the projects co-director and a professor in the School of Social Services Administration at teh university. "We want to think more broadly about health and to do that we need a map," she said. "It's really the community's data to interpret," Grogan said. "We don't want to be the ones to interpret the data and say what we should do."

Thirty two-person teams of local students and community members are walking block-by-block talking to each business to collect the information. What the surveyors bring back will all be made public and can be used by people to better find services they need and help residents better plan development of health care infrastructure, Grogan said.

Information on Hyde Park, Kenwood, Grand Boulevard, Washington Park and Woodlawn will be collected this summer and available online by fall for neighborhood residents to assess and suggest how it should be updated and expanded. "The project only works if we have continual and constant engagement from the community," Grogan said.

"Community health assets are very volatile," Grogan said. The problem with existing databases is the are so quickly out of date, she said. Community editors will be in charge of constantly updating changes to the health resources in each community. The project will determine the level of services available, but will not make any judgments about the quality of care, said Martha Van Haitsma, director of the university's Survey Lab, which will oversee the project. "That's not a step we're even thinking of taking," she said.

The project will cost more than $1 million to map the entire South Side, said John Easton, a spokesman for teh University of Chicago Medical Center. It si being funded by the university's Urban Health Initiative, grants from teh National Institutes of Health and other grants. Top

Herald editorial June 17 29: A solution to the University of Chicago's recent p.r. woes

[Suggests reporting statistically accessible to community its record on ER adequate care, and finding a provider to keep the 47th women's clinic open until it can be permanently transferred.]

The University of Chicago has stumbled into a tangled public relations snarl over practices at its medical center in recent weeks, adding to a trouble yer for the center and its relationship with the public. Marches and rallies have been following one another in succession as patients have decried the center's practices. The fallout from these community complaints include scathing media coverage and a call for congressional hearings by U.S. Rep. Bobby Rush (D-1).

What is at the heart of these rancorous proceeding? On the one hand, accusations of patient dumping at the emergency room -- allegations that poor patients are sent elsewhere for care. Compounding these charges is a recent announcement that he center plans to close its women's clinic on 47th Street. The big picture, according to critics: The Medical Center does not care about the community and is positively dismissive of its lower-income neighbors.

There is a certain irony underlying these charges. The clamor is based on an overwhelming desire among community residents to gain access to the Medical Center's top-notch staff. While the particular accusations being leveled are troubling, there is a vast agreement that what services the center does provide are the best available on the South Side and perhaps in the country. We should keep this in mind as we examine the allegations.

One one level, the patient dumping charges are patently false. As defined legally, the university is not denying care to patients on a discriminatory basis. Nobody has been able to prove that any patients that ought to be admitted to the hospital are being sent away.

Whether all visitors [to the emergency room are getting the most treatment the center can offer is another story. I]t is clear that some Medical center employees are allowing bureaucratic insensitivity to trump beside manner all patients deserve. No one should leave a medical facility with the sense that they were not wanted there. If there is good reason for patients to receive additional care elsewhere, this has to be explained in a respectful manner and with absolute clarity. To not do so violates the very spirit of the medical profession and the premise to "do no harm." Thus far, accusations that the center is doing the minimum legally possible for some patients are anecdotal-- but there are a whole lot of anecdotes. The university must find a way to signal clearly that it is doing all it can and should for its patients-- particularly for low-income ones.

Two steps could quickly transform the center's position on this issue. The first is to create a way of reporting statistically its record at the emergency room in a way that is accessible tot eh community at large. If the numbers show the university is providing adequate care, the anecdotal evidence loses much punch.

The second is related to the medical center's other big headache these days. Residents claim the 47th Street clinic provides essential services in an environment in which medical facilities are shrinking - and what's available is not high quality. The center says it cannot qualify to get the specail status needed to draw federal resources to teh clinic. It also says the existing clinics on the South Side will easily absorb their patients.

We reject the latter claim as empty rhetoric. The staff of these clinics tell us their waiting rooms are already jammed. The first claim, however, deserves to be taken seriously. If teh center cannot become certified to draw down federal money then they are at a severe economic disadvantage.

This does not mean the clinic should close down, however. The medical center must identify a worthy successor and keep that clinic open until it can be taken over by replacement ownership. Doing so will signal to the community that the medical center is concerned about the well-being of its neighbors and could also be teh symbolic action that eases accusations about the emergency room's treatment of patients.

The University of Chicago Hospitals are a positive good for the South Side of Chicago. They ar a valued employer and medical resource. Both sides of the recent flap over their treatment of community members need to come together and find ways of working out their differences. Commitment to the 47th Street clinic would be a positive sign the medical center is willing to do just that.

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CHART asks "What is the Urban Health Initiative Doing to Our Community?

As the country struggles with a growing health care crisis, the University of Chicago Medical Center should be part of the solution. But with its Urban Health Initiative, UCMC is making changes that are deepening the crisis in its own community - especially for low-income people, women, people of color, and the elderly.

UCMC has:

We say enough is enough!

The Coalition for Healthcare Access Responsibility and transparency (Chart) believes UCMC must balance its commitment to research and medicine with its responsibility to taxpayers and to the community of which it's a part5. We ask President Zimmer and Dean Madara to take the following initial steps:

  1. Keep the 47th Street women's health center open
  2. Declare an immediate moratorium on clinic closures, staff cuts and bed cuts
  3. Restore and expand transportation from the community to the hospital
  4. Expand staffing and beds in the E.R. and in General Medicine
  5. Open the hospital to new patients looking for a doctor, regardless of insurance
  6. Ensure a living wage and good benefits for all employees

What can you do? Call, email and fax President Zimmer and say "Meet with CHART!"
Call: (733) 702-8001 -rzimmer@uchicago.edu - Fax: (773) 702-0809.

Get involved! Email us at chartchicago@gmail.com or call (773) 355-8222. More information: www.stopchicago.org or chartchicago.wordpress.com.

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On the June 30 CHART rally. Herald July 8 2009: Doctor: Clinic serving fewer poor; Protesters unsuccessfully seek meeting with U. of C. President Zimmer to halt 47th Street women's clinic closure- WHICH DID NOT CLOSE AS SCHEDULED.

Protesters circles in front of the University of Chicago Administration building June 30, calling on President Robert Zimmer to halt the closure of a university-run clinic. A doctor at the clinic echoed their complaints, saying it has become increasingly difficult for him and many of his peers to treat the low-income patients that drew them to the job in the first place.

