Two clinics at University of Colorado Hospital — considered the state's safety net for the needy — are turning away patients on government insurance plans because they can't afford to treat them.
The recent changes at University's urology clinic, which stopped taking new Medicaid patients this month, and the internal-medicine clinic, which is no longer accepting patients with Medicare, have left community health centers that care for the state's poorest residents at a loss. The pool of specialists who will accept patients on low-paying government insurance plans is shrinking, they say.
University Hospital, which spent almost $270 million in the last fiscal year treating people without insurance, is under no official obligation to treat patients on federal assistance for the poor or elderly. A 1990 Colorado statute says that for every $3 the state gives the hospital from its general fund, the hospital will provide $4 in care for needy patients.
But the state has not given University Hospital money from its general fund for at least the past three years, said Dr. Greg Stiegmann, the hospital's vice president for clinical affairs.
"We have essentially no obligation since the state has not lived up to its commitment," he said.
"It comes down to economics. We're doing the best we can. But we simply are at our limit."
Stiegmann said other metro-area hospitals need to take on more of the burden and pick up additional "charity work."
Denver Health Medical Center is the safety-net hospital for needy patients who live in the city and county of Denver, but the statute governing its responsibilities is separate from the one regarding University Hospital.
"We welcome all the Medicare and Medicaid patients — we consider it insurance," said Denver Health spokeswoman Dee Martinez. The hospital also treats city and county residents without any insurance, though there is a waiting list of more than 3,000 to see a family doctor.
Accepted if need dire
University Hospital does not take patients without insurance unless they have an "acute life- or limb-threatening problem," Stiegmann said.
Even so, about one in six hospital patients and one in 10 people treated at University's outpatient clinics are uninsured. The amount the hospital has spent on uncompensated care for the needy has jumped 50 percent in the past two years and has risen each of the last 15 years.
The two university clinics that recently stopped taking Medicaid and Medicare still will accept patients in dire need of treatment, Stiegmann said. And the changes are temporary, though it's not known when the clinics again will start accepting new patients on government insurance.
The financial burden is compounded by the fact that the University of Colorado School of Medicine does not have much money to pay its professors.
The physicians who work in University Hospital clinics are employees of the medical school at the Aurora campus. The state contributes "almost nothing" for the salaries of those professors, forcing them to rely on clinical work to make money. They lose money or barely break even seeing too many Medicaid and Medicare patients.
"It's not the hospital that is saying 'no' to these patients; it's the doctors who are saying 'no,' " Stiegmann said.
The issue isn't unique to University Hospital. Many physicians across Colorado and the country have stopped taking Medicaid and Medicare patients in recent years because they say they are not reimbursed enough by those government plans. Doctors' offices typically can break even on Medicare patients and are reimbursed about 70 cents on the dollar for the costs of caring for Medicaid patients.
"Model" refuses patients
Even the Mayo Clinic's primary-care center in Scottsdale, Ariz. — one of the models for national health care reform — no longer takes Medicare patients.
Health care experts say the problem is likely to get worse as millions of uninsured Americans are added to the Medicaid program. Just because those people have insurance, some argue, it doesn't mean they will find doctors to treat them.
Colorado recently has added about 100,000 people to its Medicaid rolls, which is why the problem of shrinking access for Medicaid patients seems more acute.
"It's worse because the numbers are bigger," said Joan Henneberry, director of the state Department of Health Care Policy and Financing. "This has been a problem for a long time."
At a Salud Family Health Center in Brighton, referral coordinator Amalia Harper is struggling even more lately to find specialists who will see Medicaid patients. News that the urology clinic at University Hospital would no longer take such patients came as a major blow because it was the last urology office she knew that would take Medicaid patients with serious urological problems — suspected cases of prostate cancer, kidney stones, male infertility.
It's not just urological follow-up appointments Harper has trouble booking. She has nowhere to send Medicaid patients for orthopedics or dermatology. And the Salud clinic knows just one ophthalmologist who will see Medicaid patients