Project Health Annual Report

Transcription

1 Project Health Annual Report 2013 marks the 10 th Anniversary of Project Health and over $38 million in health care has been donated to Project Health patients by hospitals, doctors, labs, and other service providers. Participating hospitals are now: Community East, South and North Community s Indiana Heart Hospital IU Health Methodist and IU Hospitals, IU North, West and Saxony Hospitals St. Vincent 86 th and Carmel Hospitals St. Vincent Women s Hospital St. Vincent Heart Center This past year IU Health purchased several physician practices and made those physicians available to Project Health patients which increased our volunteer physician base by several hundred and greatly enhanced the specialties available. For the first time we have plenty of orthopedists, gynecologists, gastroenterologists, nephrologists, psychologists and psychiatrists. Our doctors and hospitals HAVE SAVED LIVES and restored the health of so many others who were able to return to work! There have been 40,553 patient appointments with 32,179 procedures as a result. These include: 14 Open Hearts 5 corneal transplants 3 brain surgeries 141 cataract removals 94 gallbladder removals 57 shoulder repairs 40 hand surgeries 57 shoulder repairs 94 lasers for diabetic retinopathy 3 hip replacements 2 knee replacements 88 cancer surgeries followed by chemo & radiation Summary of Demographic Statistics In past years about 77% of patients upon first intake reported using the emergency rooms. This year that slipped to only 53% of patients using the emergency rooms and 47% report never going to the ED s because they said they didn t have the money to pay. The decline in emergency room use remains at less than 1% with four patients who used the ED s frivolously. Project Health terminated one of them for repeated offenses and she continued to go to the Community North and East ER s even after we told the hospital that she was no longer our patient and they should bill her. Only one patient went to Methodist and no patients went to St. Vincent Hospital. Savings to each hospital was between $828,668 and $840,401. The ethnicity of Project Health patients remains much the same with 38% Caucasian, 18% African American and 44% Hispanic. For the first time we have more normal weight patients (29%) than in years past (<1%). Still overweight (33%) or obese (38%) patients dominate. We did have one patient close to 500 pounds, and sadly he died. The majority of patients are between the ages of 40 and 60. Most patients are employed full time (54%), or part time (14%). Of the 32% who were unemployed most were without a job for less than a year (72%). The reasons they gave for not having insurance were that their employers didn t offer insurance (30%), the premiums were too high (38%) or they were not working (32%). More and more patients did not have primary care homes when they joined Project Health (71%). Project Health finds them primary care either in one of the community clinics or with a handful of family physician volunteers. Even when they had a primary care doctor 95% report not seeing one in the past

2 year because they couldn t afford it. They had no problems with transportation, getting a timely appointment or getting off work. Money was THE reason they didn t seek care. Disease States can be seen in the bar chart below. Diseases Cancer 5% Heart Disease Asthma 9% 10% Depression 19% Diabetes 23% Hypertension 26% Referrals In referrals came from community clinics (91%), volunteer physicians (8%) and less than 1% from ER doctors or case managers. 470 Referrals 212 joined 130 unable to contact 36 under 200% and therefore eligible for Wishard Advantage 39 never returned paperwork 14 had insurance 39 rejected for other reasons Referral patients are considered unable to contact after case managers have attempted 5 phone calls at various times, leaving messages when possible, AND sending a letter which is usually returned as undeliverable. The referring doctor or community clinic is also notified. This used to happen almost all the time when referrals came from the emergency departments because many people lied about their contact information so they couldn t be billed. We almost never get referrals from ED s anymore. We are talking with Methodist about stepping up efforts to have those patients referred to us so that we can educate them, and for those who have chronic medical conditions, make sure they get the care they need so they don t keep returning to the ED s. In previous years, there were a lot of patients with gallbladder problems who were told to see a surgeon, however, without money to pay a surgeon they didn t go. They just kept on going back to the ED. Once we got them appointments with a surgeon, their gallbladders were removed and no more ED visits. Finances Total revenue for 2013, including physician donations and membership fees was $273,411. Expenses were $262,000 leaving $50,807 in carry over for Return on investment in 2013 was 14 to 1. Looking Ahead to 2014 In the fiscal year, expenses are estimated to be $214,741. IU Health and St. Vincent Health have renewed their pledges and this is now the final year for the Richard M. Fairbanks Foundation

