Sunday, June 22, 2008

Hyde Park's Impending Health Care Desert

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:

It's over.

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.


susan said...

In at least one respect, this is actually good news. It sounds like pregnant women here might actually have a choice of midwife or ob/gyn in Hyde Park again, instead of being forced into the U of C high risk for everyone model.

By the way, some of us middle class residents of Hyde Park do not currently have access to U of C health care in any affordable way because our PPO basically includes "everyone but."

Raymond said...

Do any PPO's actually include U of C Hospital? Every job my wife and I have ever had has excluded the U of C from the health plan, so we always have gone elsewhere, out of the neighborhood. And, we pay out of network fees to have our son see a U of C pediatrician (just because it's so convenient for him since little kids have to go to the doctor more).

But, I've often wondered who actually sees U of C doctors outside of the emergency room and the unfortunate folks who need cutting edge research medicine.

chicago pop said...

I've often wondered who actually sees U of C doctors outside of the emergency room and the unfortunate folks who need cutting edge research medicine.

chicago pop, for one, and my own smaller pediatric iteration, for the same reasons Raymond gives. And some other relations as well, and a whooooole lot of neighborhood folks, but no point in making a list.

Pediatrics is, I suspect, their main business at 47th St. There is only one other pediatric clinic within a 2-mile radius of the University of Chicago (at least according to a quick scan of the extensive BCBS network).

khs said...

I absolutely understand cutting costs so that only the most profitable sectors remain, although it seems that providing some primary care could fit into this model and to be even more cost effective when you consider the time off their own employees will need to take to drive north to get routine care.

When shopping for my business’s healthcare, having the U of C “in network” was the driving force in choosing a plan. (There are actually a fair number of PPO’s that include the U of C).

It’s so convenient to go to 47th street, see a great pediatrician and park for free. Ugh, driving 20 minutes with a sick kid (yes driving – public transit with a sick child is nothing I’d want to take on) and paying a fortune to park is something I just don’t even want to think about.

chicago pop said...

A possible title for this post that I toyed with was:

"Hyde Park Middle Class Screwed By University of Chicago Hospital".

Sort of the ultimate payback for Urban Renewal, when the poor got screwed. Everything comes around, no?

However, even I have some standards, and chose to be a bit more circumspect, although I think the above headline captures what is happening. Of course the economics makes sense, are understandable, who wants to stand in the way of institutional greatness, etc. etc.

But at the end of the day, if you live in Hyde Park and use the 47th St. clinic -- which has all the great advantages that khs lists -- you're going to have to make a choice:

1)either join the legions of folks who have already written of U of C hospitals for one reason or another, or who can't access it anyway, and so all go North...


2) continue on at 47th while it is transformed into one of the dozens of welfare clinics on the South Side of Chicago that the U of C wants to use to keep its ER from getting choked with chronic ailments and non-paying patients.

Should you chose Option #2, it means you'll be counting the days until your favorite pediatrician flies the coop, because unless they have missionary ideals and don't mind 80 hour weeks working on a volume basis to rake in the relatively low Medicare/Medicaid reimbursements, they are going to go find a practice where they can earn enough to pay off their med school loans before they die.

Which further means that, rather than preserving whatever degree of choice in health care existed in Hyde Park previously, the overall quality of local primary care is going to erode.

So we got the new grocery store, but are losing a pediatric clinic. I wonder if that will be brought up in any future on-campus interviews with prospective faculty.

ScottM said...

We have a BCBS PPO plan that includes UofC (the big selling point versus the nearly free HMO we could have chosen.)

My daughter was transferred from Friends Family to Comer's a few years ago and then promptly given a new Pediatrician. Comer's however has been a much better experience both in wait times and in front desk quality.

While I've never been to the 47th Clinic, if its anything like Friends Family I'd certainly ask if you Pediatrician has hours @ Comer (alas no free parking unless you luck into a street spot (though they do have a valet!))

Famac said...

You can still go to the main hospital for primary care though, can't you?

David Farley said...

By coincidence I had an appointment at the Primary Care Group at the DCAM this afternoon, and my doctor basically agreed with my second-hand recounting of C.Pop's essay, except to note that local primary care at the U of C Hospital is never going to completely go away because, well, it can't. Although it could continue to be squeezed (longer waits, fewer doctors, etc.)

Or it could morph into something else that's still "primary care" but not what it was before. For instance, when I started working here (back around 1990) - what is not the Primary Care Group was called something else and had a walk-in clinic, where you could just show up, sign in, and wait. You can't do that anymore - even if you want to see someone in what's called Urgent Care you need to have an ok and an appointment from a physician or their nurse from Primary Care. To be honest, it actually works better and is mostly more pleasant than the old way, but it's acknowledged that it's a subtle way of pushing people away.

