Categories: Schenectady County
Dr. Kevin Karpowicz, a highly respected children’s doctor, is leaving a county nonprofit medical service, saying its quality of care is jeopardized by the financial losses from treating Schenectady County’s poor and under-insured.
Furthermore, he and executives from Ellis and St. Clare’s hospitals said Tuesday in interviews that the financial strains on medical services in the county are close to collapsing the system.
Karpowicz resigned quietly as Hometown Health’s vice president of medical services in November and on Tuesday said he plans to leave the facility as a doctor in April. He joined Hometown in 2005 after spending 23 years as a prominent community pediatrician.
“When an organization is struggling for survival, what unfortunately suffers is quality of care. At this point, the quality of care has not been as good as it should be,” Karpowicz said.
Hometown Director of Development Joseph Gambino said Hometown administrators and “a great many of our patients do not share Dr. Karpowicz’s opinion. We have been providing quality medical care to the poor, the uninsured and to Medicaid patients for more than 40 years.”
Karpowicz said Hometown has not been cited for deficiencies, but “there have been issues that have made us very concerned.” He said staffing shortages have caused problems with patients seeking care. He also said that nurse practitioners and physician’s assistants, who have advanced degrees but are not doctors, are having to see more medically high-risk people without adequate supervision of doctors.
Gambino said Hometown has a “fair complement of physicians in mid levels and in the nursing staff” and that patients can walk in without an appointment and be seen. “At the end of the day, we stay here until every patient is seen,” he said.
Gambino would not provide 2007 budget figures for Hometown, saying the facility’s books were currently being audited.
Hometown plans to close its clinic at Ellis Hospital on Feb. 1 to save money. It also lost a nearly $1 million contract with Schenectady County to provide care to jail inmates this year.
Hometown serves a primarily low-income population with little or no insurance. In 2007, it saw 22,000 patients, Gambino said, about 80 percent of whom were uninsured or under-insured. It provided $3 million in uncompensated care that year, nearly twice as much as provided two years ago.
“We don’t like to think we will get to the point of closure,” Gambino said. In fact, he said, Hometown learned Tuesday it had received half of a $400,000 state grant. “Fortunately, I can say our financial picture has stabilized,” he said.
Karpowicz said the state money is only a stop-gap for Hometown’s problems and that while its financial problems are similar to those faced by other federally designated community health centers in the nation, its fiscal problems should be of special importance to Schenectady County residents.
The reason is that Hometown is part of a safety net of community institutions that provide primary care services to people with little or no insurance or who are on Medicaid. The other members of the net are the Schenectady Free Health Clinic and St. Clare’s Hospital, both of which are struggling to survive.
SYSTEM UNDER STRESS
Karpowicz said the safety net is unravelling and that its loss will force the uninsured and those on Medicaid into the emergency rooms of local hospitals, which are designed to treat trauma and not provide primary care coverage.
This influx will further tax the resources of the hospitals, causing them greater instability, Karpowicz said.
“If we don’t fix primary care system, it does not matter what Berger does. It will crash and burn as well,” Karpowicz said.
The Berger Commission was set up by the state Legislature to devise ways to control the state’s growing health care costs. Among its recommendations were that Ellis and St. Clare’s hospitals form a joint operating agreement to reduce costs and that Bellevue Woman’s Hospital close, which it did in November. The Berger recommendations became law Jan. 1.
The chief executive officers of both Ellis and St. Clare’s hospitals said the county’s safety net is definitely in bad shape. St. Clare’s CEO Robert Perry said the safety net for the poor has been eroding steadily for years across the nation but has eroded more quickly in Schenectady County.
“What has gotten worse is the impact of the Berger report,” Perry said. Since the report’s release last year, a cloud of uncertainty has hung over St. Clare’s future, he said. People with adequate insurance coverage are going elsewhere for treatment, leaving St. Clare’s to care for a growing number of people with little or no insurance.
“We’ve reached the tipping point where our profitable services do not support our charitable services,” Perry said.
He said more than half of the 38,000 people who visited St. Clare’s emergency room, the third busiest in the Capital Region, and half of the 30,000 who visited its medical and dental health centers last year either could not afford to pay for their care or had Medicaid insurance, which does not cover the full cost of the visit.
“Care is becoming segregated in the community,” Perry said. “We don’t have a war chest or a reserve to make up for tough times … and the state won’t give us any money to care for the poor.”
Perry said the solution is to combine “these organizations so that efficiencies will occur and redundancies in medical care will be eliminated so that we have a shot to take care of the poor.”
Ellis CEO James Connolly said pieces of the safety net will face collapse unless they’re dealt with. “We need to get more eligible people enrolled in insurance programs and we need to continue to commit resources.” He said the community needs to get involved in the solution.
Karpowicz said Hometown’s financial stability is eroding because it is seeing a dramatic increase in people with little or no insurance. Hometown saw 7,150 family practice and pediatric patients in 2007, up from 4,500 in 2006, he said.
More disturbing, Karpowicz said, is that the number of uninsured young children more than tripled to 1,857 in 2007 from 526 in 2006.
“These are patients who are supposed to be insured through the state or other means,” Karpowicz said. “I attribute the increase to barriers to getting health insurance,” particularly through the Schenectady County Department of Social Services, which handles local enrollments for Child Health Plus and Family Health Plus. The programs use a means test for enrollment.
“Patients tell me they are put on waiting lists, they apply and have to reapply. There seems to be more barriers than were previously,” Karpowicz said.
Schenectady County DSS Commissioner Dennis Packard said his agency’s staff is working overtime to process applications for people seeking medical insurance. Since his arrival more than five years ago, Packard said he has worked to reduce the time it takes to process an application from 100 days to between 55 and 60 days. Some people receive certification the same day they apply, he added.
However, Packard said, what some people perceive as barriers are in fact rigorous requirements to lessen fraud. A lot of applications that are pending are at the request of applicants. “We ask them for more information, and they have to come back,” he said. Some are applying for other social services, which are further time-consuming and require additional detailed information.
The county has 22,000 people enrolled in Medicaid, an increase of 3,000 since 2001, Packard said. DSS processes about 700 applicants per month.
Packard did not know how many eligible people in the county remain uninsured. But he said the state is doing more outreach to people to get them enrolled and that the county is taking a more proactive approach.
Further compounding problems, Packard said Hometown officials told him there are “probably parents in the county who are undocumented aliens who have citizen-born children and will not file an [insurance] application for fear of being reported to immigration services.”
Packard said Hometown is likely to benefit from a new rule the state is putting into effect this year. The rule allows people seeking medical care at a qualifying center to receive pre-eligibility for services, meaning they can obtain treatment first and fill out paperwork later. Gambino said Hometown already has staff in its waiting rooms with forms for people to complete for health insurance coverage.
Karpowicz said more needs to be done. “We need a multilevel approach to it. We have to change the way the state reimburses Medicaid to encourage private sector to start seeing Medicaid patients. The patients deserve the same quality care everyone does. They shouldn’t be forced into a different tier and have it crumple away,” he said.