"Boutique hospitals have sprung up and siphoned off some of the paying patients leaving metropolitan hospitals to treat a growing number of the uninsured."
Dr. Joe Meek, KUSM-W

One area of health care that’s been hit especially hard is the hospital. Because, inevitably, it’s to the ER that the uninsured go when their medical conditions become acute problems. It should be no surprise, then, that much of the escalated costs of service are borne by the hospitals.

Wichita and Sedgwick County hospitals have always contributed independently into an allocation of a specified number of donated hospital services for people without insurance. They did this by employing a “debit card approach” to health care delivery — funding a certain number of laboratory, imaging, and other services on an annual basis — and donating this allocation of hospital-based services to the area’s low-cost clinics. From there, it would be up to the clinic’s director and the medical teams to use them wisely for the patients and their needs.

“Our community has always done a good job of taking care of the underinsured and the uninsured,” affirmed David Nevill, Wesley Medical Center’s CEO. “But if we were able to do a better job of coordinating and providing care on a continual basis — meaning that these patients have access to primary care physicians and/or specialist physicians through regular office visits vs. episodic care in the emergency department — then it’s a better system in general.” Mr. Nevill also cited one of the anchoring concepts for Project Access, “If you share the wealth and everyone participates more or less equally, it doesn’t become a burden for any one physician or any one hospital.”

Which is why, when Dr. Paul Uhlig approached Mr. Nevill, who was then COO of Wesley, the benefits of participation in Project Access were quickly and distinctly understood. Mr. Nevill and his associates didn’t even approach the hospital board with Project Access. They made the decision as an administrative team to participate. “I had known Paul and worked with him for several years before he really got this started. So we had a professional relationship already established, which made it easy,” acknowledged Mr. Nevill.

Along with Mr. Nevill, Dr. Uhlig worked with then-CEO of Wesley, Carl Fitch. “I think Dr. Uhlig was good at building a constituency of people who are interested. So I think he touched lots of people in the hospital,” observed Mr. Nevill. This kind of constituency- building was important because, for the hospitals, the commitment to Project Access wasn’t as clearly defined as it was for the doctors.

The doctors’ contribution was understood to be a specific number of patients. But for the hospitals there couldn’t be such a set figure. So they were faced with a dilemma: on the one hand, as Mr. Nevill noted, “the ER is not the ideal place to receive or provide primary care and it’s not designed for that” and therefore ER costs were continuing to climb. On the other hand, they were concerned with facing an undefined commitment. To them it was like writing a blank check.

Their concerns were, in fact, well-founded. Because, initially, as more people started getting primary care, more procedures had to be performed — the kinds of procedures necessary to correct years of health care neglect; the kinds of procedures that have been costing hospitals more every year.

But then, after a period of time, it was observed that the initial increase in the number of procedures dropped off. Just how much of Project Access’ preventive care aspect has contributed to this decline, however, remains to be seen. Only time will tell. According to Mr. Nevill, “it’s hard to quantify any actual reduction in uninsured care because our volume of patients continues to go up year after year.” He also reminded that, because Wichita is the air capital of the world, “the events of September 11, 2001, have taken a toll on our economy in a very significant way.” Since this a community that’s had to absorb thousands of layoffs in its aviation manufacturing industry, “the incidents of charity care are going to go up further,” warned Mr. Nevill, adding, “I hate to think of what it would be like without Project Access. It’s been an important component in reducing the rate of increase for health care of the uninsured and the underinsured.”