KHS and Scottm - Whenever I go to any of the clinics in DCAM they ask me if I want a parking voucher. I never need one, and don't know if it's a discount or a get-out-of-the-parking-lot-free pass, but do they only do that at the DCAM?

chicago pop said...

Yes, you can get primary care at DCAM, to answer famac's question, and yes, it is through the Department of Medicine's Primary Care Group.

However, because this service exists for the purpose of training medical students and as a sort of pathological databank for researchers, it can't stand in or substitute for a full-time health clinic with general practitioners who see patients 5 days a week, like 47th Street.

The Primary Care Group, depending on which page of the website you visit, sees between 60,000 to 70,000 patients annually. However, each resident only sees patients for half a day, one day a week. And as David Farley suggests, there may be all sorts of subtle and not-so-subtle barriers to accessing this service.

That's much different than having physicians in the office every day doing clinical work. The Primary Care Group, for the needs of a large community, is not a reliable substitute, especially not when primary care physicians are juggling lab, teaching, or administrative duties, or if your needs can't be accommodated in the weekly half-hour slot that you need to fit into.

The Medical School will always need a population of pathological cases and a variety of "lesions" to train their students. This may allow a certain number of people to obtain regular and reliable health care at any given time, and although it will never go away, I don't see it as in any way replacing a real health clinic.

They don't want it to. Which is why I think they're disinvesting in the primary care of their own neighborhood.

LPB said...

Aside from the whole issue of the advantages/disadvantages of receiving primary care from the U of C, I'm disheartened that primary care is yet another good/service that I have to leave the Hyde Park to find.

I'm also in the BCBS PPO network, which happens to be one of the largest in Illinois. Thus, any medical provider who decides not to join that network is also turning away a huge pool of potential customers. With the UC Physicians Group practice going away, there is only one private pediatrics practice in the 60615 zip code where I live. In my former north side zip code, there are EIGHT private pediatric practice groups -- so I would have even had some choice there.

Gee imagine that...

Katie said...

I (and some members of my extended family) have used the Access clinic on 55th and Wentworth for "walk-in" care (which the U of C doesn't do) and found it excellent. Diagnosis was spot-on (with real doctors), wait times were refreshingly brief, staff was polite and fees were minimal.

Compare that to 47th St. where wait times were always horrible. Front desk staff were rude. And care was merely competent (in my opinion).

susan said...

Komed Holman Health Center at 43rd and Berkeley, is a federally funded community based primary care center. They take Medicaid, self pay, and yes, private insurance. You can make appointments or go as a walk-in. We've gone there a few times and you don't wait around all day. I like the doctors there. I guess maybe they have missionary ideals, or something, or they'd go off and serve the overserved. I do not know where you end up if you go there and end up needing non-primary care.

Elizabeth Fama said...

I recently discovered that Dr. Veena Arun, an ophthalmologist who bailed on the U of C Hospitals, has set up a private practice in the HP Bank building. Since the next available appointment with my optometrist (Louise Sclafani) at the U of C was in SEPTEMBER, I betrayed her and went to Dr. Arun this week. Dr. Arun is very professional and friendly; the office is small but well-appointed. The optician from the hospital tagged along with her to the new office, and has a small but growing collection of glasses frames. There was no wait, at any step.

Otto said...

recently discovered that Dr. Veena Arun, an ophthalmologist who bailed on the U of C Hospitals, has set up a private practice in the HP Bank building.

I was rather surprised to learn recently that "new" UCPG opthamology referrals (viz., those who have not been seen in three years) are now mandatorily shunted to Weiss.

I will admit that things are wicked low-key up there, and it had to be the most thorough refraction and general eye exam I've ever had. Very long wait for the 146 on the return trip, though.

LPB said...

I really like Dr. Arun, with whom my mother is a patient. It used to be even more convenient to see her at Windermere, but at least she's still practicing in the neighborhood.

I am switching my mother's neurologist to Rush, as her current neurologist at DCAM is leaving the U of C soon, and they haven't hired a replacement. I've heard through the neurology grapevine that another U of C neurologist recently left the institution. Makes me wonder if something is going on in that department.

Elizabeth Fama said...

Neurosurgery at least has been drastically reduced, due to disgruntled departures and a lack of new hires. From what I've heard, the remaining few neurosurgeons specialize primarily in back surgery -- which is not ideal if you have a stroke or other brain-related emergency.

Jason Finkes said...

I have to admit that I've been annoyed by the UChi hospital as well. I've been to the Student Care Center a few times, and honestly wish that it was becoming easier to get primary care in HP than harder.