No longer good as gold

New indigent care policy ensnares longtime ‘Gold Card’ program

Keith Smith strides into a coffee shop, laptop and files bundled in his arms. He stands 6-foot-3 with a shaved head, trim goatee and a T-shirt reading, “Don’t Trust Corporate Media.” Demure, he is not. Smith sits down and unleashes his frustrations: A popular program that allowed uninsured patients, like him, to receive discounted care is tangled in bureaucracy.

“Poor people are getting whacked,” he says.

The program is aptly known as the “Gold Card” for the sunflower-hued card qualified patients receive. Smith’s had his since 2006 after finding himself unemployed and struggling with both his mental and physical health. He slides the laminated card out of his wallet.

“You can have it,” he jokes. “It ain’t worth much.”

The card can still be used at clinics run by University Physicians Associates, or UPA, and University of Louisville. It’s University Hospital that’s decided to stop honoring the program. And that’s where Gold Card holders are sent for routine blood work, rehabilitation, even surgery. It wasn’t until Smith opened a bill that he found out about the policy shift. Blood work that usually cost him $20 at most now totaled more than $2,000.

His reaction: “What the fuck?”

Back in early July, The Courier-Journal reported on University Hospital’s decision to stop providing some free or reduced-cost care to low-income, uninsured patients living outside Jefferson County. The hospital’s chief operating officer, Ken Marshall, cited a $20 million shortfall in its indigent care fund as the impetus.

The policy switch approved by the hospital’s board in May 2010 did not specifically mention erasing the acceptance of Gold Cards. That change grew out of the larger conversation surrounding indigent care, according to a hospital spokesperson. And within the last few months, enforcement kicked in.

University Physicians Associates created the Gold Card program in 1994. An estimated 1,000 patients use the card every month, according to UPA. Every six months, patients must reapply, with documentation proving their need.

Technically, the program is called the Sliding Fee Scale Discount Program. Patients are placed in one of six categories depending on their income. For instance, a class six patient (an individual with little to no income) is charged only $15 for doctor visits.

Gold Card patients frequenting The Wings Clinic, an HIV/AIDS treatment program run by U of L, have been among the first to notice the hospital’s new policy. Smith, who’s HIV positive, is one of them

In the past, when he went for quarterly blood work to keep his disease in check, the hospital accepted his Gold Card, no questions asked. It passed as proof that the patient was uninsured and low income. As a result, the hospital’s bill would then be partially covered by the Quality and Charity Care Trust — a pot of state and local funds dedicated to indigent care.

But now, University Hospital is performing its own screening of patients — double-checking, if you will, that patients are Jefferson County residents and fit the income guidelines for charity care.

A University Hospital spokesman says they don’t know how many Gold Card members are affected by the switch, as those individuals were lumped in with other indigent care cases.

Marshall admits the abolition of Gold Cards was not communicated well, saying conversations “should’ve” been happening as card members came in to register for services. The chief operating officer says the hospital is now stepping up its counseling services to explain why Gold Cards still work across the street at clinics that fall under the University of Louisville Health Care system, but not at the hospital, which falls under that same umbrella.

For Smith and a few of his friends, the policy polarity between the hospital and clinics is somewhat nonsensical.

“I always thought of Gold Cards as applying within the (whole) U of L system,” he says. “I don’t know what’s what.”

University Hospital and UPA are separate entities, but they share doctors and patient referrals. Both also claim the same mission: serve patients, no matter what.

For years University Hospital has served as both a teaching facility and the area’s leading provider of indigent care. Today, Marshall says the hospital remains committed to the uninsured and underinsured, but that they have to be careful with limited resources.

“U of L Hospital has traditionally had 20-25 percent uninsured (patients),” he says. “Which is by itself high for teaching hospitals.” It’s true that University Hospital’s indigent load is larger than others. Vanderbilt and University of Kentucky, for instance, report their indigent patient population at 7 and 12 percent, respectively.

But at University of Cincinnati, 42 percent of their patients are poor and uninsured, says Diana Lara, the hospital’s spokeswoman.

“Everybody knows here this hospital is the safety net,” she says, noting that last year their hospital absorbed a $60 million shortfall in funds for charity care.

Marshall describes the tweaking of indigent care policy as a “cultural shift.” He says the hospital must balance charity with reality if they want to offer top-notch care.

“We can’t take as many uninsured people. I doubt that there was anyone in this institution that wanted to do that,” he says, demonstrating with his hands a small pile of “resources” and a big pile of “need.”

“If you don’t manage that resource you’re not going to be able to take care of that need at all,” he says. “It’s not what anybody likes but that’s the fact.”

Meanwhile, local HIV/AIDS activists tell LEO they’re hearing from frustrated Gold Card holders and are concerned some may choose to skip routine lab work as word of high bills and confusion spreads.

As for Smith, he applied for the University Hospital’s charity care program weeks ago. He hasn’t heard back.

After a few livid phone calls, Smith says he was told his $2,148 bill could be reduced to $800, and that a visit to the Medicaid office may help him pay the rest.

“That’s still a chunk of change,” he says. “And then I have to stand in line and wait in some Medicaid office and sweet talk someone to take care of my bill? The process alone is going to turn people off. People are going to get sick.”