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Health System Reaches Out to Uninsured Patients

nurse/patient embrace handsDecember 12, 2003

By Lauren Fischer

Monica Sparrow has been unable to work since 2001. Diagnosed with a tumor two years ago, frequent headaches and poor peripheral vision have kept the Charlottesville resident from returning to her job in the fast food industry.

Fortunately, a lack of medical insurance has not prevented Sparrow from receiving vital medical care.

Sparrow’s radiation treatments and occasional MRIs have been paid for by the University of Virginia’s Indigent Care Program. The program helps cover the cost of needed medical treatment for seriously ill Virginia residents who are uninsured and unable to pay for care on their own.

“It saves me a lot, I can tell you that,” said Sparrow. “It's a good thing when someone doesn't have the insurance.”

In 2002, U.Va. treated 27,000 indigent patients from every district in Virginia, including 1,000 from Northern Virginia, said Larry Fitzgerald, chief financial officer of the U.Va. Health System.

During that year, the Health System incurred a cost of $53.7 million to treat indigent patients and received $42.6 million from state and federal governments to partially cover the cost. The Health System paid the remaining $11.1 million.

“Some people refer to the program as free care,” said Fitzgerald. “Free care doesn't exist because someone has to pay for it.”

Indigent care has been part of the “fiber and mission” of the U.Va. Medical Center since the early 1980s —or as long as most employees can remember, he said.
“We operate under the premise that the Health System has a legal obligation to treat all patients, even if they can't pay,” Fitzgerald said.

U.Va. and the Virginia Commonwealth University Medical Center, the two largest teaching hospitals in the state, together provide nearly half — 49 percent — of all the indigent medical care utilized in Virginia. Private hospitals across the state usually refer uninsured patients who need expensive, medically necessary treatment to the “safety net facilities” at U.Va. and VCU, Fitzgerald said.

In addition to treating patients at the Medical Center in Charlottesville, U.Va.’s Health System offers a number of programs to reach out to patients in other parts of the state. These include the Office of Telemedicine, which in recent years has offered medical consultations to nearly 6,000 Virginians via video connections to outlying medical offices. The technology also offers applications in home health care and interactive distance learning via videoconference.

Other outreach activities include the Remote Area Medical Volunteer Corps’ annual health care events. Last July, the volunteer corps, which includes many U.Va. medical faculty members, offered free clinical care — physicals, visions tests and dental exams —to nearly 5,000 medically underserved patients in southwestern Virginia.

In Charlottesville, both inpatients and outpatients with the right qualifications can reap the benefits of the University’s Indigent Care Program, said Brent McGhee, administrative manager of patient financial services. A financial screening evaluates a patient's annual income, number of dependents and assets, such as cars and real estate.

Uninsured patients are considered indigent when their household income meets or exceeds the federal poverty guidelines by up to 200 percent. In addition to meeting the income qualification, a patient's assets cannot exceed a given threshold. A patient who qualifies as indigent receives a write-off on medical bills, ranging between 30 and 100 percent. The level of the write-off is set according to a sliding scale tied to income in the state university teaching hospital guidelines.

The program also can resolve medical bills accrued months before the indigency qualification was granted, McGhee said. Patients and their families typically qualify for a period of one year, at which point financial advisors reevaluate their qualifications.

While the University’s Indigent Care Program covers acute illnesses, such as appendicitis, it does not pay for elective procedures, such as cosmetic surgery — a tummy tuck or a nose job, Medical Center officials said.

“The patients are very happy to have professionals treat them for medically necessary care, and we are happy to offer them the same care that we would give them if they were the wealthiest in Virginia,” Fitzgerald said.

The financial forecast for the program, however, is cloudy. Within the next two years, a statewide shortfall of $28 million is expected, according to a study commissioned last year by Virginia Gov. Mark Warner. If not resolved, inadequate funding will threaten Virginia’s future ability to provide medical services and equipment to the state’s most financially vulnerable patients.

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