The protesters, led by the group Coalition for Healthcare Aces Responsibility and Transparency, claimed that poor and uninsured people will be hurt by the loss of the clinic, 1301 E. 47th St. "The people here want to speak to the president because the president signs off on decisions," said Toussaint Losier, an organizer with the group. "Even if he's just a rubber stamp, he's still the final decision."

Zimmer was not in his office on June 30 to meet with the organizers. The organizers were able to speak with Marina Munsters, deputy dean of students, an one of the few administrators in the building during the summer afternoon. Musters agreed to pass the group's message along to the president.

The clinic will temporarily remain open past the announced closure date of June 30, according to John Easton, a spokesman fo the University of Chicago Medical Center. "The clinic will remain open for a few more weeks while we continue to arrange for the final few patients to be seen elsewhere," Easton said in an e-mail. "It's currently open for obstetrics patients about three half-days per week."

Dr. Mishka Terplan, the head of obstetrics and gynecological care at the clinic, was still unclear what he would do after the half-day clinics end. "I'm committed to serving low-income women, something increasingly difficult to do at the University of Chicago Medical Center," Terplan said. He said he, like many of his colleagues, was attracted to the medical center because of its focus on research and a desire to serve South Side patients. "I don't have th job I had before. The institution has changed around me," he said.

Doctor's desire to serve low-income patients is coming into conflict with a medical center that is increasingly conscious of its bottom line, cutting $100 million from this year's budget and laying off 450 support staff in February. "I don't even bring in my own salary," Terplan said, adding that he treats many more patients than the average doctor at the medical center. "Other faculty support my bottom line."

The clinic where Terplan provides care treated about 3,000 patients a year, many of whom were low-income, and was losing between $600,000 and $800,000 a year, according to Jeremy Manier, a spokesman for the university. The state on average reimburses hospitals $.73 for every $1 spent on treating a Medicaid patient, according to the Illinois Hospital Association, a system that makes it more cost effective for hospitals to leave a bed empty than to treat a patient on Medicaid. Terpan said, though he billed more than $750,000 last year for treating his primarily Medicaid patients, the state reimbursed the clinic about $.07 for every dollar of care he and other doctors provided. The clinic was declared ineligible for increased reimbursement from the state as a federally qualified health center, which serve unserved and underinsured communities, according to Easton. "Department cannot operate at a loss forever adn ever," Terplan said.

Terplan said doctors at the medical center are now increasingly being reminded by administrators about the "payer mix," how their privately insured patients help make up the losses from treating patients with government-sponsored insurance. "There are institution goals for where the administration would prefer the payer mix to rest, but the are not set standards applied to every physician," he said. Physicians are becoming increasingly frustrated at the medical center, Terplan said. "Most doctors enjoy taking care of patients - period," he said. "These are changes being forced from the top."

Terplan said that dissatisfaction was being more openly expressed in the hallways of the medical center, but fear of retribution has prevented many doctors from expressing their discontent with administrators and section heads. Other doctors at the University of Chicago Medical Center the Outlook attempted to reach declined to comment for this story.

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New alliances eyed; Whitaker states case. Note- some of this was discussed by Prof. Colleen Grogan of UC at a May 2 2009 OWL meeting

Crain's Chicago Business, April 22, 2009. Hospitals eye alliance- South Side Squeeze. Access to health care is limited for South Side residents, and hospitals are serving and underinsured population. (Beds per 1,000- Chicago average 3.3, South side 1.7. Average Medicaid pending on physician services, per person- Illinois $291.18, South Side $220.35.)

Leaders of some of Chicago's largest hospitals and clinics are exploring plans to form a network to improve medical access for poor residents on the South Side. The idea is to stitch together affiliation deals that would help funnel patients to the most appropriate -- and least costly -- places for treatment. Talks involve about 20 clinics and hospitals, including University of Chicago Medical Center, Rush University Medical Center, Cook County's health system and three hospitals owned by Advocate Health Care.

Jump-starting the effort was a study completed last month and funded by the foundation of the late Gary Comer, the Land's End founder and South Side native who donated more than $80 million for U of C's children's hospital. The study offers a prescription for fixing the most common problems on the South Side and near south suburbs: jammed emergency rooms and months-long waits for appointments to see scarce specialists like neurologists.

The effort comes amid growing local and national debate over how to divvy up responsibility for fixing a frayed health safety net. U of C, for example, has for years sought partnerships with nearby hospitals and clinics to send them routine cases so it can focus on complex care like cancer treatments. But critics -- including some of its own doctors -- have accused the Hyde Park hospital of sending poor patients away so it can focus on the well-insured.

Yet local health leaders involved in plans for the South Side say coordination among clinics and hospitals to route patients to the most appropriate provider would actually improve access. "If you manage these patients in the appropriate venues, it's better for everyone's bottom line," says Leah Durst, medical director at Friend Family Health Center in Hyde Park, who has been involved in the talks. The tendency of patients to seek routine treatment at emergency rooms rather than less costly clinics "is like buying a shirt at Nordstrom when you can get the same one at T.J. Maxx."

South Side hospital executives have discussed one-off partnerships for some time. The 64-page Comer report, by Chicago-based consultancy Health Management Associates Inc., has provided a starting point for formal talks to create a network that would cover 1.4 million people -- 40% of whom are either uninsured or on public aid. Still, most are reserving judgment on ist specific recommendations -- an indication that it won't be easy getting longtime competitors to agree on the fine details. "Any partnerships have to be mutually beneficial and sustainable," says Eric Whitaker, the U of c executive vice-president in charge of building ties to other medical providers. "We're all struggling with how to create a delivery system out of a non-system."

Improving access

The report focuses on expanding access for pregnant women and children, who generally have Medicaid coverage, though backers view it as a blueprint for improving access for the uninsured, too. One example: It urges U of C to join with Friend Family to open an urgent-care near the hospital's jam-packed emergency department. Patients showing up with non-emergencies -- a big problem fo U of C -- could be redirected quickly to the clinic and its primary care doctors. Drs. Whitaker adn Durst say the ideas has been discussed, but there's no concrete plan.

It also suggests U of C send pregnant women and children with less complex needs to the nearby county-run Provident Hospital, which needs the revenue and has the capacity to double its volume of those cases. Dr. Whitaker says that idea has been discussed but hasn't gained traction because of leadership turnover at the county health system, which gets a new chief, Bill Foley, next month.

