The sudden drop in patient volume at Fairview's seven Minnesota hospitals has been significant enough that the health system is laying off up to 200 workers. It's clear that patients are holding off on certain types of procedures, says Mike Seitz, vice president of Fairview's patient financial services.
"I'd call them non-urgent procedures," says Seitz, "where you might have to have a total knee operation because your knee is sore or deteriorating. But maybe you decide, 'Well, I'll wait until next year. I'll live with the pain.'"
"We've heard numbers as high as 10 to 15 percent lower in terms of in-patient volumes from some of our members."
Fairview isn't alone. Other hospitals are reporting a similar plunge in their patient numbers.
Twin Cities hospitals are experiencing the biggest declines, according to Lawrence Massa, president of the Minnesota Hospital Association, a trade group representing most of the 150 hospitals in the state.
"We've heard numbers as high as 10 to 15 percent lower in terms of in-patient volumes from some of our members," says Massa.
Hospitals have heard a number of explanations from patients. Some people are leery about taking time off from work to recover during such uncertain economic times. Others have said they're putting off a procedure because they can't afford to pay for it - even with insurance coverage, Massa says.
"We've seen the economy get weaker and we've seen more and more employers going to higher deductible health plans and health savings accounts," says Massa. "Those two things taken together indicate that that's probably one of the causes of the downturn."
Take Mary Gallagher for example. She was laid off from her social work job in August. The 50-year-old St. Paul woman still has health insurance. But she says she can't afford to use it.
Gallagher has a sore knee that has been bothering her for about a year-and-a-half. Her doctor wants her to get an MRI that will cost around $1,200. Her insurance deductible is $2,500, so she would have to pay the entire cost of the MRI out of her own pocket. Even though knee pain keeps her awake some nights, she hasn't had the scan.
"I can still walk, so I haven't," Gallagher says.
She recently picked up some part-time work for a caterer. The job keeps her on her feet for several hours at a time which has made her knee hurt more lately. But Gallagher will probably continue to tough it out.
"I just feel like I'm kind of getting buried," says Gallagher. "I would really have to weigh it out because last week my car needed a fuel pump and that was $500. Well, you know, I don't have money."
Hospitals are worried that economic decisions like these will cause patients to get sicker and need more expensive care eventually, according to Mike Harristhal, vice president for public policy and strategy at Hennepin County Medical Center in Minneapolis.
"I think that there is the potential given what's happening in the economy for the overall health of the community to retard a bit," says Harristhal. "And eventually that could result in both additional hospitalizations and also a greater need for a safety net system such as ours."
HCMC is a public hospital. Unlike Fairview and most other hospitals, it's not allowed to turn away patients who can't afford to pay for their care. The hospital has noticed a slight jump in its in-patient numbers recently. That's not unusual in difficult economic times, Harristhal says.
"Folks are going to be looking for the emergency room as one option available to them and that's the reason that our emergency room continues to be very busy."
Harristhal does say it's also possible that a recent expansion at HCMC accounts for some of the increase in patient numbers.
But the hospital has seen a 10% jump in the number of patients on Minnesota government insurance programs in the first six months of this year. The number of patients with no insurance is up 50%.
Fairview is reporting that applications to its fund for needy patients has doubled in the last few months.
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