Because of a wave of funding cuts from University Hospital to the community health centers serving the metropolitan area's poorest patients, those safety-net clinics have been forced in recent weeks to severely limit services to uninsured patients. Several of the small medical centers that had their budgets squeezed by University are offering appointments to new patients only if they are willing to wait several months to be seen.
Other community health centers have stopped accepting new patients at all, their receptionists instructed to turn away anyone who has not visited the clinic before. The rejection can turn into a goose chase. Because the primary-care clinics for the poor operate separately from one another, communication is not always good. As a result, some patients seeking medical attention are being sent on a circular and frustrating chase for the opportunity to see a physician.
"There is a severe shortage of capacity for uninsured folks," says Pete Leibig, director of Clinica Campesina Family Health Center in Thornton. "It's the lousy system of health care in this country. If you have money, you get health care. If you don't, you don't."
The most recent blow to the city's medically indigent came in late January, when University Hospital yanked $7 million in funding it had promised to three suburban community health centers over three years to pay for expansions ("Clinical Depression," February 27). The cuts to the clinics--Salud Family Practice Clinic in Commerce City, Clinica Campesina and Aurora's Metropolitan Denver Provider Network--will be trimmed incrementally from their budgets through the middle of May, at which point University's payments will stop altogether.
The clinics, counting on the $7 million from University, had already expanded and hired new staff. Now they are being forced to scale back. Three weeks ago, Salud's director, Jerry Brasher, laid off fifteen staffers, including two physician assistants. And that's not counting the new doctor and four physician-assistant positions he is leaving unfilled.
At the same time, University Hospital is gutting its own primary-care clinic. Joyce Cashman, an executive vice president at the hospital, says the two-year-old CU Care Clinic has slashed its number of staff physicians and physician assistants from eight to six in the past two months. Cashman says that number will drop to five by June, effectively slicing the clinic's capacity in half.
Despite the drastic cuts, though, Cashman insists that University Hospital's clinic for the poor is not rejecting any patients.
"We are absolutely committed to providing medical care to the medically indigent," she says. "There are fewer new-appointment schedule slots available--you might have to wait one or two months. But we don't turn anyone away."
That may be true in theory, but it isn't working out in practice. When a Westword reporter tried to make an appointment, he was quickly denied. "We don't accept new patients here," a CU Care Clinic receptionist explained. "Try MDPN."
The referral from University Hospital didn't go over well at Metropolitan Denver Provider Network's Aurora office.
"We don't have any openings for any patients until the month of June," a clearly irritated medical assistant there said. "And CU knows that. You've got to call them back."
And don't even bother trying to get an appointment with Clinica Campesina's doctors. "We will schedule current patients or family members of patients, but we are not accepting any new indigent patients," says director Leibig. Since instituting the no-new-patients policy about a month ago, Leibig says, Campesina is turning away an average of twenty to thirty patients each day.
"We could just schedule them three months in advance," he explains. "But if you're going to do high-quality patient care, you have to know that, eventually, it would catch up with you."
Leibig says he has instructed his staff to refer patients to Salud's Commerce City clinic, where a receptionist confirmed that appointments were available as early as next week. But Brasher, Salud's director, says such accessibility won't last long.
"The need was there before [University's cuts], and it's still there, and there's only so much you can effectively do," he says. "We just can't absorb them all." He adds that Salud is contemplating restricting new admissions to a limited geographical area surrounding Commerce City.
Up until two years ago, University Hospital seemed committed to expanding its treatment of the area's poorest patients. In 1994 it joined with Children's Hospital and Denver Health and Hospitals--as well as with the Salud, Campesina and MDPN clinics--to form Colorado Access, a new HMO that would treat Medicaid patients only. The CU Care Clinic, designed to bring the cost-saving practices of managed, preventative care to medically indigent patients, was started around the same time.
Yet for reasons that are still unclear to those who oversee the operation of facilities that treat the bulk of Denver's medically indigent, demand keeps rising. Last year Denver Health and Hospitals counted an 18 percent increase in its charges for medically indigent patients. That's three times the increases seen by the rest of the hospital over the same period, according to spokeswoman C.L. Harmer. Harmer adds that she suspects some of the jump may be attributable to the number of poor people no longer served by the growing number of for-profit hospitals in Colorado, such as those owned by the Columbia Hospital Corporation, which now controls a half-dozen hospitals in the Denver area ("Roll On, Columbia," April 24).
University Hospital has seen a similar surge in demand for medical treatment among the uninsured. When the CU Care Clinic opened two years ago, it recorded 7,000 patient visits. By the end of last year that number had climbed to 33,000. In 1996 the southeast Denver hospital provided $63 million worth of uncompensated care.
In recent months the losses have been too great to be made up through cost-shifting--the practice of charging paying patients more to cover the bills of those who don't pay--and the hospital's operating margin has begun to shrink. "It changed quickly," Cashman recalls. "Usually we'll have a dip here or there. But when we had dips in September, October and November [1996], we knew we had to do something."
Some of the hospital's subsequent cutbacks have been relatively minor. It stopped serving breakfast in its cafeteria, reduced some employees' work weeks from 40 to 36 hours, and shut down one of the hospital's two outpatient pharmacies. In all, University Hospital itself has laid off only seven employees.
The impact of the hospital's cuts on other agencies that depend on it for money have been far more devastating, however. Last year, as part of its commitment to Colorado Access HMO, University funneled nearly $4 million to Clinica Campesina, Salud and MDPN to expand their clinics. Campesina used the money to build an entirely new clinic in Thornton, as did MDPN. Salud doubled the size of its current facility. Each hired new staff to man the new offices. University Hospital also promised $2.4 million a year over the next three years to operate the expanded clinics.
But on January 17, without any warning, University pulled the plug on the money it had promised.
University Hospital's retrenchment could come back to bite it. The more uninsured patients are turned away from the primary-care community clinics, the more they'll return to hospital emergency rooms--just the sort of budget-busting behavior the community health clinics are designed to discourage. Cashman says it's too early to have firm numbers to prove that that is happening at University Hospital's emergency room. But she says that anecdotal evidence suggests the hospital's urgent-care center in the ER is getting busier.
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