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County works on indigent care options
Published September 26, 2009
ANGLETON — A patient sits down on a chair in an examination room, giving Dr. Byron Brooks the chance to look him over.
A nurse reaches over and places a scope in the patient’s ear, and an image of his ear canal pops up on a TV screen.
“Is that beautiful or what?” Brooks said.
Brooks finds the image amazing, given that his patient is sitting in a room at the Brazoria County Health Department in Angleton and he is in an office at the University of Texas Medical Branch in Galveston. The scope gives him a view of the indigent Brazoria County resident during a telemedicine visit.
After Hurricane Ike slammed into the Texas Gulf Coast last September and wiped out most of UTMB’s facilities, Brooks went to his Seabrook home, fired up a generator and continued to see indigent patients through telemedicine.
“We would try and keep people out of the emergency rooms,” he said.
Telemedicine was one of the few services UTMB was able to continue providing Brazoria County’s indigent patients.
As the hospital sought funding to rebuild and reopen, Brazoria County had to find temporary service providers for indigent care, which has seen its number of eligible residents increase from about 80 to 132 in the past six months. County officials are negotiating with UTMB about another contract to provide indigent care, though some said they also might hang on to a plan they approved after Ike.
“We’re very happy with what we have right now,” Brazoria County Health Director Dr. Leo O’Gorman said.
The question comes after UTMB is almost up and running as it was before Hurricane Ike and local counties are signing up with the hospital to provide indigent health care again. UTMB Senior Vice President Dr. Ben Raimer said the hospital’s trauma center is now open, and the hospital has 370 beds available, compared with the 550 open before Ike.
TEMPORARILY PERMANENT
County commissioners approved contracts in May with other providers, including Memorial Hermann Hospital in Houston. Patients who need urgent care visit with specialists in Houston to determine if they need hospitalization.
If an indigent patient is admitted to Memorial Hermann, the county pays about 115 percent of the Medicaid rate. The hospital also applies various discounts on its charges, Brazoria County District Attorney’s Civil Division Chief Jim Wiginton said.
The final charge varies per patient, he said.
“So far, they’ve taken care of our folks,” Wiginton said.
The only drawback to the plan is there is no cap on the charges, Wiginton said.
Before the hurricane, the UTMB plan cost the county a little less than the current plan, officials said. But now that UTMB is recovering from the storm, it has changed its guidelines to reduce its costs, Wiginton said.
“They were tightening up a little bit before the storm,” he said.
Before Ike, UTMB used to take over an indigent patient’s expenses after Brazoria County’s bill had reached $30,000. In recent negotiations, hospital officials said they have to raise that amount to $60,000, Wiginton said.
UTMB also would give discount rates and charged about 35 percent of the actual costs, but now will charge about 54 percent, Raimer said.
The hospital is having to make the changes as part of a rebuilding plan, Raimer said. During negotiations for funding to rebuild, legislators asked the hospital to rein in its costs, such as at the trauma center, which was losing $4 million a month before Ike, he said.
“That was the biggest thing they requested,” Raimer said. “We still feel our prices will be competitive.”
Brazoria County Commissioner Dude Payne said the county’s costs for indigent care now are “running about the same,” compared with the costs under UTMB.
MORE REQUESTS
The county has seen more indigent patients and requests for indigent services as local companies issued layoffs in recent months, health department officials said.
The health department gets a few hundred applications for indigent status every month, said Jennifer Gutierrez, indigent health care coordinator.
The number of patients tends to fluctuate as some get off indigent status and some return, she said.
“People have lost their jobs and now they are coming back,” she said.
Indigent patients have to meet certain guidelines to apply for care. Requirements include not living in a hospital district and having an income of less than 50 percent the federal poverty level for the number of people in a household. To qualify for indigent status, income for a family of four would have to be less than $919 a month, according to documents provided by the county health department.
The number of indigent patients is low because areas that have hospital districts, such as Sweeny and Angleton, accept patients regardless of their ability to pay, officials said.
Brazoria County’s indigent patients come for telemedicine exams Tuesdays at the county health department building in Alvin or Thursdays at the Brazoria County Health Department in Angleton. A telemedicine doctor consults with the patient and either makes a diagnosis or issues a referral to a specialist.
But patients can’t go to any specialist or hospital for care, Payne said.
“They have to go where we direct them,” he said.
Other than Memorial Hermann, many patients will seek specialized care at Angleton Danbury Medical Center and Brazosport Regional Health System, he said.
MORE OPTIONS
County commissioners approved the county’s 2009-10 fiscal year budget that included $2.17 million for indigent health care, slightly more than the $2.16 million this year, County Auditor Connie Garner said.
While the county deals with other providers, it will look at going back to UTMB, Wiginton said. Wiginton said he expects to look at a contract offer from UTMB within the next week or so.
“The preference would be to have two options,” he said. “The question is are we going to have to send all of our indigent to them?”
Raimer said UTMB is not mandating counties use only its services for indigent patients.
“We’re not going to require that,” he said.
So far, 50 percent of the counties UTMB provided with indigent care before Ike have signed with the hospital again, Raimer said.
As Brooks spoke with his patient Thursday morning, he said indigent care programs keep non-emergency cases out of emergency rooms. That means better care for other patients, he said.
“We all need health care,” he said.
John Tompkins is senior reporter for The Facts. Contact him at 979-849-8581.
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BY THE NUMBERS
Numbers behind indigent care:
• 82 | Brazoria County indigent patients six months ago
• 132 | Indigent patients now
• $30,000 | Amount county had to pay before UTMB would start picking up the costs for an indigent patient before Hurricane Ike
• $60,000 | New amount negotiated in contracts counties must pay before UTMB starts picking up costs for indigent care
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