The University of Chicago's Health Care Desertification Project

posted by chicago pop

47th Street Clinic to Close by Early Spring 2009 -- University Shafts Neighborhood Middle Class

Since we posted on the prospect of Hyde Park's Impending Health Care Desert in June 2008, the situation has evolved considerably. It is now safe to say that, as a result of the subprime blowout, consequent credit crisis, and related global recession, the recently announced budget cuts at the University of Chicago Medical Center will leave Hyde Park without easily accessible primary care for everyone.

In particular, the 47th Street, University-run clinic will be closed entirely in March or April, instead of being sold to a private, federally subsidized medical group as originally planned. The tax-exempt Medical Center is transforming itself into a science colony inconveniently located among an underinsured population, with access to its basic services increasingly restricted to the original colonists.

While the issue of Chicago's ER sending l0w-priority patients to surrounding clinics or hospitals has been in the news recently, ("University of Chicago ER Sends Kid Mauled by Pitt Bull Home," Chicago Tribune, February 13, 2009) other changes strike closer to the heart of preventive, family primary care for Hyde Park residents.

If you have a doctor at 47th Street, they will be moving to DCAM.

If you want to get a doctor there, too bad, no new adult patients are being taken.

And from the word on the street I understand that it will be extremely difficult for newcomers to the neighborhood, even those with insurance that allows the University of Chicago and don't mind fighting their way into the heart of the massive Duchossois Center for Advanced Medecine, to get anything other than walk-in service with rotating physicians.

Like the idea of a family doctor who tracks your case history over years and knows your kids? The kind of medicine that can spot problems before they become the kinds of "complex" issues that the University prefers to treat?

Consider living in a different neighborhood. Until you need a liver transplant, that is, or you have a child who needs special treatment at Comer.

I felt at the time of the first post, and even more so now, that a community like Hyde Park needs a family health clinic accessible within the neighborhood by everybody -- not just faculty and staff, but anyone who can pay their bills and takes the chance on locating a family in this community.

While the University demonstrated a commitment to getting a decent supermarket in the neighborhood to replace the Co-Op, by closing the only conveniently located clinic in Hyde Park they are leaving dozens of families without local options for health care. This is a vastly more consequential decision that has received much less attention. While it is now much more enticing for people to shop locally for their groceries, it will soon be much more difficult for them to shop locally for a doctor.

Many families and individuals have already adjusted to this reality. In the comments to the original Hyde Park's Impending Health Care Desert post, it became clear that a large group of people had either resigned themselves to migrating north for primary care, have satisfied themselves with neighboring South Side, Federally Qualified Health Clinics, or somehow or another see physicians at DCAM for regular primary care.

It should be clear that the last option is not a reliable one in this neighborhood unless you are already in the system, and even then, it's not clear how many physicians will be retained.

A recent promotional brochure for the U of C had this to say about Hyde Park health care options:

U.S. News and World Report consistently selects Hyde Park's own University of Chicago Medical Center as one of the best hospitals in the United States...Also under the Medical Center umbrella are the Duchossois Center for Advanced Medicine, an outpatient facility; clinical training programs of the Pritzker School of Medicine; and several health care locations throughout the Chicago region.

The "clinical training programs of the Pritzker School of Medicine" are what you get as a walk-in from medical residents at DCAM, and there is no mention of a primary care health clinic in the neighborhood.

Ready to move your kids cross-country for that faculty job, knowing that the resident who treats them at DCAM will be gone in a few years and replaced by another?

The University of Chicago can do everything imaginable to encourage retail in Hyde Park, it can do a magnificent job coordinating the redevelopment of Harper Court, but if the families who chose to buy homes, pay property taxes, and volunteer at the local school can't see a doctor without having to travel many miles away from the coming $700 million medical center, then the University will undermine virtually everything else it accomplishes in terms of making Hyde Park a desirable place for people to settle in and live.

[This post also appears on Huffington Post Chicago]

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.