Funding cut in Miami could affect immigrants
Beneath Jackson Health System’s recent decision to stop payments for outpatient dialysis treatments lies a deeper problem: the desperate need for dialysis by illegal immigrants who cannot afford the treatment—and who do not qualify for Medicare.
Miami-based Jackson, which does not have a license to provide dialysis treatments, announced earlier this month that it would no longer provide funding for patients to receive renal-care services at outpatient clinics in Dade County, a move that will help the system save about $4.2 million a year, according to President and CEO Eneida Roldan. Consequently, Baptist Health South Florida, Mercy Hospital and the University of Miami Hospital have devised a unique—although temporary—solution to the problem: for the month of January, the three hospitals will each kick in $50,000 to fund the dialysis treatments until a more permanent solution is established.
“Jackson is too important to the lifeblood of our system right now and our safety net hospital,” said Brian Keeley, president and CEO of Baptist Health South Florida, also in Miami. “If they can’t resolve this issue, it’s a societal issue, not a Jackson or Baptist issue.”
It’s an issue in other states as well. Last fall, Grady Memorial Hospital in Atlanta closed a dialysis center for end-stage renal disease after a judge determined that patients who sued to keep the unit open were not entitled to the care. Subsequently, illegal immigrants who were told about the closing would have to return to their home countries of Honduras and Mexico, or relocate to states that provided the care regardless of immigration status. After the clinic closed, Grady offered to pay for three months of dialysis treatments at a clinic operated by Fresenius Medical Services, according to Denise Simpson, a spokeswoman for Grady. Grady then extended the deadline until Jan. 3 and again until Feb. 3. A Grady official was unavailable to comment on the issue of illegal immigrants.
In Miami, Jackson had contracts with vendors who provided dialysis for about 175 patients. In December 2009, a few of those contracts were up for negotiation, and some were terminated, which affected about 85 patients. Jackson asked patients to supply documentation to determine if those patients were eligible for federal reimbursement, and was able to help convert 44 patients to Medicare. The system, which is governed by the Public Health Trust, is trying to convert 29 more patients to Medicare, but there are 12 remaining patients who are illegal immigrants and will not qualify.
“The other 90 are being treated in a contract that will expire in September,” Roldan said. “We’re trying to see how many of those can get converted to Medicare prior to expiration of the contract,” she added. “We know that in this particular group, there will be a higher percentage of undocumentedcare patients.”
Baptist Health South Florida—one of the three hospitals working to create a temporary solution—has spent more than $1 million in the last year to cover the cost of unfunded patients who require dialysis, both on an inpatient and outpatient basis, according to Keeley. “If we don’t do something, they’re going to end up in emergency departments,” Keeley said.
That’s a concern for emergency physicians who want to treat all patients, but who recognize that dialysis patients in emergency departments could be taking beds away from other patients who are “acutely ill,” said Angela Gardner, assistant professor of the department of surgery/emergency medicine at the University of Texas Southwestern Medical Center at Dallas. “We want people to feel it’s safe to come to the emergency department,” Gardner said.
Administering dialysis to patients in the emergency department “is not ideal,” Jackson’s Roldan acknowledged, but, given that the system faced a projected loss of $168 million for 2010 when Roldan began in June 2009, ending these payments was one way to close that gap. Now the hospital has 12 patients to consider vs. 175. “As CEO, my No. 1 priority is our patients,” Roldan said, “but I also have a responsibility and stewardship to taxpayers in this county.”
Still, the question of how to treat undocumented patients in the U.S. remains, and it’s a major problem in the border state of Florida, according to Linda Quick, president of the South Florida Hospital Association. “Of the over 4 million people in Florida that are uninsured, 1 million of them are undocumented immigrants,” Quick said.
There is no Emergency Medical Treatment and Active Labor Act “equivalent for nonhospital services,” Quick said. “The issue is there is no long-term-care facility that is required to take people irrespective of their ability to pay,” she added.
That’s why Quick’s group has submitted a proposal to all of the region’s hospitals to devise a long-range solution to the problem. Still pending approval, the plan would involve a contract between the facilities and one or more for-profit dialysis centers to provide services to these patients at a negotiated rate.
“I think the problems that South Florida have should be a wake-up call to the rest of the nation,” Quick said. “Both of them are indicators why we should support healthcare reform and why we should accept the fact that this is a melting pot of a country and we are always going to have people who haven’t lived here long enough to qualify for public programs,” she added. “We’re like the wick of the large candle—it’s going to get to them eventually.” <<