posted by chicago pop
University of Chicago Getting Out of Neighborhood Primary Care
The University of Chicago, according to this blogger's source, has recently sold it's primary care practice at 47th Street to Access Community Health Network. Access is designated as a Federally Qualified Health Center (FQHC), which allows it to receive Federal funding (Medicare/Medicaid) at higher rates than non-designated clinics, for the care of low-income and uninsured patients.
What does this mean? It means that within a few years, while the University completes its $700,000,000, interdisciplinary New Hospital Pavilion, most of the University's faculty and staff -- and a lot of the neighborhood's middle class residents -- stand a good chance of switching to Northwestern Memorial for their primary care.
If you're a nice middle class resident of Hyde Park, and accustomed to having a nice, extremely competent family doctor at the University of Chicago's 47th Street clinic, the kind who can take care of your daughter's strep throat, and refer you to the U of C Medical Center if you need specialized treatment, here's some news:
The University of Chicago Medical Center is getting out of primary care. For rich and poor alike. So you might want to schedule your doctor's appointment on the North Side to fit with your next shopping trip, because unless you need a multiple organ transplant, or can get used to the high-volume, subsidized care at a community clinic, there will soon be no other options for Hyde Park residents.
In fact, your doctor may already be planning to leave. Which means more work for whoever is left to cover -- and who knows how long that will be. Michelle Obama, in her capacity as Vice President for Community and External Affairs at the Hospital, has been praised for working to steer large numbers of potentially expensive, low-income ER visits away from the Hospitals to South Side FQHC's, but it's not quite clear who will take care of the University's own faculty, or anyone else who happens to live in Hyde Park and can pay their medical bills.
As with so many other things, Hyde Park is outsourcing its own health care, possibly to the benefit of its own local competitor.
The reasons why this makes sense have all been laid out in a compelling essay by the current CEO of Chicago's Medical Center, James L. Madara, in which he argues that providing ER access and primary care to the primarily low-income neighborhoods surrounding urban Universities is bad for both research hospitals and the network of community-based clinics around it. It's inefficient and horribly expensive, Madara writes, for research universities to handle routine primary care for low-income people, and especially to run an ER in a poor neighborhood in which many patients will be uninsured. It also, he argues, cannibalizes the market of FQHC's, which are geared to preventive medicine and routine care at low cost.
The solution? Get out of primary care, and focus on being the best in "the complex specialized care academic medical centers provide." (*) Further, "This argument does not depend on defining groups by ability to pay or type of insurance; rather, it defines groups by the complexity of disease and the corresponding requirement for a facility dedicated to, and capable of treating patients with such illnesses."
That's not quite how it comes across in the local papers, however. Just in the last month, we've learned that the Medical Center is leasing space on E. Huron, in Streeterville, just steps from Northwestern's gargantuan concentration of 1,500 affiliated physicians. Just a few days ago, we learned that Chicago is also talking to Evanston Northwestern about an academic affiliation in the heart of the well-insured North Shore.
"Such a relationship could allow University of Chicago to tap into the wealthy base of patients the north suburban hospital operator is known to treat. University of Chicago has been reaching into areas for more affluent patients, recently confirming a lease of office space for U. of C. doctors in Chicago's Streeterville neighborhood near Michigan Avenue," writes the Tribune's Bruce Japsen ("Northwestern Ending its Academic Affiliation with ENH," June 16, 2008).
There are other signs of shifting priorities. The Hospital recently closed its ophthalmology and psychiatry units, and obstetrics is shifting away from low-risk, normal pregnancies to prenatal, fetal medicine (ask some local moms about the now-defunct hospital midwifes group).
Exiting primary care is part of the restructuring that underlies these changes. Where the Medical Center can't be world class, or where its services become a cost center, it is pulling out, the better to compete with Mayo or the Cleveland Clinic at the very top. The economics of the situation make perfect sense.
In the meantime, the Hospital is setting up shop to take care of insured men with high blood pressure on East Huron, and a lot of Hyde Parkers will soon have to leave the neighborhood to see a doctor.
*Laurence D. Hill and James L. Madara, "Role of the Urban Academic Medical Center in US Health Care," Journal of American Medical Association, November 2, 2005 -- Vol. 294, No. 17: 2219-2220.