Austin hospitals are walking the walk on preventive care

For years many healthcare policy works and others have asserted that the our system(s) should be re-oriented around preventive care, as it's more cost-effective than treating patients for acute complications of chronic disease.

Well, it turns out that the Seton hospital system in Austin (where I used to volunteer as a college student) not only buys that assertion but does something based on it, changing the way it provides care.

In one 18-month period, Ms. Dodd, 38 [and an insulin-dependent or Type 1 diabetic], was rushed almost monthly to the emergency room, spent weeks in the intensive care unit and accumulated more than $191,000 in unpaid bills.

That is when nurses at the Seton Family of Hospitals tagged her as a “frequent flier,” a repeat visitor whose ailments — and expenses — might be curbed with more regular care. The hospital began offering her free primary care through its charity program.

With the number of uninsured people in the United States reaching a record 46.6 million last year, up by 7 million from 2000, Seton is one of a small number of hospital systems around the country to have done the math and acted on it. Officials decided that for many patients with chronic diseases, it would be cheaper to provide free preventive care than to absorb the high cost of repeated emergencies.

With patients like Ms. Dodd, “they can have better care and we can reduce the costs for the hospital,” said Dr. Melissa Smith, medical director of three community health centers run by Seton, a Roman Catholic hospital network that uses its profits and donations to provide nearly free care to 5,000 of the working poor. Over the last 18 months, Ms. Dodd’s health has improved, and her medical bills have been cut nearly in half.

Reaching out to uninsured patients, especially those with chronic conditions like diabetes, hypertension, congestive heart failure or asthma, is a recent tactic of “a handful of visionary hospital systems around the country,” said Karen Davis, president of the Commonwealth Fund, a foundation in New York that concentrates on health care. These institutions are searching for ways to fend off disease and large debts by bringing uninsured visitors into continuing basic care.




This isn't just happening in Austin. According to the 25 October 2006 NY Times article "Hospitals Try Free Basic Care for Uninsured," hospital systems in NYC and Denver have been encouraging patients to visit community clinics for negligible to no fees, so that their chronic conditions are better managed and they themselves can avoid going to the ER.

Has picking up the tab for preventive care saved these organizations any money? Yes, according to these statements.

Denver’s public system, Denver Health, has 41,000 uninsured patients enrolled in its clinics. Officials there calculate that for every dollar they spend on prenatal care for uninsured women, they save more than $7 in newborn and child care....

A special effort to educate 631 asthma patients saved the plan $475,000 in one year, Seton officials said...

Ms. Dodd still has problems, but the use of a $3,200 insulin pump paid for by Seton, which automatically adjusts her insulin levels, along with access to an endocrinologist and home counseling have reduced their severity. Her care in the last 18 months has cost Seton $104,697, far below the $191,277 for the previous period. More important, the later figures include less hospital time and more medicines and expert advice.

“The money we save,” Dr. Smith, of Seton, said, “money that is not hemorrhaging through the I.C.U., is money we can do so much more with to help her upfront.”

Seton has gone a step further by offering free preventive care for patients not traditionally eligible for free care from their charity fund.

In a more unusual step, Seton officials also look for frequent emergency room users who do not qualify for the hospital’s charity plan because they live in a different county, like Ms. Dodd, or have incomes just above the threshold. In a dozen cases so far, all involving diabetics, a committee has judged that it makes financial sense to bring these people into the charity plan anyway and provide intensive support.

The article highlights state efforts to reduce costs and increase coverage with "the creation of subsidized, bare-bones policies for small businesses. Vermont, Maine and especially Massachusetts are using combinations of state and federal money and employer mandates to extend insurance. "

But this isn't the case here, where "without counting the large immigrant population, Texas has the country’s highest share of uninsured, at 21 percent." Which is why Seton's model is more interesting, since it may provide a lesson for all hospital systems in Texas.

In addition to Seton, another Austin hospital named St. David's runs the People's Community Clinic to care for about twice as many patients as are covered by Seton's charity fund. And luckily for locals, "Austin hospitals and charity clinics have also joined in a pioneering data-sharing system to track visits by uninsured patients and fight unnecessary use of the emergency room."

While Seton and St. David's are addressing the cliched problems of our healthcare system(s) in innovative ways, their measures are considered a "band-aid." Still, with little motivation from our national and state leaders to more drastically reform healthcare, a band-aid is what's needed in the immediate. And thus, Seton and the other progressive hospital systems provide not only a beacon of hope, but models that can be applied by others.