Another suggestion from the report: Rush and Mount Sinai Hospital could jointly serve as a hub for specialty care for kids and pregnant women on the Southwest Side, which the report says is plagued with "health care dead spots." The hospitals' CEOs have discussed the prospect of a joint specialty outpatient center and how they might share hard-to-find specialists like pediatric neurosurgeons. "We're trying to flesh out what the roles and investments of the institutions could be," Rush CEO Larry Goodman says.

The study was commissioned by Stephanie Comer, the foundation's president and daughter of Mr. Comer. She says she is ready to donate money toward capital projects or other plans that may hatch from the effort. "Some of these providers have never spoken to each other before," Ms. Comer says. "It's exciting to get them all in one room and have them at least acknowledge there's a problem." Top


By Eric Whitaker, UC VP Strat. Initiatives, comm-based research. We can make the South Side a model for health-care. Chicago Tribune, April 23, 2009

I was born in a legendary Chicago hospital that has nearly disappeared. Michael Reese Hospital was once a showcase of the South Side, a first-class research center that served as a beacon for people from many walks of life. Scientists there helped develop electrocardiography, found new links between cholesterol and heart disease, and did groundbreaking work on insulin. When my mother studied to be a nurse, Reese and cook county Hospital were the only teaching hospitals in town that welcomed black trainees. Once I dreamed of practicing medicine at Reese. Now the hospital is bankrupt and wil close soon. The last time I drove past, all the lights were out.

Reese's fate gives a sense of the vast health-care challenges in underserved areas like the South Side. Tight financial resources here can make it difficult to sustain advanced-care centers such as Reese and the University of Chicago Medical Center, where I work. Yet my home community desperately needs the best care available. We contend with widespread poverty and some of the nation's highest rates of Chronic disease -- diabetes, hypertension, asthma.

We don't have to accept a future of declining community health and struggling hospitals. If we take the right steps now, the South Side could become a national model for how to build an innovative and sustainable health network. We'll need to put aside institutional turf and accept that no single medical center can meet all of our patients' needs.

The best strategy would be to combine the strengths of many South Side centers and treat them as one "virtual hospital," which patients can access in different locations depending on their medical needs. Such an approach makes economic as well as medical sense. It would sustain the area's network of community hospitals and clinics, and connect low-income patients with the primary care they need to prevent serious complications of chronic conditions. My hospital has worked on this through the Urban Health Initiative, which strives to match patients with local clinics and physicians.

But we will not reach any of our goals without restoring trust within the community. Our patients don't always trust that if we refer them to a different institution, they will still get care of the highest quality. And hospitals often don't trust each other, fearful that the patients they refer elsewhere will never come back.

The hospital where I work has not always been a good partner for this kind of collaboration. The U. of C. has been seen as as detached from its medical neighbors and at times arrogant and overly competitive.

I think we can change those views and build a true partnership on the south Side. More faculty and residents from my hospital are fanning out to smaller centers where they are sharing knowledge and helping new groups of patients. Many of our patients who voluntarily transfer to those centers report greater satisfaction that they had at our hospital. That's humbling, and a sign that we can learn a lot from our neighbors.

Together we can learn more about our patients' unique health problems. The health disparities that exist between rich and poor are a huge problem for Chicago, yet we still don't know enough about why they persist. For example, why are diabetic adults on the South Side nearly three times more likely to be hospitalized than diabetes patients in the rest of the state? we suspect that diet, genetics and a lack of preventative care all play a role, but we don't know the specifics -- or how to correct the problem.

That's why a coalition of groups from around the city will soon embark on the South Side Health and Vitality Study, an ambitious effort to understand and begin remedying these glaring gaps in health outcomes. We want to create a resource that patients and researchers will draw on for decades, much as the Framingham Heart Study in Massachusetts has shaped ideas about cardiovascular disease.

No single hospital wil solve the South Side's health disparities by working within its own four walls. And no center here can thrive without strong affiliations -- that's one lesson of Reese's demise. But if we learn to trust one another and work together, we can help our patients and prevent more hospital lights from flickering out.

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Herald June 17, 2009. Clinic fallout spreads. By Sam Cholke

Closure of a women's clinic run by the University of Chicago has re ignited a debate about how its medical center treats the poor. The controversy began in January when medical center officials announced they were considering new policies for the emergency room. At several rallies in recent weeks, complaints abut emergency care surfaced alongside protest of closure of the women's clinic, 1301 E. 47th St.

Some former patients claimed that while they were admitted to the emergency room, they didn't receive adequate care -- a charge medical center officials deny. Cynthia Ashley protested alongside about 30 people May 29 outside the University's Administration Building, 5801 S. Ellis Ave. She said she was admitted to the emergency room in July 2008 with a broken kneecap. She alleges that doctors there gave her an X-ray, painkillers and a set of crutches, and told her to head straight to John H. Stroger Jr. Hospital of Cook County for follow-up care. She said she believed the medical center had referred her to an outside hospital because she is covered by Medicaid. "I don't want to feel like that again," Ashley said. "If you don't have good insurance, they'll throw you out."

Stories like Ashley's are part of a pattern in the view of activists group such as Southside Together Organizing for Power and the Coalition for Healthcare Access Responsibility and Transparency. They claim that Medicare and Medicaid patients get less care because private insurers compensate the medical center at higher rates. Under federal laws aimed at preventing patient dumping, emergency room doctors are barred from refusing care to anyone whose health is in immediate peril. But once patient have been stabilized, the law does not require the emergency room to continue to treat them.

Just what amounts to proper stabilization is a key bone of contention between activists and the medical center. "Those of us who went into medicine die not go into medicine to decide who gets treatment and who doesn't," said Dr. Pete Thomas of the Woodlawn Health Center, 6337 S. Woodlawn Ave., said at a June 3 rally. "When I tell them 'I'm your doctor, you can come back here for care,' that's what matters."

Medical Center officials say the hospital is following the law and stabilizing patients appropriately. Ashley declined to sign a release allowing medical center staff to discuss her case publicly, but Jeremy Manier, a spokesman, said she received timely care appropriate to her condition. For patients who don't need to be kept overnight, the medical center frequently makes referrals to partner institutions after a discussion between the doctor and the patient, according to John Easton, a spokesman. Referring outpatients to other hospitals shortens wait times fro patients and significantly cuts costs, Easton said. Costs for care at the medical center run 60 percent higher than at community hospitals because of its research and teaching component, according to to James Madara, CEO of the medical center.

