HCMC to reduce charity care, cut jobs

  • Article by: CHEN MAY YEE , Star Tribune
  • Updated: November 18, 2009 - 11:02 PM

The strapped hospital is cutting nonemergency care to uninsured patients outside the county.

Facing a crippling loss of state health care funds, Hennepin County Medical Center plans to stop seeing uninsured, nonemergency patients from other counties, cut 150 to 200 jobs and close two clinics on its downtown campus.

The state's biggest safety net hospital, and one of its premier teaching institutions, faces a 2010 budget that is "not sustainable,'' officials said Wednesday. The changes, which would take place in 2010, were approved Wednesday by the hospital's board and go to the county board next month for final approval.

HCMC officials have warned for months that the hospital, which sees 140,000 patients a year in its emergency department alone, cannot continue to absorb losses in state funding and still continue to care for the flood of uninsured patients who show up at their door.

The hospital, which suffered a $12 million cut in state funding last winter, has become an emblem of the cost pressures facing Minnesota's health care system, with two rounds of layoffs this year that eliminated 200 positions. It has also cut overtime, frozen nonunion salaries, delayed building a new outpatient center and brought in consultants to raise productivity.

Starting in April, "people who call to make a clinic appointment and their residence is not Hennepin County and they are uninsured, they will be turned away," said Chief Financial Officer Larry Kryzaniak. They will also lose access to pharmacy services.

However, HCMC will continue to see patients who show up for emergency care, regardless of where they live. County property taxes accounted for almost 6 percent of HCMC's revenue this year.

$40 million in lost funds

The austerity measures were approved Wednesday as part of a $536.6 million operating budget with a record $25 million deficit.

"This budget is not sustainable," said Kryzaniak. "We are not a viable entity with this budget." (Taking into account depreciation and other non-cash items, the hospital breaks even on cash flow.)

Hospital officials said that the shutdown next spring of a state program for the indigent, General Assistance Medical Care (GAMC), could cut reimbursements to HCMC by as much as $40 million next year and another $50 million in 2011.

Late Wednesday afternoon, more than 200 people turned up to protest the loss of GAMC, forming a line outside the hospital that stretched around the block, meant to depict a "never-ending" line for emergency care. They carried signs: "Insulin." "Dialysis." "Chemo."

The protest was organized by St. Stephen's Human Services, which runs a Minneapolis homeless shelter. The hospital's top executives, including chief executive Arthur Gonzalez, came outside and stood nearby in solidarity.

Charles Flinshaw, 48, held up a sign saying,"You want me on my meds." Flinshaw lost his construction job a few years ago and now does odd jobs. GAMC pays for his depression medication. Taking away GAMC, he said, is "just going to have a domino effect."

HCMC officials say they expect many more uninsured people to land at their door, not just the former GAMC recipients they used to treat, but others who will be turned away from other facilities in the metro area. They are pinning their hopes on the Legislature somehow coming up with funding when it meets in February.

"We need targeted relief," said Mike Harristhal, the hospital's vice president for public policy. Otherwise, "the default health plan becomes the ER here at HCMC," Harristhal said. "This is not just a problem for these people but for everybody else in Hennepin County. How long does it take for the ambulance to get to your house? What about a year from now?"

Meanwhile, in addition to cordoning off nonemergency care, officials also propose cutting an additional 150 to 200 jobs, or 3 to 5 percent of the workforce, to save $15 million in 2010.

They plan to close a senior care clinic and move its 500 patients to a nearby clinic. They also plan to close an outpatient cardiac rehab program and refer 25 to 30 patients outside the system. Those program cuts are estimated to save $2 million.

Hospital officials said they were continuing to review other programs to see whether they should continue offering them.

Chen May Yee 612-673-7434

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