State Medicaid office abandons case against University Hospital on indigent care

By Kristin Jones
Rocky Mountain PBS I-News

The University of Colorado Hospital is the largest and highest-ranked hospital in the state, an academic institution that is nationally renowned for its cancer and other specialty care.

The complex towers over an area of acute poverty. The poverty rate in the neighborhood of Montview Park, which includes the Anschutz Medical Campus, is around 40 percent. That’s roughly in line with the poverty rate in the Mississippi Delta.

Desiree Martinez talks about living at the King's Inn motel in Aurora, Colo., on March 26, 2015 near University Hospital. (Mary MacCarthy/Rocky Mountain PBS I-News)

Desiree Martinez talks about living at the King’s Inn motel in Aurora, Colo., on March 26, 2015 near University Hospital. (Mary MacCarthy/Rocky Mountain PBS I-News)

A persistent complaint has dogged the hospital in recent years, recorded in state warnings and public meetings. The thrust of it is that low-income patients have trouble getting in the door to see specialists or to get inpatient care.

The hospital strenuously refutes the assertion, noting that more than half of its patients have public insurance or none at all. Furthermore, University cites numbers to show that it was the second-largest provider of uncompensated care in the state in 2013, the most recent year for which numbers are available, behind only Denver Health.

In December 2013, the state regulatory office charged with oversight had a chance to bring answers to questions that have bred lingering resentment.

Susan Birch, who heads the state department that administers Medicaid, sent a strongly worded letter to the hospital, writing that her office had received complaints that “border on patient abandonment.”

Juan Falcon (Photo by Mary MacCarthy;Rocky Mountain PBS I-News)

Juan Falcon (Photo by Mary MacCarthy;Rocky Mountain PBS I-News)

She pledged to conduct an in-depth analysis of hospital records, using Medicaid claims data. If the analysis showed “a conscious policy” to deny access to Medicaid or indigent patients, the department would alert federal Medicaid and Department of Human Services officials.

But the analysis was never done.

Dawn Fetzko is a nurse practitioner who runs a small safety-net clinic in Aurora, south of the hospital. One of her patients is Juan Falcon, a 49-year-old Medicaid client who came to her in July.

He had an enlarged prostate that had brought him earlier to the emergency room of Aurora Medical Center, and he was concerned that it might be cancer.

After a blood test showed worrying signs, Fetzko referred her patient to University Hospital in September last year for a biopsy. But she couldn’t get him an appointment.

“After the Christmas holiday, no one had ever gotten back to me,” says Fetzko. “I made another phone call back to the urology department and they said, by the way, we’re not going to accept him as a client.”

Fetzko said many of her other patients have also had trouble getting into University Hospital. She’s been sending her patients elsewhere – to Aurora Medical Center, or to other hospitals as far away as Parker and Boulder.

Last fall, she helped organize a meeting between primary care providers and hospital administrators to air grievances. But she said she doesn’t believe things have improved.

Over the years, the state Medicaid office has received numerous complaints that echo Fetzko’s.

“Our perception at the Department is that University Hospital is more focused on financials and the bottom line than serving Colorado’s most vulnerable patients,” Birch wrote in her December 2013 letter to Lilly Marks, the former chair of the hospital’s board of directors.

Birch spelled out several specific concerns, citing reports indicating that, among other things:

– The hospital was limiting access to Medicaid and indigent patients. One patient, for instance, was given chemotherapy, but was told to go to another hospital for follow-up.

– The hospital seemed to accept just enough indigent patients to qualify for a significant break on fees due from the hospital to the state.

– The hospital was actively seeking to send Medicaid and indigent patients to other hospitals for emergency care.

Marks refuted the allegations at length in a March 2014 letter to Birch.

Dr. Fernando Kim, left, a urologist at Denver Health Medical Center meets with Juan Falcon, 49, of Aurora, on March 11, 2015 in Denver before a biopsy was taken to determine if Falcon had prostate cancer. Falcon went to Denver Health after the clinic that originally treated him could not set a follow-up appointment with University Hospital in Aurora. (Mary MacCarthy/Rocky Mountain PBS I-News)

Dr. Fernando Kim, left, a urologist at Denver Health Medical Center meets with Juan Falcon, 49, of Aurora, on March 11, 2015 in Denver before a biopsy was taken to determine if Falcon had prostate cancer. Falcon went to Denver Health after the clinic that originally treated him could not set a follow-up appointment with University Hospital in Aurora. (Mary MacCarthy/Rocky Mountain PBS I-News)

University Hospital “would soon be financially incapacitated” if it provided access to every indigent, uninsured and Medicaid patient seeking care, Marks said. Its mission by state statute is to be a state-of-the-art teaching and research university.

