trauma, and high risk
don’t notice whether a person has health insurance. Catastrophic
illness has become the most common cause of bankruptcy. In the old
days, patients with good insurance helped make up the difference for
those with little or no insurance. But those days are gone. In the
present environment, the number of uninsured and underinsured Georgians
continues to climb, even among those who work one or more jobs. As
the cost (and curative power) of new treatments increase, the amount
that payers are willing to reimburse health care providers continues
In a time like this, what do
Emory’s doctors, hospitals, and clinics do?
What they have always done: provide
the best care possible to the patients who need it. That means in
2004, the last year for which complete figures are available, counting
patients from every county in Georgia, Emory Healthcare physicians
provided $51.7 million in charity care, a number that appears likely
to continue to rise (see table on left).
By the time the young, South Georgia woman arrived in Emory University
Hospital’s emergency room, her liver was failing because of
unexpected reactions to a prescription drug. The week before, she
had been perfectly healthy. Now, she would die unless a new liver
could be transplanted within 48 hours. Having listed her as Status
One—highest priority—on the liver registry, Emory Healthcare
clinicians focused on getting her ready if an appropriate donor match
could be found. There was no time to worry whether she had insurance.
They were going to save her life whether Emory got paid or not. They
did save her life, and only the business office ever knew if the institution
received any money for it.
Emory’s policy regarding patients
who will die without a liver, heart, or lung transplant is to operate
without regard to financial status. That’s a big gamble. The
average cost of liver transplantation is $150,000, although complex
cases can easily top $1 million. With one of the Southeast’s
largest liver transplant programs, Emory Healthcare provided $7.95
million in direct charitable care for liver, heart, lung, and other
transplant patients between September 2001 and April 2005.
The patient had been referred to Emory Healthcare because he needed
specialized surgery unavailable in many hospitals in the state and
because he had a medical history that would alarm any surgeon—or
hospital administrator. Sometimes inexplicably, the patient’s
blood failed to clot normally, and he experienced hemorrhage. Sure
enough, at Emory this patient’s surgery went perfectly, but
he continued to bleed. And bleed. And bleed. None of the usual medications
could make it stop. The surgeon called for the first dose, then the
second, then the third of factor VII, a synthetic blood-clotting agent.
The drug is used widely for people with hemophilia, but many insurers
refuse to cover its use for any other clotting problem. This man did
not have hemophilia. Knowing that two other patients had needed the
same medication within the past quarter, chalking up large unreimbursed
expenses for the hospital, the surgeon called the hospital administrator
with a heads-up. It wasn’t a question of permission, since both
knew this was the only way to keep the patient alive, whether the
insurance company agreed or not. It took more than 20 doses—at
$10,000 a shot—before the patient’s own body took over
the work of clotting and he was able to go home.
Caring for the elderly and chronically ill >>
Doing what's needed most <<