This document discusses a case of a 21-month-old patient presenting with a rash and the differential diagnosis and treatment considerations given the patient's medical history and lack of insurance. It then discusses cost shifting in healthcare and strategies to improve access to care for low-income uninsured patients, including enrollment in Medicaid/CHIP programs and referrals to low-cost clinics. Barriers to care for undocumented patients are also addressed.
Original Description:
Pediatric morning report at Primary Children's Hospital
This document discusses a case of a 21-month-old patient presenting with a rash and the differential diagnosis and treatment considerations given the patient's medical history and lack of insurance. It then discusses cost shifting in healthcare and strategies to improve access to care for low-income uninsured patients, including enrollment in Medicaid/CHIP programs and referrals to low-cost clinics. Barriers to care for undocumented patients are also addressed.
This document discusses a case of a 21-month-old patient presenting with a rash and the differential diagnosis and treatment considerations given the patient's medical history and lack of insurance. It then discusses cost shifting in healthcare and strategies to improve access to care for low-income uninsured patients, including enrollment in Medicaid/CHIP programs and referrals to low-cost clinics. Barriers to care for undocumented patients are also addressed.
Eva Chavez, MD, PGY-1 Case WBN Mommy Call: Early Saturday morning 3:15am 21 month old, previous 28 week preterm with CP, now with a rash. Started earlier (<24 hours) on the face then progressed to the trunk, now is all over the body. He has been well except for recent diagnosis of AOM, he just finished his last day of Amoxicillin Denies any other symptoms including fevers, cough, congestion, rhinorrhea, shortness of breath, no drooling or trouble swallowing. No new medications, foods, soaps, etc. Mom noticed his upper lip has some swelling, but talking happily in the background PMH: 28 week preterm, h/o Grade III IVH, spastic CP, developmental delay. Recent AOM Imms: UTD Social history: Hispanic family, patient was born unexpectedly while family was visiting Mexico, therefore undocumented. Patient has no insurance and family is a very low income family. SMC patient on sliding scale for visits
Non-emergent rash, no concerning signs on questioning. Dose of Benadryl given and followed up the next day. At PCH ED Uninsured Meet with Eligibility Determine whether they qualify for Medicaid/CHIP/Other If not Medicaid Eligible they receive 25% discount on the visit Can also receive pre-service discount of additional 15% if they can pay in full at time of service If Medicaid/CHIP eligible they are responsible for the estimated amount they would pay once enrolled Eligibility works with family to help fill out paperwork for Medicaid/CHIP/Other Admission to PCH Emergency Medicaid for Undocumented who qualify Financial Assistance Program through IHC Charity Non-profit organization Needs to meet a minimum of charity work to maintain status
Cost Shifting Hospital cost shiftingcharging private payers more in response to shortfalls in public payments
How Much Do Hospitals Cost Shift? A Review of the Evidence - Austin B Frakt
Conclusions: Review of literature since 96 shows that there is not strong evidence that cost shifting is large and pervasive Cost cutting, another response to shortfalls in public payments to hospitals Cost shifting may be higher in cases of uninsured patients. Higher private premiums paid for providing services to the uninsured. Estimates vary. Cost Shifting Insuring Children ~48,200 of Utahs uninsured are children from low-income families who qualify for Medicaid or CHIP. 185,900 of the states uninsured live at or below 138 percent of the federal poverty level and would qualify for Medicaid under an expansion of the safety net program.
Insuring Children Eligible for Medicaid/CHIP Barriers to enrollment: education/awareness, stigma of welfare, paperwork, rural areas Strategies to improve enrollment: Getting the word out through various outlets, single application to determine eligibility for multiple programs, simplify enrollment policies (those eligible for reduced/free lunch automatically start application for Medicaid/CHIP), community organizations assisting, simplifying renewal policies
Voices for Utah Children Insuring Children Case - Rash For emergencies direct to PCH OSH and urgent care will likely not provide financial assistance if not eligible Non-emergent, direct to follow up with PCP or clinic the following day Options for uninsured include clinics such as Maliheh Free Clinic, Utah Hope Clinic, Magna Exodus Clinic, 4 th street Clinic, Community Health Centers, Redwood Clinic, etc. http://slcohealth.org/html/medicalresources.html References Frakt Austin B. How Much Do Hospitals Cost Shift? A Review of the Evidence. Milbank Q.2011;89:90, 123. [PubMed] Eligibility Office at PCH Voices for Utah Children Utah Health Policy Project http://slcohealth.org/html/medicalresources.html Health.Utah.gov
Medication A.R.E.A.S. Bundle: A Prescription for Value-Based Healthcare to Optimize Patient Health Outcomes, Reduce Total Costs, and Improve Quality and Organization Performance