Hospitals, clinics, Wake to track uninsured patients

Eight clinics, health systems and county agencies are teaming up to keep Wake County's uninsured patients out of emergency rooms and lighten the financial burden on the hospitals that are straining to care for them.

Through the CapitalCare Collaborative, they're working to connect patients with nonprofit and county organizations that can provide care more cost-effectively than emergency rooms can.

The program also will consolidate uninsured patients' financial -- and some medical -- data in one location online, which the groups expect will save time and money by helping them better coordinate care.

As medical insurance becomes increasingly expensive for employers and employees, there is growing concern about the swelling ranks of the uninsured. CapitalCare estimates that 20 percent of Wake County residents 18 to 64, or about 100,000 people, are uninsured. Half of that group lives in poverty.

Those patients usually go to hospital emergency departments for their medical care, said Susan Weaver, president of CapitalCare and executive director of Alliance Medical Ministry, a clinic for working uninsured adults.

But the average emergency-room visit costs at least $1,000, she said, and the hospital must absorb much of that cost if patients can't pay. An average appointment at her Raleigh clinic costs $80.

Likewise, care for a child's ear infection costs $350 in an emergency room or about $60 in a clinic, said Peter Morris, medical director of Wake County Human Services, a member of CapitalCare.

"If you can shift those kids from emergency rooms to clinics, you've clearly saved the system" money, he said.

WakeMed Health & Hospitals spent $66.1 million on charity care in its 2006 fiscal year, and Rex Healthcare will spend about $28 million in the year that ends in June. Those costs are passed along to insured patients as hospitals increase charges to cover their losses.

Both hospitals are members of CapitalCare, which is a program of the Wake County Medical Society. Duke Raleigh Hospital, Wake Health Services and the Open Door Clinic are also members.

Until now, the hospitals and community or county-sponsored clinics have operated independently, with little to no communication about patients. Although hospitals worked with uninsured patients to find payment options and charity and government programs, they rarely referred them to other resources they could use the next time they became ill.

"In the end, what we have created is a network for these patients that very often they don't have," said Jill Frye, director of access management services at Rex. "They fall through the cracks in the health-care system now, because everyone is working in an isolated environment."

CapitalCare's first phase uses Web-based software to screen and refer patients to community, state and national programs, from Medicaid to the medical society's Project Access. Once one hospital or clinic enters and reviews a patient's financial data, the record is accessible to all of them.

The next phase, which starts in July, will use that financial data to sign up patients for the drug industry's discount programs.

And next year, CapitalCare plans to create a shared database containing information about the medical care that patients have received.

Uninsured patients often seek treatment of the same problems at different hospitals, resulting in duplicated tests and high costs, said Weaver, who also is director of community access for WakeMed. A CT scan, for instance, costs $1,300 to $1,400, she said.

But with CapitalCare's software, medical-care providers will be able to see if someone else has performed a desired test, and they can seek those results before providing additional care, she said.

As the software collects records, CapitalCare can have its most critical effect, helping identify and fill the medical-care gaps that uninsured patients in Wake County experience, said Morris, of Wake Human Services.