Christian Co. Health Dept. to stop providing cancer screens, contraceptives to residents of other counties

As of Jan. 1, the Christian County Health Department will not provide contraceptives or cancer screening to indigent patients if they do not reside in the county. Nick Tabor of the Kentucky New Era reports the department will provide those services to other counties' residents if the county in which they reside has signed a contract with Christian County before the Jan. 1 deadline agreeing to repay Christian County for those services. Tabor writes that the policy is not applicable to those services that are covered by state or federal government reimbursements.

The health department's move was prompted by a budget deficit that is close to $200,000, some of it traceable to a lack of reimbursement for contraceptive care. Mark Pyle, director of the department, told Tabor that residents of both Todd and Trigg counties often seek services in Christian County and Christian county taxpayers foot that bill. Pyle explained that there’s nothing in state law saying the health departments have to serve anyone who comes in, regardless of residence.

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University Hospital cuts contribution to U of L by half

University Hospital. Photo by Bill Luster, The Courier-Journal.

In the midst of financial woes, University Hospital gave just half of what it normally does to the University of Louisville Health Sciences Center — and is considering reducing its contribution to zero.

The hospital gave $5.5 million rather than its usual $11 million annually.

In the past, critics have asked why the hospital wasn't using the funds given to the health center to shore up its own financial problems. Dr. David Dunn, U of L's executive vice president for health affairs, said "symbiotic arrangements between teaching hospitals and health sciences centers are common across the nation, and cutting the contribution in half has meant struggles to recruit and retain physicians and nurses," Laura Ungar reported for The Courier-Journal.

University Hospital has long been looking at ways to stabilize its finances. Last year, Gov. Steve Beshear nixed plans for the hospital to merge with a Catholic health system since it would have been subject to Catholic health directives. Since, it's been looking for a new merging partner, a process that has been delayed until the end of this month. (Read more)

University Hospital's trust to pay for indigent care lacks oversight, state auditor finds

An audit of the trust that disburses more than $30 million in state and local funding to provide indigent care at University Hospital has found there is a lack of oversight. There is no evidence taxpayer dollars were abused, however.

"The audit, released by state Auditor Adam Edelen, found that the board structure wasn't suited for proper oversight and the agreement between University Medical Center, which runs the hospital, and state and local governments to administer the money is outdated," reports Laura Ungar of The Courier-Journal.

The audit also found there is insufficient record keeping. "The responsibility for providing a safety net for our most vulnerable is a critical one shared by the university, city and commonwealth," Edelen said. "While this audit underscores the need for modernization and reform of the governing structure, it does not provide justification for those who desire a retreat from that mission." (Read more)

ER at Louisville's University Hospital says it is pushed to brink; many other hospitals seeing more emergency patients

Louisville's University Hospital is straining to meet the vastly increased demand of patients coming to the emergency room. Last year, there were 58,010 visits to the ER to the facility, which is meant to act as a safety net for indigent care. That's way up from 33,058 in 2006.

"The safety net is frayed and getting ready to break completely," said Bill Wagner, executive director of Family Health Centers and ex-officio member of the Louisville Metro Board of Health. "The current situation isn't sustainable ... The system is broken and it's gonna get worse."

"The rising number of uninsured patients is a major driver" of the exploding ER volume, reports Laura Ungar of The Courier-Journal. Between 2008 and 2010, 663,000 Kentuckians — or 15.5 percent of the population — lacked health insurance. In 2010, University Hospital received almost $69 million from federal, state and local governments to pay for indigent care, but it fell short by $20 million of the actual cost.

The strain has strapped the facility for cash to make improvements such as adding beds — to deal with overflow, 12 have been installed in the facility's hallways — or upgrading technology. Recently, University tried to merge with Jewish Hospital & St. Mary's HealthCare and Catholic Health Initiatives to gain an influx of funds, but Gov. Steve Beshear blocked the move, since it would mean losing University as a public asset. University is now looking for other merger options.

Some of the increase in visits is due to the fact that fewer people are leaving the ER without being treated because of long waits. In 2009, 15 percent left for that reason, but "That's down to 1.7 percent this year, after a push to attend to patients immediately and get physicians to see them more quickly," Ungar reports.

But there's evidence there are just more patients coming to the hospital for treatment, as is the case in a program called First Care, meant for patients with less serious ailments, such as tooth abscesses. "Two-thirds or more of First Care patients are uninsured, and in recent years increased demand has led the hospitals to expand its beds from six to 13, become a 24-7 facility and hire a handful of new nurse practitioners," Ungar reports. "First Care cases, which are not included in the hospital's ER volume totals, rose from 8,353 in 2006 to 20,546 last year." Of those patients two-thirds or more were uninsured.

Other area hospitals have also seen increases in ER visits. From 2006 to 2010, visits increased from 45,377 to 49,462 at Kosair Children's Hospital; from 27,836 to 29,357 at Norton Hospital; and from 29,779 to 33,508 at Jewish Hospital. Some hospitals have seen slight declines, such as Baptist Hospital East, but that may be due in part to its retail clinics in Walmart and increased numbers of urgent-care centers. (Read more)

State auditor will examine University Hospital's indigent-care trust

After the Jefferson County attorney said the fund lacked oversight, state Auditor Adam Edelen said he will audit and review the indigent-care trust in Louisville through which $32 million tax dollars flow. (Courier-Journal photo by John Rott)

The audit will determine "whether there are adequate resources to treat indigents in the Louisville area," reports Patrick Howington of The Courier-Journal. The issue came up recently when University Hospital, the recipient of the funds, tried to merge with two other hospital systems.

Earlier this month, County Attorney Mike O'Connell said the trust's board, which is appointed by the University of Louisville, "had not met in more than two years," Howington writes. The next day, U of L President James Ramsey asked Edelen to look into the trust's financial records.

Edelen spokeswoman Stephenie Steitzer said the lack of board meetings raises the question of "whether there is a proper and effective governance structure in place."

The trust receives $25 million each year from the state and $7 million from Louisville Metro Government. University Hospital uses those funds to treat poor, uninsured patients. Last year, the trust only paid for "about one-third of the facilities' charity care last year, which cost $88 million and involved more than 63,000 cases," Howington reports. (Read more)