The Harris County Hospital District is treating a shrinking number of patients in its hospitals and clinics, possibly because of the rise of walk-in clinics at retail outlets and expanded government prescription drug coverage for seniors, district officials said Thursday.
The dropoff has district officials worried, particularly as paying patients who seek medical care elsewhere are replaced by uninsured charity patients who pay little or nothing.
So far this year, the district has seen 5.5 percent more charity patients than in 2006, putting it on track to spend an additional $47 million on charity care, Chief Financial Officer Ferdinand Gaenzel said.
The Hospital District serves as the health care safety net for the poor. Nearly a third of the county's 3.8 million residents lack health insurance, a scenario that would seem to make the slumping patient numbers all the more puzzling.
"We're losing patients. Are we doing anything to figure out why we are losing patients?" board member Elvin Franklin asked at Thursday's monthly meeting of the district's board of managers.
The board directed district administrators to report back with information on patient volume and market trends.
Patient drain
During and after the meeting, officials pointed to the increasing popularity of in-store clinics that have sprouted at Wal-Mart s, CVS stores and retail outlets across the city and nation as a possible source of patient drain.In-store clinics allow patients to get treated, without an appointment, by physician's assistants and nurse practitioners for minor ailments.
Patients who use the district's community health clinics do not receive same-day service, often waiting two weeks to be seen.
It may be time for the district to look at replicating the walk-in clinic model, said George Masi, the district's chief operating officer.
"That's the American way. Ask the customer what he wants," Masi said.
"We're not in the business of making money, but we could introduce convenience clinics in our community health clinics."
Another possible cause of the shrinking patient load, officials said, may be the changes in Medicare prescription drug coverage that took effect two years ago.
Before Medicare Part D began, senior citizens without prescription coverage could get medicines when they were treated at district facilities.
Now, senior citizens who can get medications at any drug store through Medicare Part D are choosing other health care providers over the district's doctors, said Dr. Fred Sutton, the district's chief medical officer.
Fewer Medicare patients
The district treats fewer Medicare patients these days. They represent 10 percent of its patient population this year, a 28 percent decline from 2006, Gaenzel said.Overall, admissions at the district's two general hospitals, Ben Taub and Lyndon B. Johnson, and Quentin Meese, a rehabilitation facility, have declined 8 percent this year. Births at Ben Taub and LBJ are down 11 percent, and visits to the district's community health clinics have declined 5 percent this year.
The district already is considering ways to retain patients.
Some expectant mothers receive prenatal care at district facilities but deliver at Texas Children's Hospital, Women's Hospital and other hospitals in Houston, Sutton said.
The district will begin taking these mothers on tours of LBJ and Ben Taub's maternity and operating rooms.
"Some people have a concept that the district looks a certain way," Sutton said.
"Once they come in, they see we don't have that kind of look."
District officials have welcomed one decline in patients: Visits to LBJ and Ben Taub emergency rooms are down 4 percent this year.
Two years ago, the district opened urgent care clinics in or near LBJ and Ben Taub's emergency rooms.
Those with non-emergency ailments who come to emergency rooms are advised that they could be treated in urgent care or at a community health clinic.
Treatment in the district's urgent care clinics have doubled since 2006, Gaenzel said.