3 support. This brings our revenue to $163,657, leaving us $51,084 short. The Marion County Health Department has pledged $25,000, but we are not sure this will happen. We are hopeful that the combination of membership fees and physician donations will make up the difference. Membership fees will take a big hit as patients are transitioned into the healthcare exchanges. Project Health is not eligible for State or Federal grants because it is not a clinic with walls where patients come to see doctors in our offices. The Affordable Care Act As of this writing we still do not know how the Affordable Care Act (ACA) is going to affect Hoosiers, especially since the mandate on employers to offer health insurance to all full time employees (anyone working 30+ hours) has been set back to This alone means that 145,000 Marion County residents will still be without health insurance in Many questions have yet to be answered. Does this mean that any other provisions, such as disproportionate share funding will continue until 2015? How many people were going to gamble that they wouldn t get sick (or hit by a truck) and not buy health insurance, as they do now? How many people will be able to afford purchasing health insurance on their own? The costs are still pretty high, especially if one is not going to get state or federal tax subsidies to help pay those premiums this year. Indiana was going to roll back the Healthy Indiana Plan (HIP) to serve only those people with children, asking everyone else already on HIP who is not a caregiver to find something else. HIP is currently not taking new applications and hasn t for some time now because it is funded by tobacco taxes, and when the money runs out HIP is in pause mode. This action will leave 10 s of thousands out in the cold. The Indiana Comprehensive Health Insurance Program for high risk patients is also slated to be dissolved and 8,000 of those patients will be told to find other health insurance. These are the most vulnerable patients. It was, and still is, Project Health s intention to help our patients who do not qualify for State or Federal programs transition into healthcare exchanges, particularly our undocumented patients who comprise 44% of Project Health patients. In Summary It would be disaster if Project Health had to close before we could get everybody situated with health care insurance. It is our intent to approach patients before their renewal dates and inform them about the changes coming, explain the benefits of the Affordable Care Act (Obamacare), the importance of becoming insured and give them the resources to shop around for companies and policies that will meet their needs. Project Health needs your help to finish the job we started 10 years ago. Please call Carrie Jackson Logsdon at or send an to carrie@imsonline.org if you have any questions or concerns.

4 Doctor/Hospital Contributions 2013 June PROVIDER DONATIONS SUBTOTAL Community In-patient $3,314,148 Community ER $605,337 Community Surgery Center ER $3,104 Community Out-patient $6,456,616 Indiana Heart Hospital $1,274,717 Community Home Health $40,331 $11,694,253 Methodist In-Out Patient & ER $10,800,433 IU Hospital In-Out Patient $1,200,484 IU-North $574,940 IU South $21,040 IU West $40,826 IU Saxony $61,963 IU Labs $123,972 CICC $493,201 IU Residents $158,941 IU Health Physicians $252,630 $13,728,430 St Vincent In-patient $1,910,489 St. Vincent ER $317,858 St. Vincent Out-Patient $2,723,377 St. Vincent Surgery Center $1,577 Women's Hospital $7,992 St. Vincent Heart Center $21,712 St. Vincent Stress Center $27,920 St. Vincent Home Care $24,196 $5,035,121 Rehabilitation Hosp. $35,554 $35,554 Total Hospitals $30,493,358 Volunteer Physicians $7,859,114 TOTAL DONATED HEALTH CARE $38,352,472 isalus EMR Software $65,000 TOTAL IN-KIND DONATIONS $38,417,472 40,553 total encounters June

5 Project Health Statistics as of June 2013 Hospital-Doctor Contrib Hospitals $1,930,921 $3,670,604 $6,381,418 $8,917,708 $10,460,172 $12,501,640 $16,426,128 $18,453,121 $30,493,358 Doctors $1,003,987 $1,345,799 $2,103,295 $2,467,198 $3,884,958 $3,967,210 $3,967,210 $4,725,586 $7,859,114 Total (cumulative) $2,934,908 $5,016,403 $8,484,713 $11,386,914 $14,345,130 $16,470,860 $20,393,338 $23,180,719 $38,354,485 Note: Jump in services from 2012 to 2013 is due to recalculation from I.U. Health Annual Increase in Services Physician & Facility Fees $2,109,010 $2,081,496 $3,468,310 $2,902,201 $2,958,216 $2,125,730 $3,922,478 $2,787,381 $15,173,766 Doctor-Patient Growth Volunteer Doctors (Cumulative Patients (cumulative) Decline in ER Use ER Use 2% <1% <1% <1% <1% <1% 0% 0% 0% Frivolous ER Cost Savings Projected Cost $1,160,748 Actual Costs Savings Actual Costs Savings Actual Costs Savings Savings Savings Savings Methodist $4,353 $774,088 $ 25, $ 833, $16,362 $922,129 $986,949 $1,159,391 $840,401 Community $85,506 $692,935 $ 95, $ 762, $19,847 $918,644 $980,450 $1,101,321 $828,668 St. Vincent $55,244 $723,197 $ 42, $ 815, $36,539 $901,952 $996,822 $1,100,722 $840,661 Average ER visit $ Projected Costs 2013 $840,661-53% used ER 47% did not Ethnicity Caucasian 36% 37% 38% 37% 37% 37% 36% 38% 38% African American 27% 23% 23% 21% 21% 21% 19% 19% 18% Hispanic 36% 39% 38% 41% 42% 42% 44% 43% 44% Gender Female 60% 60% 67% 60% 59% 58% 58% 66% 58% Male 39% 40% 33% 40% 41% 42% 42% 35% 42% Education Elementary 22% 25% 24% 25% 25% 25% 21% 24% 23% Some HS 26% 24% 23% 24% 24% 24% 20% 22% 22% HS Grad 31% 28% 29% 30% 29% 29% 26% 29% 30% Some College 15% 15% 15% 15% 15% 15% 14% 15% 15% College Degree 6% 6% 6% 6% 6% 7% 6% 8% 10% Body Mass Idx Under 25 NA 20% 16% 20% 1% 7% <1% <1% 29% % 41% 54% 44% 33% 34% 72% 45% 33% % 29% 39% 52% 51% 21% 52% 38% % 14% 6% 3% Smoking History

