In addition to an all-out effort to qualify those patients for insurance, Montefiore, which has roughly 40% of the market share in the area, is also using outreach efforts such as the medical home and encouraging access to primary care for preventive treatment.
"You want to get the best outcomes and prevent the admission to the ER," he notes.
For the 13-plus hospitals that make up Hospital Sisters Health System, serving those in need of charity is as much a part of their mission statement as it is for the Franciscan ministry. "We have a special concern for the poor and we have to report to our board of directors how we are achieving that mission," explains Ronstrom.
With rising numbers of charity care they are achieving that mission. From 2008 to 2009 charity care increased just over 10% of total gross charges from $9.2 million (2008) to $10.4 million (2009). "It's still at a manageable level, but we're watching it," says Ronstrom.
Ronstrom says to offset the uncompensated care numbers Hospital Sisters Health System takes a strategic growth strategy approach, "For us to help we have to grow across the state, strengthen our volumes, and run efficiently."
But they also strongly believe that community outreach is key. The health system is concentrating efforts on a variety of community programs to help feed the poor as well as establishing free clinics in some of the hardest-hit areas—their free clinics have already seen a 30% increase in demand for services.
"We use the need assessments to figure out what the needs of the poor in the community are and then we work to accomplish those goals," he notes.
In sunny California, the uncompensated care picture is no less gray than anywhere else in the country. UCLA Health System is one of the largest health-science centers in the country and encompasses nearly all of the university's patient care, clinical education and research programs and facilities.
"Our community has people who just don't have insurance now, but there's still no one more important than the next patient," says Feinberg.
At UCLA, Feinberg and his team have worked to make patient-centered care the driving force behind their organization's success—even when the levels of uncompensated care are on the rise.
"Right now you have people deciding between paying their COBRA or their mortgage, it's a whole different situation," he says. This shift in economic circumstances is just another reason that UCLA has decided to continue to emphasize their patient experience and they have seen their patient referral numbers rise from 30% to nearly 99% as a result of their diligence.
"We have figured out patient-centered care in a big way," he says.
To learn more about how UCLA Health System and all of these facilities tackled patient satisfaction while simultaneously addressing their uncompensated care, check out part two of my column next week.