Holding on for Now on East Tennessee Medical News

Holding on for Now

By: SCOTT BROOKS

Beverly Coulter, Memorial North Shore Health Center

Creativity, Determination needed to cover Tennessee's Uninsured

It's a statistic that is becoming a daily part of doing business for healthcare professionals in Tennessee: one in three Tennesseans spent at least part of 2008 without health insurance.

Healthcare providers are having to get more creative to treat the growing numbers of under insured and uninsured patients, even as their income streams remain flat or shrink.

For nurse practitioner Beverly Coulter, all she has to do is look in the front lobby at Memorial North Shore Health Center to see those numbers come to life.

"People are coming in a lot sicker; they are going without their medications. It's not a good situation," she said. "We are a lot more busy than we were a year ago, but we never turn people away."

North Shore is one of two full-service healthcare centers run by Memorial Health Care System in Chattanooga. They are managed by a team of nurse practitioners, including Coulter, who provide care regardless of ability to pay.

Coulter said conditions such as high blood pressure and blood sugar can be controlled with medications and diet, but people are balancing the cost of those treatments with the need for basics such as food and shelter.

"We try to get them generic medications whenever possible, but sometimes there's not a generic equivalent."

From small clinics to major health systems, more new patients are coming in with little or no insurance and no guarantee they'll be able to pay the bill.

At Covenant Health System, which operates seven hospitals across east Tennessee, the cost of uncompensated care has more than doubled in the past five years to nearly $70 million a year according to CEO Tony Spezia.

"We are cutting some programs, but not services, to maintain the bottom line. We need to get back to our core."

Spezia said the amount of charity care a facility provides is influenced by the types of services. For example, more than 50 percent of the 6,000 babies born at Covenant facilities every year are from families with no insurance or on some level of TennCare.

Mental health services are also more often provided to patients with no insurance and no ability to pay.

But even with the costs, Spezia said there are no plans to change Covenant's long-standing policy of providing discount or charity care for anyone who can show a need.

"Unfortunately, over time it will impact our ability to fund capital expenses and facilities and new technology. But we're holding our own for now."

Both Coulter and Spezia say programs like Project Access are crucial in helping fill the need for treating people who otherwise wouldn't be able to afford it.

Founded in North Carolina in 1996, Project Access is a network of healthcare providers in various communities who agree to volunteer time and resources to treat uninsured and under insured patients.

Programs started in Chattanooga in 2002, Knoxville in 2006 and the Tri-Cities in 2007, as well as other locations around Tennessee.

"There is a misconception that these patients have always been on welfare or public assistance," said Lacey McDonald, director of Appalachian Mountain Project Access in Johnson City. "But many have just fallen on hard times and only need one or two procedures to be healthy."

She believes part of the key to treating patients in need involves going beyond the physical symptoms. "We ask them if they are having trouble paying bills and buying groceries. That affects their overall health."

McDonald said AMPA then works with other non-profits to find those resources. Usually, Project Access programs operate under the direction of area medical societies. AMPA is a community initiative.

The agency also is among the first in the nation to include college students as part of its network of care. As part of an agreement with East Tennessee State University, students provide free mental health counseling. "It's very hard for people without insurance to get this type of counseling," McDonald said. "That university tie is very helpful to us."

As the need for this type of service grows, McDonald said more physicians are willing to sign on to provide care.

Spezia said Project Access also helps lighten the burden on area emergency rooms because it gives people another option for routine care such as medications and minor illnesses.

But long-term solutions to the crisis will likely be more complicated. Proposals such as universal healthcare or expanding government services would serve the population, but Spezia said it would require a major adjustment for providers.

"The problem is, the patients who can pay now would be paying less for the services and if we see the same number of people but get paid less, that's not good for us."

Coulter said her clinic is also looking at other options to change the way they do business.

"Instead of scheduling patients for routine visits once a month, sometimes we can space those out without affecting the care we provide. We are having to really consider every aspect of our work because of the volume of cases we're managing."