The recent economic downturn is behind broad cost-cutting measures at the medical center, which announced in January a plan to cut its budget by $100 million. One of its major cutbacks, announced in May, was the closure of the women's clinic, which allowed patients to pay on a sliding scale. The closure renewed activists' claims that the medical center is focusing its care on wealthier patients -- abrogating its responsibilities as a nonprofit. Their outcry has prompted rep. Bobby Rush (D-1) to call for congressional hearings on the allegations of patient dumping at the medical center.

"Patient dumping has been a widespread problem across many of the nation's medical center and hospitals, and Congress has a duty to expend its power to mitigate and prevent this despicable practice from continuing in centers that receive federal funds," he wrote in a May letter to the congressional Committee on Oversight and Government Reform.

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Outsourcing of geriatrics by U C- good or bad?

Herald, April 15 2009. By Sam Cholke

The University of Chicago Medical Center wil be reducing its geriatrics department by eight beds and moving some patients to Holy Cross Hospital. "The strong partnership of a highly specialized teaching hospital will give the highest quality of care to geriatric patients and their families in a setting that is easier for patients to navigate and less complex for everyone involved," said Wayne M. Lerner, CEO of Holy Cross Hospital, 2701 W. 68th St., in a prepared statement.

Spokesmen from both institutions described the collaboration as mutually beneficial. "We have an excess of patient rooms and space for the program and room to house people who are delivering care," said Dennis Ryan, vice president of external affairs for Holy Cross Hospital. "In the biggest sense of this, it's to get an excellent level of care at the facility that makes the most sense at which to do that."

A University of Chicago physician will still treat patients from the medical center that transfer to Holy Cross. "It's good for us... in that our costs are probably 75 percent higher than that of a well-run community hospital," said John Easton, a spokesman for the medical center. Easton said that the referral program would be "payer-blind," and patients who did not require complex medical treatment would be given the option to transfer to the cheaper and less complex community hospital before any insurance information was collected.

"At Holy Cross they can get into a bed pretty quickly," Easton said. Holy Cross will also have an additional source of patients, he said. The University of Chicago will provide physicians for the program and Holy Cross will provide all support staff. Easton and Ryan were not able to comment on whether the medical center would compensate Holy Cross for administrative costs associated with the medical center physicians.

The shift of patients is the most recent in a series of cost-saving measures undertaken at the University of Chicago Medical Center. The medical center plans to cut one general medical unity, about 24 beds, according to Easton. The institution is also considering reducing the number of beds in intensive care units. The shift in geriatric patients comes a month after the medical center tabled a program that would have given emergency room patients the option to transfer to a community clinic if their medical condition did not require immediate medical attention. The system would have also been "payer-blind," according to hospital officials, and patients' insurance information would have been processed until after the patient had made a decision where to receive care.

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Women's clinic closed.

May 29, STOP got involved, held a press conference there (1301 S. Woodlawn, and marched to the University 's admin. bldg.

"The University of Chicago has treated our community like a guinea pig since its inception. Now that they are at the Forefront of Medicine, they want to treat us like we are toxic waste. We as patients need this clinic and other local clinics cannot handle the dumping the University is planning,” says Deborah Tayler, a patient at the clinic and spokeswoman for Southside Together Organizing for Power (STOP).

 

Arguments

Chicago Maroon, May 22, 2009. By Alison Sider

The Women's Health Center, a University-run clinic on East 47th Street [at Woodlawn] that serves Medicaid and Medicare patients, will close at the end of June. Administrators say the decision was made for financial reasons, and as part of the University of Chicago Medical Center's (UCMC) effort to focus on research and treatment of complicated cases, but critics say the clinic's closing will severely limit access to University health services for low income patients. UCMC spokesman John Easton said discussions about closing the gynecological and obstetric care clinic have been underway for about a year, but were spurred along by the Medical Center's $100 million budget cut earlier this year.

"It has been difficult to run these clinics in a way that didn't lose money," he said. "Because we are research- and teaching-oriented, we have much higher costs. The clinics are seen as a place where we can get outpatient experience for residents. That brings more eyes and attention to each case, but it's not always more efficient."

In searching for ways to provide more efficient care, the UCMC, like many other academic medical centers, has started to back away from the regional health clinics it set up throughout the 1980s and '90s, Easton said. Two other primary care clinics were closed and the physicians' practices relocated to the Duchossois Center for Advance Medicine (DCAM) in April.

The UCMC has turned its focus to building "non-acquisitional" partnerships with local clinics and community hospitals, hoping to enable these partners to provide the bulk of routine community health care. In the last three years, the Urban Health Initiative has worked for this reorganization of local health care.

But some say that the new policies will create a two-tiered healthcare system in Hyde Park, in which the University will see patients with private insurance and delegate the uninsured and those with public insurance to local clinics. "When you get down to it, a Medicaid patient who has a gynecological complaint is going to be seen in a community clinic. A patient with private insurance with a gynecological complaint is going to be seen by OB/GYN department faculty. That's a disparity of where care is delivered. I'm not sure it it translates into disparity of health outcomes," said Dr. Mishka Terplan (A.B. '91), head of the clinic.

Some of the clinic's patients will continue to be seen by the University. The center's high risk pregnancy clinic will still operate through the University, though in a new location. Patients with complex medical issues will be seen at a once-a-week clinic at the DCAM. Terplan said that this accounts for less than 10 percent of the nearly 4,000 patients the clinic saw last year.

But the rest of the clinic's patients must find a new provider of gynecological care from clinics in the South Side Healthcare Collaborative (SSHC), a group of federally-qualified health clinics throughout the area that have established relationships with the UCMC. Laura Derks, the director of the SSHC, said that after a meeting between representatives of the 25 SSHC clinics and the Women's Health Center earlier this year, nine clinics can provide comparable care for current University patients.

"The difficulty is in deciding who should be seen in [the new DCAM clinic] and who should be seen in the community," terplan said in an e-mail. Patients with public insurance seeking care at teh U of C have generally been referred straight to the Women's Health Center instead of to teh general OB/GYN practice at the Medical Center for financial reasons, according to Terplan. The clinic's patients came from well beyond Hyde Park: Terplan said 6 percent of the clinic's patients in the last six months have traveled over 20 miles to see the University faculty and residents who staff it. "Regardless of income, [patients] want to go where they perceive the care is best. U of C is at the forefront of medicine; they're willing to travel," Derks said.

