Children's Healthcare of Atlanta knows the meaning of unreimbursed care. The top-ranked hospital system provides lots of it at both its campuses: Children's at Scottish Rite and Children's at Egleston, which is adjacent to Emory University. Early in 2006, Children's commitment to Atlanta's pediatric population expanded when it assumed responsibility for the management of services at the 82-bed Hughes Spalding Children's Hospital, a component of Grady Healthcare. Both Children's at Egleston and Hughes Spalding are staffed primarily by Emory pediatricians. That means when Children's has to absorb the costs for nursing, labs, and other components of hospitalization for thousands of indigent patients seen in those facilities, the Emory pediatricians who provide care to those patients also are likely going to lose money. And those losses are in addition to uncompensated care provided to other infants and children in the Emory Children's Center for outpatient care and in Emory Crawford Long Hospital's neonatal ICU.
  Tracy did her best to be a normal 8-year-old, despite frequent flare-ups of her Crohn's disease. The abdominal pain could be bad, but she preferred it to the other, more embarrassing symptoms: rectal bleeding and persistent diarrhea. There was never any problem getting Tracy to cooperate with the medication regimen that kept her intestinal inflammation under control.
     After she began a series of outpatient antibody infusions at the Emory Children's Center, the number and intensity of her flare-ups decreased, she gained weight, and she had started to feel, well, like a normal kid. But in the middle of her infusion cycle, her private insurance suddenly terminated her coverage. With help from the Emory Children's Center, her parents began seeking a new insurer who would take their daughter. Unwilling to disrupt Tracy's infusion schedule until coverage was in place, her doctors sweet-talked a pharmaceutical company into providing the drug she needed for free, and Emory waived all physician and other professional fees associated with her treatment.
    Before Renee and her parents traveled to Atlanta, the 5-year-old had never been away from her hometown in Tennessee. But her doctor there had insisted that she needed to be seen by the doctor who could diagnose definitively the strange disease causing large, coffee-colored patches and small, rubbery bumps on her skin.
     At Emory's genetics clinic, pediatric geneticist Paul Fernhoff put a name on the little girl's problems—a rare disorder called neurofibromatosis type 1—and designed a surveillance and treatment plan focused on preventing dermatologic and nervous system complications. The Tennessee primary care physician had warned his Emory colleague while making the referral that the little girl's family had no insurance. But Fernhoff had the unusual expertise the child badly needed, and Emory agreed that he could provide it with no hope of compensation for himself or his staff.
     Renee's disorder is one of numerous examples illustrating the specialized and unique diagnostic and treatment services to be found within Emory Healthcare.

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