“Like all hospitals, we have to ‘manage’ access to services for (Colorado Indigent Care Program), self-pay and Medicaid patients in order to provide some reasonable balance to our overall payer-mix,” Marks said in the letter.

The hospital flatly denied diverting Medicaid and indigent patients from its emergency department – an act that would violate federal law.

At the same time, Marks said the hospital has a tradition of providing care to medically underserved patients.

Dr. Christina Finlayson is a surgical oncologist at University Hospital. The hospital put her forward as the best spokesperson on the issue. She called Birch’s letter “very hurtful” to her colleagues.

“We don’t see ourselves that way at all,” said Finlayson.

University Hospital draws its doctors from the faculty of the University of Colorado School of Medicine. Many of them could be earning higher salaries elsewhere, Finlayson said.

“You come here for your ability to teach, your ability to do research, your ability to improve care for everyone across the city and the state,” she said. “To have those accusations made is pretty hurtful because it really strikes at the core of what we consider our mission to be.”

A half mile from the hospital on a gleaming late March day, a group of nursing students from the Anschutz campus was knocking on doors at the King’s Inn motel. They were volunteering for a local group called Colfax Community Network, which helps connect homeless people with food and other help.

The recession – and Denver’s gentrification – have squeezed people without other shelter into motels like this one along Colfax.

Desiree Martinez opened the door. She has been living here since September with her 7-year-old son. She’s been to the University Hospital emergency room a few times – most recently when she was bitten by a brown recluse spider as she was sleeping on Christmas Eve, she said.

“They gave me antibiotics and told me there was nothing I could do, and they sent me home,” says Martinez.

The neighborhood around the hospital has sunk further into poverty over the past decade, as Anschutz Medical Campus has erected its world-class facilities in the footprint of the old Fitzsimons Army base. University Hospital opened its doors there in 2007. The poverty rate in Montview Park jumped 50 percent from 2000 to 2010.

Megan Vizina, who heads the Colfax Community Network, says there’s a negative perception of the hospital among the people she works with.

“A lot of folks here see it as the ivory tower,” said Vizina. “There’s a lot of fear and a sense that they’re not really connected to this community, despite being part of it.”

The Affordable Care Act has meant that many more people now have insurance. Medicaid rolls especially have grown. For hospitals, this means less money spent on charity care, according to the Colorado Hospital Association, and more Medicaid patients.

University Hospital spokesman Dan Weaver said the hospital hasn’t yet calculated how much charity care it provided in 2014. But he said that for all hospitals in the University of Colorado Health system – which also include Memorial Hospital in Colorado Springs and Poudre Valley Hospital in Fort Collins – Medicaid charges rose 69 percent to $1.8 billion, while indigent care sank 80 percent to $89 million. (Charity care and indigent care overlap, but they aren’t the same; charity care is totally uncompensated, while some indigent care is paid for by state programs.)

Falcon didn’t account for any of those charges. He got his biopsy earlier this month by looking outside Aurora. Early in March, he showed up with his teenage daughter for an appointment with Dr. Fernando Kim at Denver Health.

Falcon was worried. His father died at 76 from prostate cancer; he only lived three months after he was told he had cancer.

“If they tell me, ‘If you would have come six months earlier, you would have had a better chance,’ I have to blame somebody for that,” says Falcon.

In an interview with I-News, Birch, the state Medicaid office head, backed away from her concerns about University Hospital. She says she’s now confident that University Hospital is acting aggressively to ensure access to Medicaid patients.

In a letter sent to the hospital after I-News began making inquiries, Birch thanked University of Colorado Health Systems Chief Executive Officer Liz Concordia for a series of “high-level, productive” meetings with her and her staff.

When asked if Birch’s original letter had been in error, Marc Williams, the spokesperson for state Medicaid department, said, “It wasn’t a mistake. We have an obligation to look into concerns when they arise of these kinds of things. We are stewards of taxpayer dollars.”

In the subsequent meetings with University Hospital officials, Williams said, the Medicaid office felt that further action wasn’t warranted.

Birch told I-News that her department has access to hospital records, and check them periodically. But pulling the data to prove – or disprove – any conscious policy of discrimination would be too costly, she said.

Health News Colorado brings you this report in partnership with Rocky Mountain PBS I-News. Learn more at Contact Kristin Jones at [email protected].

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