ISSUE:  INDIGENT CARE CHALLENGE – ECU BRODY SCHOOL OF MEDICINE

DESIRED OUTCOME:  East Carolina University (ECU) is requesting $3 million of recurring funding in FY 2010 and an additional $2 million of recurring funding in FY 2011 to reimburse the Brody School of Medicine (BSOM) for direct costs incurred for providing medical care to indigent patients in eastern North Carolina.  The university currently receives NO funding for such care.

OUR CHALLENGE:  The school’s tri-partite mission from the N.C. General Assembly includes access to health care for all people of eastern North Carolina, a ‘social contract’ that is the foundation of the school.

• Indigent patients of eastern North Carolina are increasingly dependent on the medical school’s clinics for their care.
• Indigent patients are those that have no health insurance or have no way to pay for medical care.
• Despite continuing progress in operations improvement, cost containment, and pursuit of new sources of clinical income, the medical school is unable to absorb the cost of caring for these patients without recurring state funding.
• With significant cuts in reimbursement from government payors (amounting to nearly $4.5 million in annual revenues), local and national physician shortages, and mounting capital needs, the medical school cannot remain fiscally viable and continue to provide “free care”.
• During times of economic recession, safety net services like the medical school see an ever-increasing proportion of indigent patients. Many of the indigent wait longer to seek medical care, therefore arriving with more severe illness that requires more resources. The safety net of patient care provided by the medical school for eastern N.C. is unable to keep pace with the demand.

FACING THE FACTS:  While BSOM has excelled at its mission for over 30 years, the current model is not sustainable given the marketplace today.  Providing a full range of health care services to indigent patients poses insurmountable financial challenges.

• Indigent patients have a higher proportion of chronic and complex medical conditions that consume medical resources at a higher rate than the population at large.
• Of all patients seen at BSOM:
       1 of every 7 patients has no insurance.
       1 of every 3 has no means of payment or is only covered by Medicaid.
• ECU’s percentage of uninsured patients is nearly double that of the average private physician practice.
• The majority of indigent patients fall below the federal poverty level of $17,600 (family of three).

THE BOTTOM LINE:  The net losses incurred by ECU’s BSOM in providing care for indigent patients throughout eastern North Carolina hinder the opportunities for the school to reinvest funds in education, patient care, research, and economic development in rural and underserved areas.  A modest annual investment now by the state to support this underprivileged population will produce an immediate return on investment and avoid a greater burden in the future for taxpayers. At a minimum, providing $3 million in funding in FY 2010 and an additional $2 million in FY 2011 for indigent care will enhance the school’s ability to continue to sustain service, grow, and develop additional vital medical services for North Carolina.  Without the requested appropriations for indigent care, erosion of the quality of the Brody School of Medicine may be inevitable.