There's a Hole in the Safety Net

Yesterday, I convened a meeting at the health system of a variety of professionals to talk about the vulnerable patient and how to support the needs of such patients without WMHS going broke in the process.  Previously, there were a multitude of agencies to assist; today, not so much.  The funding has been cut and many of the agencies that could assist previously are either gone or refocused in other areas where funding may exist.  The shelters are full, assisted living is too expensive and drug rehab funding has been severely cut.   Many of these patients have no one; no family, no friends or at least no one who cares; some are drug abusers; many have behavioral health issues.  As one physician in the meeting described these patients, "they are truly pathetic people who may not survive without that safety net." 

Unfortunately, hospitals no longer have the luxury of being that safety net; although legally, we may not have a choice.  Not only are we no longer paid for such patients, we are now penalized for caring for and keeping such patients in our hospitals.  Yet, we cannot discharge these patients until a safe discharge plan can be successfully executed.  Last month, there was an article in the NY Times about a hospital in NYC that had an illegal immigrant from China who was a patient for over 4 years, costing the hospital millions because no one would take the patient.  He was eventually placed in a rehab facility once the federal government certified him as a permanent citizen.   The hospital even offered to fly him back to China at their expense, but the Chinese government refused.  We deal with such patients all of the time.  Four years isn't the norm at WMHS, but it can be many months as for these vulnerable patients until we have worked through all of the legal requirements in getting such individuals placed. 

Hospitals are now being required to be responsible for the health of the population that they serve.  In order for that concept to be successful, there needs to be a faster way to get our vulnerable patients into the most appropriate care setting.  If that doesn't happen, hospitals will not be able to sustain the losses created by having patients who are in need of care, just not acute care.