The clinic's staff has worked with the Urban Health Initiative in order to ensure a smooth transition for patients. "Before the UHI, the Medical Center would have made the decision to close 47th Street, and that would have been th end of it," Derks said, noting that the same would bed true of any academic medical center. "What the Urban Health Initiative says is that we know there are other community resources that can help fill in the gaps, and do just as good a job in caring for patients. Let's make sure patients know about these resources, so they're not wandering around blind.

On-site patient advocates have reached out to most of the clinic's patients with information about the alternative clinics. They have scheduled appointments at the new facilities for many patients, and have also made efforts to ensure a smooth transfer of records between the University and local clinics. Speaking about the transition process, Terplan said, "I had incredibly low expectations for the process," but he recognized that the Medical Center was doing the best it could in a difficult situation.

Medical residents, who staff the clinic under faculty supervision five days as week, will complete the clinical aspect of their residency at NorthShore Medical Center in Evanston, through a new partnership established last year. The clinic's other staff, including nurses and technicians, have not been promised employment at the UCMC, and most plant o seek employment elsewhere once the clinic closes. [Their services are lost to other communities. Also, not addressed here: How easy is it to get timely appointments at the other clinics or are they all booked up; will insurance honor service there or plans allow you to use them; and what does it say that only 9 in 25 SSHC affiliates quality-- the others don't have OB/GYN? Are inadequate?]

Herald, May 22. By Sam Cholke

The University of Chicago Medical Center will in late June close its clinic at 1301 E. 47h Street, a primary care clinic for women that treats about 3,000 patients a year. "If patients have a complicated disease, like [gynecological] cancer, we'll continue to take care of those," said John Easton, a spokesman for teh medical center. For the others, the ones who need routine care, Pap smear, routine [gynecological] exam, we have sent them a list [of community clinics] and have been talking to them and helping them make appointments if they want one."

Crystal Blalock, who has been a patient at the clinic since 2006, said she had been given a list of clinics and was offered help setting up an appointment with a new physician. As she led her daughter out of the clinic on May 20, she said for her keeping teh same doctor was not a concern.

Easton said the doctors from the clinic would remain with the medical center. The clinic was staffed by a rotating 10-person team comprised of an attending physician and resident physicians. Most of the nursing and clerical staff wil also remain with the medical center, Easton said. "I think we'll be able to find jobs for most but not all of them," Easton said.

Easton said the clinic had become increasingly expensive and was proving detrimental to the hospital's relationship with partner primary care clinics. "It has not worked well for us and it winds up competing with our partners if we run little clinics like this throughout the community," Easton said. "We don't want to compete with people we're trying to form partnerships with."

Easton said teh university was unsuccessful in finding an entity that could take over the clinic as a federally qualified health care center, community clinics that receive more government subsidies for treating Medicaid and uninsured patients. Friend Family Health Center and the access Community Health Network both run clinics across teh South Side that receive federal grants as federally qualified health centers. "We tried to do that, but it proved to be difficult to do," Eason said. Federal restrictions exclude the medical center from applying for the grants, he said.

The medical center closed the Walter G. Zoller Memorial Dental Clinic at the end of last month, which was created in the 1030s with a $3 million endowment fro Hyde Park millionaire Walter Zoller. Two of the dentists have moved to other private practices and a third will remain with the medical center, according to Easton. Though the dental clinic has closed, the medical center continues to oversee the endowment which is "earmarked for research, education and dental and oral care for the poor," Easton said. The endowment will continue to be used for dental care for the poor and by plastic surgery teams teams to cover the cost for patients who don't have insurance but need some sort of intervention like surgical reconstruction, cleft palettes and other emergency medical treatments, he said.

Dr. Mishka Terplan, who runs the [women's] clinic, told the Chicago Tribune that he worried closing the health center would push uninsured patients to community clinics while patents with insurance would be treated at the medical center. The medical center has repeatedly expressed that it is not reducing the number of patients it teats that are on Medicaid or are uninsured.

In reports filed with the Office of teh Attorney General, the medical center reported that it provides free medical care to anyone who makes up to twice the federal poverty level, which is $10,830 for an individual and $22,050 for a family of four. The policy also indicates anyone making less than four times the federal poverty level will receive some form of financial assistance from the medical center. The medical center admitted 11,323 Medicaid patients from June 2006 to June 2007, about 43 percent of a total 36,377 patients admitted during that period. That is almost 75 percent more Medicaid patients than were treated by the second largest academic medical research institution in Chicago, Northwestern Memorial Hospital, according to the Illinois Department of Healthcare and Family Services.

Reports filed with Office of the Attorney General show that the medical center spent more than $116 million on treating Medicaid and uninsured patients. The medical center spent more than $225 million on community benefits during the same period. Northwestern devoted almost $139 million to treating Medicaid patients and the uninsured during the same period, according to its annual report. The Evanston-based clinical provider spent almost $210 million on community benefits. Northwestern admitted 8,711 Medicaid patients during the same period, about 20 percent of a total 43,855 patients admitted.


Clinic Closure protested.
Herald, June 3 2009. By Sam Cholke.

About 30 people rallied May 29 to decry the closure of a women's health clinic at the University of Chicago said has become too costly to run during a period of economic hardship. The University of Chicago Medical Center is the "only comprehensive health care provider around," said Marcia Rothenberg, a resident at the Coalition for Healthcare Access Responsibility and Transparency rally. "There should be a balance that weigh the needs of the people that surround [the university.]"

The university said it was unable to find a separate entity to take over operations of the clinic and run it a a federally qualified health center, which would be better equipped to seek government subsidies for the treating of Medicaid adn uninsured patients.

"The services we need are the ones that are being cut as we're being pushed out," said Shannon Bennett, an organizer with the Kenwood Oakland Community Organization.

The 3,000 patients the women's clinic sees are being referred to surrounding clinics. On a recent visit to the clinic, several patients were referred to Friend Family Health Center, 800 E. 55th St., which is an affiliate of the University of Chicago Medical Center and staffed by university doctors.

Protesters at the rally decried the closing of the clinic as part of a long-term plan by the university to shift funds from charity care to research. "They say they want to do research. They're been doing research since day one," said Deborah Taylor, a lead organizer at the protest. "How much research do they want to do?" The medical center reported to the Office of the Illinois Attorney General it spent $19 million on research at the medical center in fiscal year 207. About $116 million was spent o healthcare for the Medicaid patients during the same period.

