Jackson Health System trying to figure out why the surge in uninsured patients

01/15/2014 6:06 PM

01/15/2014 6:13 PM

Officials at Jackson Health System say they do not know what has caused a surge of uninsured patients to flood emergency rooms in the past few months, leading to nearly a $1 million loss for December.

On Wednesday, the Public Health Trust that runs Jackson asked hospital administrators for weekly updates on the influx of uninsured. The change in the financial picture could potentially threaten the success story pitched last fall to Miami-Dade voters, who approved $830 million in taxpayer financing to upgrade the county’s aging hospital network.

Jackson executives said they’re monitoring patient admissions daily to better understand what’s driving the greater numbers of uninsured, who are being admitted largely through the hospital system’s emergency rooms at the main campus in Miami and at the satellite in South Miami-Dade.

Jackson’s third hospital, in North Miami Beach, saw a decrease in uninsured patients.

Carlos Migoya, chief executive, said the number of uninsured patients at Jackson has been rising steadily since about October.

But as of this week, said Mark Knight, chief financial officer: “We don't know why.”

Knight said Jackson administrators screen all uninsured patients to see if they are eligible for public assistance such as Medicaid, the state-federal health program for the poor and disabled.

But the surge of uninsured patients at Jackson aren’t people who qualify for Medicaid, he said, and only about 5 to 6 percent were undocumented immigrants, who do not qualify for any government assistance.

Jackson officials reported more than 6,090 patient admissions at the system’s three hospitals for the last month of 2013, exceeding the budgeted number of 5,922, and the prior year’s December total of 5,926.

About 65 percent of those admissions originated at the emergency room, Knight said. And while the greatest rate of increase in uninsured occurred at Jackson South Community Hospital, the largest number entered through Jackson Memorial in Miami.

About 17 percent of patients admitted to Jackson Memorial in December were uninsured, compared to 13.3 percent in December 2012.

At Jackson South, about 19.6 percent of patients were uninsured, exceeding the December 2012 rate of nearly 14 percent.

The patients were not referred through the hospital system’s network of community clinics and primary care centers, Knight said, but almost all live in Miami-Dade.

Often, the uninsured do not have a primary care physician who monitors their health regularly, Knight said, so many times these patients wait until their condition worsens before going to the emergency room.

But they’re typically not in a highly critical condition, and many could be served more efficiently through a primary care center, Knight said.

Jackson has opened a primary care clinic in Jackson Memorial to help address the problem.

“That has allowed us to refer patients out of the emergency room to that center to better manage their care on a routine basis,” he said.

Knight said he has not yet seen evidence that the new primary care clinic has reduced emergency room visits.

Jackson has also used a federal grant to hire navigators, or counselors, to offer in-person counseling to consumers applying for insurance coverage through the Affordable Care Act’s insurance exchanges. So far, he said, counselors have helped about 100 people enroll in health plans using the federal exchange for Florida.

Migoya said that despite the December loss of $963,000, the hospital system remains ahead of budget by $600,000 for the financial year that will end Sept. 30.

In November, after Miami-Dade voters approved the bond measure by a wide margin, Jackson officials announced that the hospital system had closed the year with an unaudited but better-than-expected budget surplus of more than $45 million.

The positive financial finish marked the second consecutive year that Jackson earned a surplus after an era of hemorrhaging cash — losing about $419 million from 2008 to 2011.

But Migoya did warn of challenges in 2014, and projected a more modest surplus of $11 million for the year that will end Sept. 30. That positive forecast now is in question, depending on whether Jackson's estimated 10,000 employees will continue to contribute 5 percent of their base pay toward group healthcare costs.

Miami-Dade commissioners will hold a special meeting at 9:30 a.m. Thursday in an effort to resolve that issue with the employee unions.

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