Sick Figure Salary

Eyes darkened by a persistent strain of the flu that won't leave her slight body, my sister Traci Bishop sits in the center of a cramped living room in Springfield, Ga., weighing her limited options on how to finally feel better. She could again try over-the-counter remedies, though they've yet to relieve the aches that have endured for nearly three weeks. She could schedule an appointment with one of only a small handful of general physicians in town, though their schedules are often booked and, without insurance, costly.

By all definitions, Traci is medically indigent, a chronic condition with little chance for a cure in Georgia. There is no real figure on how many indigent patients there are in Georgia, though as the economy continues to slide, joblessness increases and public assistance falters, more of the state's patients are likely to find themselves without many choices for care. Approximately half of all Americans who file for bankruptcy in the United States do so because of medical bills they can't afford, despite the staggering statistic that three-quarters of those patients had health insurance when they fell ill. And of the 100 counties in the nation with the highest rates of bankruptcy, 45 are in Georgia.

Traci, 35, and her 62-year-old husband are both disabled. They live below the poverty level, only receiving a meager government check the first of each month. To supplement their income, they sell fruit out the back of a truck alongside the highway during the spring and summer months, clean fairgrounds for less than minimum wage during the fall, and often wait out the winters in a two-bedroom apartment shared with four other adults. Located about 200 miles south of Atlanta, Springfield is a poor town, like many in the state. Health care is limited to those who have insurance, and almost nonexistent to those who don't, unless they are able to travel to Savannah, the nearest city with nonprofit facilities like Memorial University Health Center and Candler Memorial Hospital.

Traci’s last option for health care is to go to the emergency room where she can receive assistance as a poverty-stricken patient. Most nonprofit hospitals participate to some degree in the Indigent Care Trust Fund (ICTF), an 18-year-old program that allows tax-exempt health care facilities to draw down funds from the state. The program aims to expand Medicaid eligibility and services, support rural health care facilities that serve the medically indigent and fund primary health care programs. But even with funding, many still offer limited indigent care, so much so that Memorial announced in December last year it would severely limit care for uninsured patients unless they had a medical emergency. As southeast Georgia's largest health care facility, that executive decision is detrimental.

The CEO of Memorial, who earns more than $1 million each year, made clear his intention to ostracize those without insurance. The same intentions are often present at similar facilities, though not as transparent. In 2005, Northside Hospital marked up prices approximately 300 percent. Some services, like anesthesiology, were raised 3,060 percent over cost. Most private insurance companies generally negotiate an average 60 percent discount from this marked-up cost. Only those who pay for their care out of pocket are stuck with the actual sticker price, which is approximately one in every ten patients.

There, a patient like my sister has little financial recourse. Many patients aren't told of the availability of assistance through ITCF, as notification of eligibility isn't required by law. Also not required by law is the initial disclosure of costs a patient could incur at a given hospital, and billing is often confusing, with excessive costs not clearly explained. And because care at those facilities is overpriced and complicated, an effective barrier is placed between indigent patients and hospitals. Patients are often left with little choice than a discount care clinic or, in Atlanta, Grady Memorial Hospital, the fledgling facility that has itself nearly buckled under the burden of tremendous health care debt. Northside Hospital provides approximately one-third less indigent and charity care than Grady Memorial Hospital. The net income of Northside Hospital eclipses that of Grady Memorial by more than $71 million. Grady continues to slip further into the red.

As its tremendous debt continues to swell, the delay for care continues to lengthen, with some patients literally waiting days before they are able to receive any sort of medical attention past emergency care. If the wait is expected to stretch past three days, patients are then sent to the Emory Healthcare, one of the more affluent nonprofit facilities in the state. Even so, Grady is expected to reimburse Emory for the care of a patient who is unable to pay. It is easily one of the more devastating financial deals Grady currently has, as well as the most offensive, considering that both are nonprofit hospitals operating within six miles of each other.

Even more offensive is the high salaries given to many executives at these nonprofit facilities. Two Emory Healthcare executives pulled in a combined $2 million in the system's 2005 fiscal year. That is the same year Archbold Medical Center CEO Ken Beverly banked an impressive $1 million. The median household income in Thomasville, Ga., where Archbold is located, is $31,500. Just 60 miles away in Albany, CEO Phoebe Putney was paid approximately $972,000 in an area considered the ninth poorest congressional district in the country.

In Atlanta, former Northside CEO Sidney Kirschner saw his salary rise from $912,746 in 2001 to $2 million in 2002 back down to a cool million in 2003 with no stated reason. His replacement, Robert "Bob" Quattrocchi, was paid $1.5 million in 2005, the most current tax records publicly available. Piedmont Hospital's Timothy Stack and Robert Maynard made a combined $2 million in 2005. Meanwhile, these facilities contributed less than 2.15 percent of their annual adjusted gross revenue—figures that can rise into the billions—on indigent care. Grady, on the other hand, offered a combined 15 percent indigent and charity care.

So what's the solution? This past legislative session, some lawmakers introduced measures that would have forced all nonprofits to offer a basic level of indigent care—five percent of their annual adjusted gross revenue. The measure was strongly fought by hospital lobbyists who argued the facilities couldn't afford to provide that level of indigent care. It was eventually tabled. A bill introduced a few sessions back would have capped off costs to uninsured patients at the average negotiated price a private insurer pays. That too was shot down.

Currently, there are no groups in the state that offer mediation services for patients and hospitals to resolve high bills that could've been relieved through state financial assistance. Patients are able to argue their bills, but without knowledge and assistance, they often do not stand a chance against the hospitals and the collection agencies they employ. Until legislative measures are passed to force a facility's hand into providing affordable and accessible care for Georgia's indigent and uninsured patients, education and persistence is the only hope, as well as the resolve that health care is not a luxury but a right deserved by all.