Byline: MIKE COLIAS
Getting patients to show up at her South Side clinic for a three-hour wait is difficult enough for Michele Walker.
Telling them to wait three months for a referral appointment with a specialist is deflating.
'That's the biggest complaint we hear from patients: `Why do we have to wait so long?' '' says Dr. Walker, who runs the Access Community Health Center clinic in a strip mall at 54th Street and the Dan Ryan Expressway.
She hopes wait times for the 75 patients she sees a day are about to shrink. An almost-completed $350,000 expansion funded by nearby University of Chicago Medical Center will double her clinic's size to 16 exam rooms. Patients will be able to see an on-site U of C specialist to treat diabetes or asthma.
U of C is assuming the unlikely role of white knight for small health centers and cash-strapped hospitals on the South Side.
Seeking to free up beds to take more complicated cases like organ transplants or brain surgeries, the medical center's CEO, James Madara, is forging alliances to treat the rising number of poor patients needing routine care. While the effort is aimed at stemming the tide of these patients coming through its own doors, U of C also is helping to solve a growing health care crisis on the South Side.
'This is driven by their own institutional interests, but those interests end up being the right thing for the community,'' says Pat Terrell, a consultant at Chicago-based Health Management Associates Inc.
In addition to freeing up beds, the strategy is intended to ease pressure on U of C's emergency room, where visits rose 22% from 2000 to 2006. As other South Side medical facilities have closed or cut back, the teaching hospital has been forced to take a larger number of uninsured or Medicaid patients.
'We were just passively taking care of whatever showed up at our door when they were things that could be handled by community hospitals,'' Dr. Madara says. 'We were eroding their base business while also making it more difficult on ourselves to serve our unique function.''
U of C's hospital partners can squeeze out a small profit margin on low-paying Medicaid patients because their costs are much lower than those of U of C, which has expenses for research and training students and residents. Medicaid payments cover just 79% of what it costs U of C to treat those patients, a hospital spokeswoman says.
Almost 100 U of C physicians have been scattered across neighborhood clinics and a few hospitals on the South Side in the last year. The medical center also has spent more than $2 million in the last six months to expand walk-in clinics like Dr. Walker's and relocate some of its own doctors and patients to other facilities, including moving its 10-bed psychiatric unit to nearby Mercy Hospital.
U of C is seeing the benefits at its own facilities. A year ago, it was turning down half the requests from other hospitals to transfer critically ill patients for complex treatment because it didn't have space. Today, with partners taking routine cases, U of C can take 90% of the more-complicated transfers, Dr. Madara says.
Dearth of specialists
Bigger capital investments are coming. U of C is drafting plans for a $20-million outpatient center that would be staffed by hard-to-find HIV and heart specialists and filled with pricey medical technology, like CT scans, that other South Side hospitals can't easily afford. U of C would put up as much as half the money and jointly staff the center with other South Side medical providers; the university has asked the state for the other half of the money.
To be sure, the investments come nowhere near those being made on U of C's own campus-improved facilities that will bring in profitable, fully insured patients. U of C spent $235 million in the last few years to build Comer Children's Hospital and plans to spend $700 million more on another hospital.
Demographic factors have overwhelmed South Side hospitals in recent years. U of C says its service area includes two thirds of the city's poorest neighborhoods. Medicaid accounts for 37% of its hospital patients, compared with 13.5% at Northwestern Memorial Hospital in Streeterville, state data for 2006 show.
Its new strategy has put U of C at the center of a nascent effort by city health officials to address jammed emergency rooms and a dearth of specialty care. Chicago Department of Public Health Commissioner Terry Mason convened a meeting of South Side providers last month to examine those issues.
Dr. Mason, a urologist who has practiced on the South Side for more than 20 years, says the patient-access problem is made worse by the fragile finances of the area's 10 hospitals, most of which lose money and have little capital to spend on the equipment and physicians needed to develop specialty programs. One once-thriving hospital, Michael Reese, is expected to close by yearend.
'It's incumbent upon hospitals in better financial positions to find creative ways to help shore up the other hospitals and outpatient centers,'' Dr. Mason says. The city is pulling together data to identify neighborhoods with the biggest gaps in services, he says.
thankful Partners
For now, Dr. Madara has found eager partners. Donna Thompson, CEO of Access Community Health, which runs 50 clinics citywide, hopes the more than half-dozen U of C physicians staffing a few of her locations will bring an extra 12,000 to 15,000 patient visits a year.
Other partners are just as eager. 'There's no question that it's better for both of us if we handle more of these routine cases,'' says Holy Cross Hospital CEO Wayne Lerner, who is in talks to accept some U of C pediatric cases and expectant mothers. 'And it's best for the patient.''
Contact: mcolias@crain.com
CAPTION(S):
Michele Walker runs an Access Community Health Center clinic on the South Side.
