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Uninsured patients and WakeMed

This past weekend Janice Frohman, administrative director of emergency services at WakeMed Health & Hospitals, and Jim Palombaro, M.D., president of Wake Emergency Physicians and of the medical staff at the WakeMed Raleigh Campus, submitted the following op ed about the care of the uninsured to the News & Observer.

Uninsured patients and WakeMed

Almost daily in newspapers across the country, you can find articles, editorials, letters to the editor and op-ed articles written by health policy experts, academics, caregivers and consumers discussing health care reform. When you get to the heart of each of these articles, it all comes down to who is caring for and paying for the un- and underinsured.

The reason for this continued conversation is that there is a significant difference between the services available to the insured and to the underinsured and uninsured. Yet, the uninsured and underinsured, whose ranks continue to grow, remain drastically underserved and misunderstood.

The reality for far too many members of our community is that WakeMed’s five emergency departments serve as the default front door to the health care system. Each day we see heartbreaking situations. For example, uninsured patients who lack access to primary care and who must choose between purchasing medications to manage chronic conditions or putting food on the table. Beyond the obvious tragedy of the dilemma, this dangerous combination frequently lands patients in the hospital with acute, life-threatening illnesses.

The uninsured do not fit a specific mold. They are usually not homeless, do not always have mental illness or substance abuse problems, and increasingly are not exceptionally poor. The uninsured today are more frequently middle-class individuals who have always worked hard and have always been insured, but due to the recession and job loss, extenuating circumstances or the simple inability to afford insurance due to pre-existing conditions, they find themselves uninsured or uninsurable.

At WakeMed, our mission since our founding in 1961 has not changed; for the past 50 years we have been dedicated to providing care to all who seek our services regardless of the ability to pay. Last year WakeMed’s investment in treating the un- and underinsured was $103 million, including $68 million in charity care plus $35 million in unreimbursed Medicaid costs.

As a private not-for-profit, we cover this investment without direct funding from taxpayers, the county or the state, other than Medicaid (which doesn’t come close to covering the cost of care). In fact, not all hospitals receive the same Medicaid reimbursement, and WakeMed currently receives a significantly lower Medicaid reimbursement rate than state-supported hospitals.

Although the cost of delivering on our mission may seem staggering, we take great pride in delivering this care, and we are proud to provide it without discrimination or bias. In fact, up until discharge, when they need to make a referral, the majority of our emergency department physicians and staff do not know or care to determine a patient’s insurance status.

WakeMed continues to serve more than 80 percent of our community’s Medicaid, uninsured and underinsured residents, and we fully anticipate the amount of charity care we provide will continue to increase for the foreseeable future. Insurance status is not and never will be a barrier to care in our emergency departments, but the need in our community is great and growing.

It is therefore time for all of our hospitals to provide their fair share of services to the un- and underinsured. In addition, all of our community hospitals and physicians should receive the same reimbursement from Medicaid and other government-funded programs. It is imperative that Gov. Beverly Perdue and members of the General Assembly work to level the playing field to ensure that all hospitals and physicians that treat Medicaid patients are reimbursed appropriately and in an equitable manner. A level playing field will enable fair competition, ensure appropriate and timely access to care for all members of our community and allow WakeMed to deliver upon its mission and service.