Hospital provider organizations around the country that that serve a large uninsured or indigent population are challenged with sustaining a viable bottom line while serving the needs of the community. These organizations are faced with inadequate yet decreasing reimbursement from Medicaid and other state funded programs for services provided to this population. In many markets the low reimbursement has eliminated or decreased the access to primary care physicians pushing more of the responsibility to Emergency Departments as the primary care provider. The Emergency Department is the most expensive and not the most effective setting for the delivery of primary care. This trend adds to the problem reducing the efficiency and effectiveness of the health system.
Strategies & Tactics for Sustainability
Most hospital providers include serving the medical needs of the community as core to the organizational mission and vision. The successful organizations that serve a large indigent population go beyond a strategy based on the profit and loss of departments or services. They look at the health needs of the community and the exisitng landscape (i.e., reimbursement, regulatory, competition, access to care, physician) and devise a devise a organizational strategy to meet the prioritized needs of the community while maintaining sustainable financial viability.
Some healthA recent articles about the success of Montefiore Health System in the Bronx, NY highlights some of the tactics.
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http://www.nysun.com/article/67885
http://www.crainsnewyork.com/apps/pbcs.dll/frontpage
