Doctors say CU Hospital is refusing poor patients

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Doctors say CU Hospital is refusing poor patients
Medicaid, Medicare users can face 6- to 8-month waits

By Allison Sherry, Denver Post

October 22, 2003

Doctors referring people to University of Colorado Hospital's specialty clinics say Medicare and Medicaid patients are turned away or made to wait months for appointments, sparking concern that University is screening out government-pay patients in favor of those with private insurance.

Referring doctors said that in the past year, they have collected refusal notices from University stating that patients won't be seen because clinic doctors are not accepting new Medicaid or Medicare patients. Others said their patients face six- to eight-month waits for appointments.

The delays anger Colorado 's chief administrator for Medicaid funding.

"I think it's wrong, and I don't think it's appropriate that it's happening in a vacuum without people knowing," said Karen Reinertson, executive director of the state's Department of Health Care Policy and Financing.

"If you need to see a doctor and you're waiting eight months for an appointment, it's wrong. How far are they going to push it? Until someone dies?" she asked.

Dr. John Sbarbaro, medical director for University Physicians Inc., said the refusal slips are clerical errors.

But Sbarbaro said each clinic is allowed to decide how many government-pay and uninsured patients to accept, and to put Medicaid and Medicare patients on long waiting lists.

The clinics must be able to pay physician salaries and other expenses, he said.

"You can't make your salary on Medicare patients, period. Nobody could earn their salary if we took them all," he said.

Medicaid recipient Amber Bryan,who lives in Adams County , is on a seven-month waiting list to see a University neurologist.

When Bryan was pregnant with her son, now 6, she fainted so abruptly, she would wet her pants. These days, her fingertips and palms often inexplicably go numb. Her primary-care doctor thinks she may have a seizure disorder.

Bryan is eager to figure out what's wrong.

"I'd just like to get it over with," Bryan said. "I'm pretty patient. I'm pretty used to waiting, but for this, it's different."

A federal law prohibits some hospitals from discriminating based on how patients pay for care.

In 1965 and 1977, the University of Colorado Health Sciences Center collected $343,000 under the federal Hill-Burton Act. By law, hospitals that received those grants cannot turn away Medicaid patients. A handful of hospitals have been sued under Hill-Burton and ordered not to differentiate between Medicaid and other health insurance.

But University officials say the hospital has no legal obligation under Hill-Burton because it became a quasi-independent authority in 1991 and is not bound to agreements made before the conversion.

The U.S. Department of Health and Human Services, which oversees enforcement of the act, wouldn't comment.

Private hospitals have long restricted new Medicaid and Medicare patients because reimbursements are roughly half of what private insurance pays. A state Division of Insurance study released this year found that only 36 percent of metro-area doctors are taking new Medicare patients.

But state health officials and doctors say University is a particular concern because it is a public institution. The hospital receives about $30 million in federal money annually to treat the poor, in addition to Medicare and Medicaid reimbursements.

A sampling of local private hospitals shows that they take roughly the same number of Medicaid and Medicare patients as University.

Some take even more.

In 2002, Presbyterian St. Luke's Medical Center billed Medicare for 24 percent of charges at its outpatient clinics and Medicaid for 6 percent.

During the same period, University billed Medicare for 15 percent of outpatient clinic charges and Medicaid for 12 percent.

Both St. Anthony Central Hospital and University billed Medicare for 29 percent of inpatient charges in the last fiscal year.

Denver Health Medical Center billed 20 percent of its outpatient clinic charges to Medicaid. At University, that number was 12 percent.

Sbarbaro said he wouldn't be surprised if many University clinics have hit their limits for accepting Medicare and Medicaid patients.

Only 4 percent of University doctors' salaries come from the state. The doctors make up the rest from patient fees or research grants, he said. Some doctors see patients only a few days a week because they are teaching and conducting clinical trials.

"Seeing patients is very important, but the responsibility for the doctor in academia is research and to get promoted," he said. "You must publish papers and get research grants. ... You can't get to everybody."

Many clinics are full regardless of payment status, with even privately insured patients waiting weeks for appointments, Sbarbaro said. Some primary-care clinics aren't taking new patients at all.

Reinertson, the state administrator, hasn't received any complaints about Medicare or Medicaid patients being turned away. But she said she worries about the hospital straying from its state requirement to treat the poor.

"Has something changed? Do they not still have an indigent-care mission?" she asked.

State Rep. Andrew Romanoff, D-Denver, said the possibility that University is rejecting or delaying treatment of government-pay patients is troubling.

But, he said, that problem is just a symptom of increasing health care costs and shrinking pots of money to take care of people.

"Medicaid is the canary in the coal mine," Romanoff said. "Something's got to give in this system because obviously it's not sustainable."

Teaching hospitals nationwide face similar financial constraints and competing demands for service, said Robert Dickler, senior vice president at the American Association of Medical Colleges.

"You have to do everything ... patient care, research and education," Dickler said.

More and more teaching hospitals might have to reduce service to the poor so they can afford to teach medicine, he said.

Local doctors say they are frustrated not just at University, but by the general lack of available treatment for government-pay patients.

At Clinica Campesina in Adams County , referral coordinator Eleanor Montour said she's had about one patient a week turned away by University over the past several months.

"You always thought that Medicaid was good health insurance," Montour said. "But it apparently isn't viewed that way. It has gotten way worse."