Evelyn Barnes, a former patient at teh clinic, said she was disappointed the clinic would close. "My doctor here was good, real nice," barnes said. At other hospitals and clinics, barnes said she did not feel she was treated with the same level of care and respect she received at the university-run clinics. She said teh medical center was one of teh few hospitals on teh South Side that continues to have a god reputation in the community. "Something needs to be done about the hospital system," she said.

Herald June 10 reports on protests. As reported by Sam Cholke, the UC alleges it is losing $600-$800 thousand a year on the clinic. Opponents CHART do agree with Dean Madara's long-time insistence that academic hospitals cost per is about 60% higher than community hospitals and clinics, largely because of clinical research and training and capital-intensive sophisticated equipment and that academics shouldn't compete with community hospitals, which receive federal reimbursement. An interview-based paper by UC public policy graduate student Laurie Bankhead says the South Side lacks specialty care and at the same time underutilizes primary care infrastructure. Illinois Health Connect allocates slots to areas and particular providers and matches Medicaid patients with a primary doctor compensated at a higher rate for having a Medicaid recipient-- but many of the slots are not used, allegedly due to resident's skepticism about routine care (itself or on the South Side?) and that it may cost more than an ER! or this or that hospital "is a dump"

Re referring routine patients away, Rep. Bobby Rush has called for a Congressional hearing on whether UC et al are "dumping" and therefore should lose federal funding. Law provides that a patient must be able to make the transfer without adverse heath effect and the receiver hospital the capacity to admit the patient. Heather O'Donnell policy director for Center for Tax and Budget Accountability told the Herald free and discounted care for the poor (by UC?) was $8.7 million in 2008 and the hospital cannot count bad debt and shortfalls from government programs. UC disagrees citing reports and the IRS. In Illinois, hospitals get 73 cents on the dollar for Medicaid and 93 cents for Medicare patients. UCMC for 2008 reported shortfalls for the two of $49.2 m and $70.2 m. The UC says it provided $10.9 million charity care. The UC cites $42.6 for education and $10 m for research as among its community benefits.


Herald June 17, 2009. Clinic fallout spreads.
By Sam Cholke

Closure of a women's clinic run by the University of Chicago has re ignited a debate about how its medical center treats the poor. The controversy began in January when medical center officials announced they were considering new policies for the emergency room. At several rallies in recent weeks, complaints abut emergency care surfaced alongside protest of closure of the women's clinic, 1301 E. 47th St.

Some former patients claimed that while they were admitted to the emergency room, they didn't receive adequate care -- a charge medical center officials deny. Cynthia Ashley protested alongside about 30 people May 29 outside the University's Administration Building, 5801 S. Ellis Ave. She said she was admitted to the emergency room in July 2008 with a broken kneecap. She alleges that doctors there gave her an X-ray, painkillers and a set of crutches, and told her to head straight to John H. Stroger Jr. Hospital of Cook County for follow-up care. She said she believed the medical center had referred her to an outside hospital because she is covered by Medicaid. "I don't want to feel like that again," Ashley said. "If you don't have good insurance, they'll throw you out."

Stories like Ashley's are part of a pattern in the view of activists group such as Southside Together Organizing for Power and the Coalition for Healthcare Access Responsibility and Transparency. They claim that Medicare and Medicaid patients get less care because private insurers compensate the medical center at higher rates. Under federal laws aimed at preventing patient dumping, emergency room doctors are barred from refusing care to anyone whose health is in immediate peril. But once patient have been stabilized, the law does not require the emergency room to continue to treat them.

Just what amounts to proper stabilization is a key bone of contention between activists and the medical center. "Those of us who went into medicine die not go into medicine to decide who gets treatment and who doesn't," said Dr. Pete Thomas of the Woodlawn Health Center, 6337 S. Woodlawn Ave., said at a June 3 rally. "When I tell them 'I'm your doctor, you can come back here for care,' that's what matters."

Medical Center officials say the hospital is following the law and stabilizing patients appropriately. Ashley declined to sign a release allowing medical center staff to discuss her case publicly, but Jeremy Manier, a spokesman, said she received timely care appropriate to her condition. For patients who don't need to be kept overnight, the medical center frequently makes referrals to partner institutions after a discussion between the doctor and the patient, according to John Easton, a spokesman. Referring outpatients to other hospitals shortens wait times fro patients and significantly cuts costs, Easton said. Costs for care at teh medical center run 60 percent higher than at community hospitals because of its research and teaching component, according to to James Madara, CEO of the medical center.

The recent economic downturn is behind broad cost-cutting measures at the medical center, which announced in January a plan to cut its budget by $100 million. One of its major cutbacks, announced in May, was the closure of the women's clinic, which allowed patients to pay on a sliding scale. The closure renewed activists' claims that the medical center is focusing its care on wealthier patients -- abrogating its responsibilities as a nonprofit. Their outcry has prompted rep. Bobby Rush (D-1) to call for congressional hearings on the allegations of patient dumping at the medical center.

"Patient dumping has been a widespread problem across many of the nation's medical center and hospitals, and Congress has a duty to expend its power to mitigate and prevent this despicable practice from continuing in centers that receive federal funds," he wrote in a May letter to the congressional Committee on Oversight and Government Reform.

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In July 1 Herald, Charles Stephen Thompson says Herald coverage smacks of bias. Says Thompson, the Herald tears apart ER and 47th clinic policies but relegates to page 4 the University partnership to upgrade Provident to receive patients he says the UC cannot afford to treat due to its budget straits-- which the Herald reports are affecting all institutions.

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Another UC shoe- UC soon to close, trying to sell Physician's Group (sports etc.) at Bally's on 47th

Herald, July 15, 2009.

The University of Chicago Medical Center continues to look for a health care provider to take over operations at the Physicians Group clinic, 1301 E. 47th St. Negotiations continue with potential providers, though university officials declined to identify any interested parties.

The university plans to end operations at the clinic later this month after all current patients have been referred to a new provider, according to John Easton, a spokesman for the medical center. Though all care will soon end at the clinic, teh university will honor its lease on the building through next year, Easton said. Top

Biological Sciences faculty concerned over Madara's Medical Center leadership- see below on resignation

Chicago Maroon, May 8, 2009. By Erin Robertson.

