New Indigent Care System in Washington, D.C., Working To Reduce Number of Nonemergency Care Visits to ERs

Reducing the number of uninsured Washington, D.C., residents who seek nonemergency care in emergency rooms is "proving to be a tough challenge" for D.C. Healthcare Alliance, the private corporation that runs the city's indigent health care system, public radio station WAMU reports in its series on public health services in the District of Columbia (Jones, "WAMU News," WAMU, 4/18). Last April, the District transferred management of the city's indigent health system from the bankrupt Public Benefit Corp. to D.C. Healthcare Alliance and began to phase out inpatient and trauma services at the former safety-net facility D.C. General Hospital. Under the new indigent care system, D.C. Healthcare Alliance manages a network of more than 20 clinics that contract with private physicians, and Greater Southeast Community Hospital treats patients requiring hospitalization or trauma care. Residents may participate in the system if they have a permanent District address and annual incomes less than 200% of the poverty level, or $17,720 for an individual. As of December 2001, 17,000 individuals had enrolled in the system, short of an expected 25,000 (Kaiser Daily Health Policy Report, 4/3). According to the D.C. Hospital Association, visits to emergency rooms in the District are up about 20% compared with last year. Sister Carol Keehan, president and CEO of the northeast Washington, D.C.-based Providence Hospital, said that ER visits increased by more than 3,000 patients during the first seven months after D.C. General closed, while the number of emergency room visits resulting in hospital admissions, an "indication of severity of illness," stayed the same. She added, "Most people have just found a new medical home. Unfortunately, we still have a fair number of those people for whom that medical home is an emergency room."

Evaluating the Increase
D.C. Healthcare Alliance Chief Operating Officer James Christian said, "This is not a phenomenon that is here in Washington alone. It is all over the United States where emergency room visits are up. So I really think you need to step back first before you try to draw any conclusions to see if there is something happening with our health care system nationwide that is directing more and more individuals to the emergency room because they are unable to access care." However, according to the American Hospital Association, the District's "spike" in emergency room visits is "well above" the increase hospitals in urban areas have experienced ("WAMU News," WAMU, 4/18). An audio clip of the segment is available online. Note: You will need RealPlayer to listen to the clip.