Healthcare for the Low Income

Second Healthcare Forum Held at CSU

The topic of discussion at the second forum focused on how the Affordable Care Act will affect our economy. The essential goals behind health care reform are to create better access and quality at a more affordable price. With healthcare reform 32 million uninsured individuals will be insured. For clarity, Medicaid is state funded insurance for those with financial hardships while Medicare is federally funded for the elderly and disabled, something I habitually mix up. Both of these programs face big challenges with the implementation of healthcare reform. The forum had several knowledgeable speakers from a wide range backgrounds including:

• Thomas S. Campanella, a professor at Baldwin-Wallace College as well as the Director of the Health Care MBA Program.
  
• Bill Ryan is the President and Chief Executive Officer of the Center for Health Affairs and serves as the leading advocate for northeast Ohio hospitals.
  
• Dick Christie, MD. the Director of the medical Residency Program at St. Vincent Charity Medical center.
  
• Patricia Gray, PN, PhD, Vice President of Healthcare Education Initiatives at Cuyahoga Community College and
  
• Bette Bonder, PhD, Dean of the College of Sciences and Health Professions at Cleveland State University also spoke.

Campeanella stressed that the idea creating many Accountable Care facilities have great potential. Accountable Care Facilities are a key component in the new healthcare reform in regards to access and increasing efficiency and then ultimately cost. Accountable Care Facilities are essentially facilities that provide primary care practitioners that oversee and coordinate patients care. It is intended to improve the general health of citizens and prevent people from using emergency rooms as their only source of healthcare. This would necessitate an increase in the number of primary care doctors, nurse practitioners and physician assistants. Campeanella also predicted that private insurance companies would provide programs to those covered by private insurance company to create incentives to increase and encourage clients to lead healthier lifestyles. However, he cautioned that “just because you build it does not mean that they will come.” Undoubtedly having access to preventive and maintenance care will improve people’s health, but personal responsibility to seek out available services and address one's health needs on a day to day basis will play a big part in the success of health care reform.

Ryan focused on the role of hospitals in Cuyahoga County. He pointed out that locally medicine is big business especially with the number of hospitals and colleges that provide healthcare programs. He stated that 140,000 jobs in Northeast Ohio are healthcare related. However, Ryan pointed out that just because healthcare is big business does not mean that the community healthcare needs are met. He went on to say that most hospitals are approaching 50% of their patient’s being on either Medicare or Medicaid. Hospitals are having to re-evaluate how to best serve the needs of their communities. In his opinion, hospitals are starting to do just that and Ryan predicts this will increase in the future. He did comment that Accountable Care facilities are few and far between and therefore citizens are hesitant in accepting them at this time. Many communities have strong attachments to the hospital in their communities. Ryan used the Huron Hospital closing as an example and the developing of an Accountable Care Facility opening up in its place. (Although many of the residents concern over the closing of Huron Hospital had to do with not having an emergency facility in close proximity that could care for individuals in extreme medical distress.)

Christie, addressed the issue of the shortage of Primary Care Physician as well as Nurse Practitioners and Physicians assistants. He holds the opinion that many of the loan reimbursement and forgiveness programs for those going into primary care medicine will create little change as the 2.4% increase in funding for loan forgiveness is too little to create large scale change. Christie pointed out that at a minimum it will take 8 years to produce more primary care practitioners, just because of the time it takes to educate and train such fields of study. His prediction for healthcare did not echo the theme of potential. He also explained that it is costly to go into primary care medicine and that many go into specialty fields. Specialist make twice as much as a primary care doctor in order to cover the mountain of debt they incur from med school. Also specialist and research doctors are often med school professors, therefore students have more direct communication with specialist and are more likely to go into specialized care. Christie fells the Affordable Care Act is not going to be a “game changer.” Ryan chimed in that there is no new money coming in, and that healthcare access, quality and cost would all be positively affected with the creation of decent paying jobs and or public work programs.

Gray and Bonder outlined the extensive work Tri-C and CSU have done and will continue doing to prepare healthcare workforce for the coming needs. This includes using extensive partnerships to save money and attempting to meet the needs of the growing healthcare industry. However, there was a comment by both speakers that it will cost a great deal to train students in medical occupations due to the students needing exposure and practice in the field. It is hard to expand programs and that many of the programs have a two year waiting list and many of the recent grads are having a hard time finding employment. The example used was radiological technician programs which have saturated the market. Dr. Bonder made a great point at the end of the rather bleak forum when an audience member asked what can we do now to improve the problem in the future? Bonder suggested that people volunteer their time reading to children in underperforming school districts or other work with the next generation.

It was a somber end to an overwhelming forum. While there was some optimism expressed, intense hesitation at how successful healthcare reform will be was the bottom line message expressed at the forum . All forum are archived on CSU’s website with a link provided.

by Holly Lyon
Posts reflect the opinion of those who sign the entry.

Follow Up on Homeless Stories

Does That Happen Here?

On Sunday, 60 Minutes (which oddly only has 42 minutes of content) aired a segment on the dumping of homeless people from hospitals in Los Angeles. The premiere news magazine in the United States had guest correspondent Anderson Cooper spending time on Skid Row to find out the extent of the problem. It was amazing to see the number of the homeless people in the homeless capital of the United States compared to Cleveland. LA has four times as many people homeless every night as we have in the entire year, and a sizable number are concentrated in this one neighborhood of LA.

I was asked at least three times this week if this happens in Cleveland? Yes, but no where to the extent it happens in other cities. MetroHealth moves people as fast as they can and there is a long wait sometimes in the emergency room, but I have not seen them improperly discharging people to the streets. I am not sure that we all realize what a gem MetroHealth Hospital is for our community. The other hospitals need some work. I recently met with St. Vincent about this and other issues. So, give them credit for trying to work on the problem. They have done some work to try to build relationships with the current homeless social service providers. The other hospitals seem to do everything they can to avoid providing care to poor people and then have no problem "relocating" people to the shelters. It does not happen everyday, but there is a problem. Neighbors wonder how a King from Jordan travels 2,500 miles to go to the hospital here in Cleveland, while the Fairfax resident cannot walk around the corner and get access to health care.

Every few days we see people arrive with bandages that need changed or colostomy bags or prescriptions that cannot be filled. There is this slow dribble out of the hospitals into our shelters with open wounds or follow up services needed. We only have 9 respite beds located in Cleveland and those are for men. We have only sporadic nursing care within the shelters, and we now see regular ambulance runs from our shelters back to the hospitals. We have many who are not sick enough for hospital beds, but too severe for the shelters. Few want to be confined to a nursing home, and so they are stuck in limbo. The economics are that the hospital saving money by discharging a homeless person for a broken leg is wasted when they show up a week later with an infection and an improperly healed leg. Cleveland has a growing problem with hospital dumping, but certainly a solvable problem.

Brian
Posts by Northeast Ohio Coalition for the Homeless staff and Board.