Many Biological Sciences Division (BSD) faculty remain worried that Dean James Madara has made insufficient efforts to reach out to researchers in the department, one month after signing a letter expressing concerns with Madara's leadership in his new role as C.E.O. of University of Chicago Medical Center (UCMC).

The April 3 letter, addressed to madara and signed by 76 members of the BSD, was written in response to his performance since the 2006 merger of the BSD and UCMC, forming Chicago BioMedicine. Prior to the merger, Madara was academic dean of the BSD. As a result of the combining of these two positions, the letter argued, "The faculty has been disenfranchised." The letter continued, "[Madara's] combined responsibilities as C.E.O. and dean have distanced [him] from faculty affairs and aspirations."

In an April 6 response, Madara and Provost Thomas Rosenbaum cited Madara's creation of the Faculty Science Review Board, whose members work to provide greater faculty input in Chicago BioMedicine governance, as evidence of Madara's commitment to engagement with researchers. The committee of 30 faculty members will present Madara with its recommendations in June.

"The goal of the committee is to try to develop some recommendations for the dean that respond to the concerns fo the faculty," Professor Janet Rowley, co-chair of the committee, said. Rowley stressed that the members on the committee specialize in a range of academic disciplines and "include as many voices of basic research and clinical faculty as possible."

But while Rowley noted a strong faculty response to the committee, several faculty members expressed a doubt that the committee's recommendations would bring about change. "I believe that teh committee wil come up with a good response," a faculty member who signed the letter said, but she worried that Madara's reaction to the committee's suggestions would be insufficient. The professor wished to remain anonymous to avoid souring inter-department relations.

The faculty members also sent the letter to Provost Rosenbaum and University president Robert Zimmer in the hopes that they may become more involved in Chicago BioMedicine's governance. "Personally, I've been disappointed that they have not been more involved," the unnamed faculty member said.

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August 2009 Dean Madara resigns; UC says there wil be no changes in direction

Herald, August 19, 2009. By Sam Cholke

University of Chicago Medical Center CEO James Madara said Aug. 14 he will resign his post on Oct. 1 and return to a faculty position. "It is time to turn things over to anew leader, who will inject fresh energy and ideas into our work and ensure our momentum and pace of accomplishment can continue unabated," Madara says in a letter announcing his resignation. Madara will also resign his position as dean of the Biological Sciences Division and the Pritzker school of Medicine at the university.

Everett Vokes, deputy director of the university's Cancer Research Center and vice-chairman for clinical research in the Department of Medicine, will serve as interim CEO while a nationwide search is conducted to find Madara's replacement. "Under his [Vokes'] leadership, I am confident that important specific priorities initiated and advanced under Jim Madara's leadership, priorities that have my support and that of the university board and the medical center board, will be successfully completed," university President Robert zimmer says in an Aug. 14 letter to medical center faculty and staff. "These include the continued recruitment and retention of the best scholars in basic sciences and clinical endeavors, the construction of the New Hospital Pavilion and the expansion of community partnerships and research to improve health care in our community as part of the Urban Health Initiative."

The 58-year-old Madara became CEO of the medical center in 206 after four years as vice president for medical affairs and headed the medical center during a period of reorganization and expansion. Madara oversaw the expansion of the Comer Children's Hospital, the Gordon Center for Integrative Science and the Knapp Center for Biomedical Discovery. During Madara's tenure the medical center began construction of the $700 million New Hospital Pavilion, slated to be completed in 2013.

He also helped design and launch the Urban Health Initiative, a program that partners the hospital with community clinics and other health care providers. Madara also oversaw the medical center's $100 million budget cut that began in February and a staff reduction of 450. "I wil be working closely with the president and the boards of the medical center and the university to ensure a smooth transition," Madara says in a letter to staff and faculty.

_________________________________

Concerns, demonstrations grow over fear of closures of mental health facilities as as result in part of the state fiscal crisis.

January 29 there was a demonstration at the Woodlawn Center, 63rd at Woodlawn by STOP and Chicago's Community Mental Heath Board. If Woodlawn is one th 4 o 12 th city closes, the nearest clinic will be in Englewood. Especially disturbing to some is that the burden is born by the South and Southeast sides, minority populations, and that it could be tied to pro-gentrification thinking. Affected certainly would include homeless including those trying to restabilize after prison (as experts said also at a forum January 31). The clinic is also seen as as community anchor.

April 7, 2009 Mayor Daley put closure of the 4 South Side health clinics on hold, South Side Solidarity reports:

On Monday, members of the Southside Solidarity Network joined community organizers, mental health advocates, union leaders, and patients to picket Mayor Daley's office in protest at the closure of four mental health clinics on the south side. While we made some noise for the TV cameras, a small group of leaders dressed in suits and ties managed to gain access to the Mayor's office, at which point they refused to leave until they got a meeting with the Mayor's chief of staff. An hour later, they got the meeting.

On Tuesday, the day of the scheduled closures, the Mayor went on television and announced that the plan to close the clinics is being put on hold.

This is not the end. We still don't know how long the clinics are going to remain open. All that we know is that the closures are being reviewed. Nevertheless, this is a massive victory. It's a victory for Southside Together Organizing for Power (STOP), who have organized a series of protests and meetings over the last couple of months that led up to this announcement. It's a victory for the clinic patients who had the courage and poise to stand up in front of the cameras and tell their stories. It's also a victory for us. Not everyone can make it to protests in the middle of the day, but it's only because of the strength of our network - to which ALL of us contribute in a variety of different ways - that students were able to play such an important role in standing alongside our neighbors and making change happen. So: good job everyone.

It's still possible that next week we'll hear that the closures are back on, and in that case we'll have to be ready to stand up again. In the meantime, though, we need to celebrate what we've achieved. The value of organizing is real, but it can often feel pretty intangible, so when the Mayor goes on TV to tell you he's giving in to your demands, you don't want to let the moment pass you by.

City Hall says the closed clinics will reopen in about two weeks and permanent funding will be sought. Stimulus funds will be used for now.

Maroon, April 10, 2009. By Louise Lerner

Mayor Richard M. Daley announced an 11th-hour halt to the closing of four South Side mental health clinics Tuesday, the day after a city Hal sit-in attended by U of C students. The city announced it would close the clinics, which serve 2,000 patients across the South and West Sides, in January, spurring local organizers into actions. "We saw the neighborhoods were all black and Latino. That set off a red flag," said Deborah Taylor, a member of Southsiders Together Organizing for Power (STOP), which helped spearhead the campaign to keep the clinics open.