6 Project Health Statistics as of June 2013 Smoke Yes 34% 39% 33% 28% 26% 27% 29% 28.00% 27.50% Smoke No 66% 60% 66% 72% 73% 73% 71% 71.00% 72.50% Employed Full Time 40% 57% 48% 54% 32% 51% 51% 52% 54% Part Time 10% 16% 19% 14% 14% 14% 14% No 51% 42% 41% 30% 49% 35% 35% 34% 32% Unemployed years 36% 77% 76% 3% 11% 2% 32% 2% 2% 1-3 years 23% 9% 9% 76% 7% 34% 38% 26% 26% Less than 1 year 13% 14% 15% 21% 81% 64% 30% 72% 72% Poverty Level < 100% 52% 49% 47% 44% 44% all over 200% all over 200% NA % 24% 28% 30% 30% 29% % 13% 11% 12% 14% 14% % 11% 11% 10% 11% 12% Why No Insurance Not working 30% 34% 23% 30% 31% 23% 30% 28% 32% Can't Afford 30% 34% 54% 30% 38% 53% 40% 44% 38% Co. doesn't offer 37% 31% 22% 39% 30% 24% 30% 28% 30% Length of time uninsured years 36% 53% 50% 64% 65% 75% 65% 65% 64% 1-3 years 23% 26% 28% 28% 27% 19% 27% 27% 26% Less than a year 13% 17% 22% 7% 7% 6% 8% 8% 10% Primary care at intake Yes 28% 61% 59% 43% 37% 36% 35% 34% 29% No 72% 38% 40% 56% 62% 64% 65% 66% 71% Transportation Own car 50% 74% 68% 66% 56% 67% 68% 68% 68% Relative/friend drives 22% 25% 29% 29% 38% 29% 29% 28% 28% Bus 4% 0% 3% 3% 4% 3% 3% 3% 3% Taxi 4% 1% 0% <1% 1% 1% 0 <1%` 1% Language Spoken English 76% 63% 63% 61% 60% 64% 60% 60% 60% Spanish 22% 36% 35% 38% 39% 36% 40% 40% 40% Other 3% 1% <1% <1% <1% <1 <1% <1% Who Interprets for you

7 Project Health Statistics as of June 2013 Family 3% 6% 1% 8% 7% 7% 7% 6% 6% Friend 5% 4% 1% 4% 4% 4% 4% 4% 3% Need interpreter 20% 89% 97% 87% 87% 89% 89% 90% 91% How often Sick Pre-PH Once 35% 37% 37% 33% 33% 33% 34% 32% 29% Twice 35% 37% 37% 36% 37% 37% 37% 35% 31% 3 times 15% 13% 14% 12% 12% 13% 13% 14% 13% 4+ times 12% 10% 10% 6% 17% 17% 17% 18% 27% Why didn't see doctor? No money 61% 95% 99% 93% 95% 93% 99% 95% 95% No ride 1% 1% 1% 2% 1% 1% 1% 1% 1% No timely appt. 1% 1% 0% 2% 3% 3% 2% 2% 2% No time off work 0% 0% 0% <1% <1% 2% 3% 2% 2% Disease States Asthma 13% 12% 13% 12% 9% 10% 9% 12% 10% Cancer 3% 3% 3% 3% 3% 3% 4% 5% 5% Diabetes 28% 41% 40% 32% 29% 33% 23% 26% 23% Depression 41% 26% 19% 21% 20% 17% 17% 21% 19% Heart Disease 6% 5% 5% 7% 6% 6% 6% 9% 9% Hypertension 17% 16% 18% 23% 21% 19% 20% 27% 26% Prescription Access Doctor samples 18% 13% 20% 23% 25% 26% 26% 21% 21% Self-pay 50% 65% 83% 73% 74% 53% 74% 62% 62% Pharm Assist Prgm 12% 7% 11% 8% 8% 7% 7% 5% 5% Family-friend pays 6% 5% 6% 6% 6% 6% 6% 5% 5% Don't fill 14% 10% 8% 7% 7% 7% 7% 5% 5% Referral Sources Community Clinic 80% 86% 86% 88% 89% 66% 90% 91% 91% Volunteer Physician 19% 11% 11% 10% 9% 33% 9% 8% 8% ER doctor 1% 1% 1% 1% 1% <1% <1% <1% <1% ER social worker 0% 1% 1% <1% <1% <1% <1% <1% <1% Age Ranges yrs yrs yrs yrs yrs % 22% 27% 26% 8% % 23% 27% 23% 8% % 23% 27% 23% 8% % 11% 34% 36% 4%