Miami hospital system cuts dialysis services for the poor

From The New York Times:

To chip away at an overwhelming budget deficit, Miami’s public hospital system stopped paying for kidney dialysis for the indigent this week, officials said, leaving some patients to rely on emergency rooms for their life-sustaining treatments.

A total of 175 patients were affected by the decision by Jackson Health System, which runs South Florida’s largest charity hospital, Jackson Memorial, and a number of smaller hospitals and clinics.

The situation at Jackson is similar to that at Atlanta’s public hospital, Grady Memorial, which closed its outpatient dialysis clinic in early October to curb costs.

At Jackson, officials said patients could come to the emergency room for treatment, and eight have this week. “That’s the best we can do right now,” said Dr. Eneida O. Roldan, Jackson’s chief executive.

Federal law requires that emergency rooms treat patients in serious medical jeopardy, regardless of their ability to pay. For patients with end-stage kidney disease, going without dialysis can prove fatal in as little as two weeks.

To be treated in an emergency room, however, dialysis patients often must show up in severe distress. In an interview, Dr. Roldan said patients could be treated in Jackson’s emergency room as often as three times a week, the national standard for continuing dialysis.

Dialysis provided through an emergency room admission is considerably more expensive than routine treatment at a clinic. But while Jackson was not reimbursed for treating uninsured patients at private clinics, it can receive emergency Medicaid payments for dialysis provided through emergency rooms.

The hospital’s decision thus shifts the financial burden from Miami-Dade County taxpayers, who support Jackson’s charity care through various levies, to the state and federal governments, which finance the Medicaid program.

Dr. Roldan said the hospital hoped that South Florida hospitals and dialysis providers would form a consortium to pay for the care of uninsured renal patients.

At Grady in Atlanta, most of the patients were illegal immigrants who were not eligible for Medicare and Medicaid. The hospital helped about 10 immigrants relocate to their home countries and paid for dialysis there for a transitional three-month period.

About 50 patients have remained in Atlanta because Grady offered to pay for their dialysis at commercial clinics until Jan. 3. This week, the hospital extended that deadline by a month.

Industry officials said they did not know of other hospitals that had ended dialysis services.

Unlike Grady, Jackson did not operate its own dialysis unit but rather paid private clinics to provide the service to indigent patients. The treatments run about $50,000 a year.

The hospital was losing more than $4 million a year on dialysis, contributing to a deficit approaching $200 million this fiscal year. Over the last year, the economy has generated a nearly 50 percent increase in uncompensated care, and the hospital is also closing two community clinics this week.

All but 41 of Jackson’s 175 patients continue to be treated — at least for the short term — at the commercial clinics, hospital officials said.

Jackson discovered that some dialysis patients were eligible for government insurance. Others will be treated for a few more months because of contractual obligations.

Some clinics accepted small numbers of uninsurable patients as charity cases. One patient wed her boyfriend of two years to qualify for his health insurance, a clinic social worker said.

For the patients, including a dozen illegal immigrants, it is a time of worry. “My hair has been falling out,” said one of them, Josefina Tello, 37, from Mexico. “From everything I’m seeing, the only choice is the emergency room.”