ED, primary care clinic pilot program for uninsured

'Working poor' are focus of services

A pilot program under way in Tucson, AZ, aims to direct uninsured patients who show up for care in the hospital emergency department to a nearby primary and specialty care clinic where they can find an ongoing medical home, says Nancy Johnson, RN, PhD(c), executive director of St. Elizabeth of Hungary Clinic.

The clinic, which is celebrating its 45th anniversary, was recently recognized by the Arizona Department of Health Services as the "gold standard" for care of the uninsured in southern Arizona.

People who come to the St. Mary's Hospital ED for conditions that are not emergencies because they have no regular provider and those who end up there because they are at the crisis point of an illness are the project's target population, adds Johnson, who also operates a consulting business called Quality Health Consultants with her physician husband.

"[ED staff] fax us every day a list of anybody who has come in for care that is uninsured, doesn't have a physician, and isn't an emergency," she says. "That's usually 12 to 15 people in a 24-hour period."

A staff member at the clinic calls the patients, explains how their names were obtained, and says something like, "We'd like to invite you over to establish St. Elizabeth as your medical home, a place to get care when there is not an emergency."

Patients at the clinic, which serves individuals who are not eligible for federal or state-funded health care programs, are put on a sliding scale and pay whatever they can afford, Johnson notes. "As a result, hopefully, the ED is seeing fewer uninsured people who are not emergency [cases]. ED care is very expensive and we want to make sure we have that for people who really need it.

"It's that idea of 'right person, right place, right service,'" she says.

"We're tracking what percentage of those people we can register for care, and what percentage actually keep their appointments," Johnson adds.

Cooperation between clinic and hospital staff is an ongoing focus at St. Elizabeth of Hungary, she says. "When one of our patients needs to have surgery for cancer, we call ahead to let the hospital know the person doesn't have insurance so they can be prepared to help rather that have it be a traumatic experience."

Clinic personnel work with hospitals to set up packages and payment plans for uninsured patients, Johnson adds. "It's a collaborative effort. We don't want people in the position of not seeking care because of fear of the system, that the cost will wipe them out [financially]."

One example is an arrangement with Tucson's University Hospital on obstetrics care, she explains.

Pregnant women without health insurance who don't qualify for government assistance are set up with a "package," whereby they make payments throughout the pregnancy, Johnson says. By the time the child is born, she adds, the payments are completed.

"It's a discounted total, but the flip side is that otherwise these women would just show up at the ED in labor with no [prenatal] care," Johnson points out. "The message here is that our staff work collaboratively with hospital registration and business staff, rather than letting things fall where they may."

Misconceptions about uninsured

Johnson says experience has shown her that most people — including many in the health care field — have a number of misconceptions regarding the uninsured population.

"People think [the uninsured] don't work, but in fact eight of 10 are working," she says. "These are the working poor. There are 46 million people in the country without health care coverage, and here in Arizona, there are usually at least a million people without it at any one time."

Another thing many people believe, Johnson notes, is that it doesn't really matter if one has health insurance because necessary care will be provided regardless.

In fact, the uninsured are much less likely to get care, even with serious symptoms, she says, citing a woman with breast cancer who knew she had a lump but delayed seeking care because she was concerned about her inability to pay.

Children without health care coverage, Johnson says, don't get care for things like asthma, ear infections and sore throats.

At a recent presentation on uninsured care she made to a group of case managers, she notes, many had some of the same misconceptions as the general public.

Exacerbating the situation, Johnson adds, is the fact that health care insurance premiums were expected to rise between 6.7% and 9.9% in 2006. The average increase in Arizona was 10%, she says.

The web site (www.covertheuninsuredweek.org) is an excellent resource for health care professionals, Johnson says. "If you go there, you can click on your state, and it tells you, in English and Spanish, what services are available for the uninsured, how to find health insurance, and how to get both public and private coverage.

"This is something we all need to be knowledgeable about," she adds, "if we want to keep our health care system as effective and efficient as possible."

(Editor's note: Nancy Johnson can be reached at njohnson@ccs-soaz.org.)