STOP and others, including three U of C students, staged a sit-in at Daley's City Hall offices Monday. Several protesters were admitted to a meeting with Daley's chief of staff, said Mark Hopwood, a second-year philosophy graduate student and member of the Southside Solidarity Network (SSN), a campus group involved with the protests. "The next day, the mayor went on TV, apparently without telling anyone else, and said they were holding off the closings," Hopwood said.

Hopwood said SSN found it easy to rally students around the issue. "It was something that really struck a chord with a lot of people," he said. "It's certainly been one of the best examples of student and community collaboration this year, and one of the most successful." He said that 20-30 students had been involved with advocacy over the course of the campaign, attending pickets, protests, and town hal meetings on the fate of the clinics.

The mental health clinics are scattered across the South Side, including one in Woodlawn. A fifth clinic on the near North Side was originally also scheduled to close, "but that one got pulled out of the fire," Hopwood said. "That's one reason it's made people very angry -- in the absence of a better reason, it makes it look like the South Side is being targeted."

Daley's announcement was only a temporary reprieve, however, and his office has not specified whether the clinics will remain open permanently. "We're all still on pins and needles," Taylor said. When STOP checked on the clinics Thursday morning, they found movers still packing boxes, she said. City Hall has since promised to reopen the clinics within two weeks. A Daley spokeswoman said Thursday that the city will use federal funds from the economic stimulus to keep the clinics open until the issues are resolved. "I suspect this will not be the last action on these clinics," Hopwood said. "Still, when the mayor goes on TV and tells you you're getting what you asked for, its' time to celebrate."


 

OWL Says. From the Hyde Park OWL (Older Women's League) newsletter, October 2008. Health Care Research

Those with a serious interest in the delivery and design of health care services... will want to check out the websites listed below. All are non-partisan, and all focus on health services research, which looks at how people get access to health care, how much that care costs, and what happens to patients as a result of that care.

Health services research is applicable to both single payer and mixed private-public payer systems. It's not about who pays for the services, but rather about the quality, delivery and costs of those services, and about who has- or doesn't have- access to them. The focus is on health care accessibility, affordability and effectiveness, which are issues that concern all of us.

Readers of these sites will learn about new methods of bringing health care to the public. Items you may want to check out include a Health Affairs article about storefront clinics, an approach that could reduce costs and increase access. Another issue is about medical homes, a new concept designed to improve patient care by centralizing it in a single medical home. Other articles examine the effectiveness of various plans for delivering health care services. The Academy Health site references a project funded by the MacArthur Foundation to establish a code of ethical conduct for the recruitment of foreign educated nurses into the U.S.

Good medical care is useless if you can't get it because of cost, location or long waiting lists. Bad medical care is dangerous, even if it's readily available and cheap or free. These sites look into the cost, quality and accessibility issues implied in these statements.

Following these are three useful sites [without implying endorsement of content]. For more sites listed by Ellie Hall, visit http://www.Owlillinois.org. Or visit our Helpline and Community Resources pages.

http://www.commonwealthfund.org (The Commonwealth Fund)

http://www.healthaffairs.org (Project Hope)

http://www.academyhealth.org (Academy Health: Advancing Research, Quality and Practice)

Alerts, opportunities, information for you

Flu shots: Learn locations at 311.

Colleen Grogan of UC Health Studies spoke to an OWL meeting in May 2009 on parameters for health care reform. What she said about both present practices and likely outcomes under any scenario were very discouraging.

The governor signed in November a law requiring coverage for testing of autism and giving state coverage for children with autism to age 21.

Touch no bats (the flying kind, not fly-out kind)!

Link to an interview with Hyde Park's Dr. Quentin Young, National Coordinator for Physicians for a National Health Program, being interviewed by Amy Goodmane about the Obama health plan http://www.democracynow.org/2009/3/11/dr_quentin_young_obama_confidante_and,

 

Some new resources

http://www.youreldercareconsultants.com. Online.

CMS Launches Physicians Compare Website

The Centers for Medicare and Medicaid (CMS) launched a new feature in their Healthcare Provider Directory at www.medicare.gov. "Physicians Compare" expands CMS' site by adding new information about physicians and healthcare workers so Medicare beneficiaries can more easily learn about Medicare-participating doctors.

HHS Announces Regulations that will bring Transparency to Health Insurance Rate Increases

After a decade of hefty health insurance premium increases, Americans will now be protected from excessive and unjustified premium hikes under the Affordable Care Act.

The Affordable Care Act will:
•Give states $250 million towards enhancing rate review procedures
•Require health insurance companies to publicly justify any unreasonable premium increases
Learn more about the new procedures and view HHS Secretary Kathleen Sebelius' video explaining them at: www.whitehouse.gov/blog (Scroll down to the entry on December 21st by Stephanie Cutter.)

National Institute of Health Offers Websites Focused on Older Adults

The National Institute of Health (NIH) in conjunction with the National Library of Medicine (NLM) has started a new website focused on health issues that affect older people. NIHSeniorHealth features easily accessible information on health topics such as Alzheimer's disease, ways to exercise properly and safe use of medicine. To improve usability for older adults, the website features short, easy-to-read segments available in large-print, audio versions and open-captioned videos.

One new topic addressed on the website is anxiety disorders among older adults. NIHSeniorHealth's page on anxiety disorders features information on risk factors, symptoms and treatments, and detailed information on specific phobias like obsessive compulsive disorder, post-traumatic stress disorder, fear of flying and fear of public speaking.

Anxiety caused by stressful events like losing a job is a normal part of life. Anxiety disorders occur when these stresses become persistent, excessive and disabling and get progressively worse if untreated. Anxiety disorders affect between 3 and 14 percent of older adults. NIH's website helps provide older adults with easily accessible information that is pertinent to them.

Visit NIH's Senior Health page here: http://nihseniorhealth.gov/

Visit NIH's Senior Health page on anxiety disorders here:

http://nihseniorhealth.gov/anxietydisorders/toc.html

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Services such as senior care, dialysis, sports health, women's seem to be leaving or directed out of have areas like Hyde Park to underserved areas rather than creating additional in the underserved areas. At the least this makes it further to go and weakens the stronger area without necessarily improving quality in underserved areas. Some of this would happen due to search of businesses for less expensive land or rents. But one has to wonder if this is now the "planning" policy, at least of the University.