Officials Work to Solve Health Care Puzzle for Poor in Jefferson County

When Cooper Green Mercy Hospital closed its doors in 2013, Jefferson County officials were reeling from health care costs that had spun out of control. At that time, the $50 million indigent care fund – generated by a percentage of sales tax revenue – was not enough to cover costs and officials were dipping into the county’s general fund to cover the shortage.

“We were losing money,” Jefferson County Manager Tony Petelos said recently. “We had too many employees and it was not financially feasible. It didn’t make sense.”

So the Jefferson County Commission made the unpopular decision to shutter the hospital’s in-patient and emergency care. Cooper Green was reborn as an urgent care and primary care clinic. The model allowed the county to pay for care at Cooper Green and at other hospitals under contract without going outside the indigent care fund.

The move has reduced costs over the past four years, but some commissioners recently expressed concern at the amount the county was paying UAB, which provides in-patient, emergency and specialty care to Cooper Green’s poor patients. The payments to UAB are projected to reach about $24 million this fiscal year – nearly half of the county’s indigent care fund.

Petelos said that, while those costs appear high, the county is not in danger of exceeding the money set aside for indigent care, and the commission will not have to rely on the general fund to cover health care costs. “We are being proactive to make sure that we never go into the general fund,” he said.

That does not mean it is as cost effective as it could be, Petelos said. He said it is costly operating the aging building designed to be a hospital, not an urgent care clinic. Petelos and Cooper Green Mercy CEO Roger McCollough have both been pushing an effort to replace Cooper Green Mercy, which was built in 1971 as a 300-bed hospital.

Honing in on Preventive Care

William Smith, controller of Cooper Green Mercy Health Services, recently said some cause for concern with the county’s health care spending was the number of poor patients who were showing up at emergency rooms with minor issues that could have been handled at Cooper Green. Cooper Green’s urgent care clinic is equipped to handle most situations such as the flu or minor injuries and will see patients on the same day without an appointment.

Cooper Green Mercy will have about 70,000 patient visits this year. Just 13,000 of those visits is to the urgent care part of the clinic.

Those emergency room visits to other hospitals cost the county more, he said. The county expects to spend about $1.4 million this year on emergency services, provided under contract at UAB and Baptist Health Systems.

But even more concerning, according to McCollough, is that so many of the county’s poor patients end up with more serious conditions that require even more costly in-patient care. The county has projected it will spend about $11.6 million this year on in-patient care at UAB, UAB West, St. Vincent’s Hospital and Baptist Health Systems. Additionally, it has budgeted to pay about $4.6 million to UAB’s Kirklin Clinic for indigent patients to see specialists.

Cooper Green Mercy Health Services offers an urgent care clinic along with 20 specialty clinics that serve patients with chronic conditions such as kidney disease, cancer and diabetes. McCollough said Cooper Green partners with UAB to offer a comprehensive team approach for patients with chronic illnesses.

“This is an expensive model of care,” he said. “We could not provide it to every poor patient in the county.”

There are also doctors on staff who serve as primary care physicians for the poor patients. The bulk of Cooper Green Mercy’s patients, about 16,000 this year, seek primary care services. About 28,500 visits to Cooper Green Mercy will be to the primary care staff.

This is where McCollough said the best work can be done, helping patients stay well and preventing long-term issues.

Wait Times of up to Three Months

But this also is where patients can have their longest wait times to see a doctor.

McCollough said that, with current staff, new patients typically can see a doctor within 45 to 90 days. In some cases, he said, a new patient can see a doctor within two to three weeks.

Waits for some health care, particularly the specialty care clinics, can be somewhat longer.

McCollough said it’s his charge to figure out how to operate the best clinic he can with limited resources.

Health care professionals want to see patients getting regular care long before they would have to go to the emergency room for something like kidney failure, he said.

“We are trying to understand how do we change those behaviors,” McCollough said.

New purpose, new building

While McCollough works to stretch the dollars allotted for health care for the county’s poor, Petelos is hoping to steer officials toward building a new Cooper Green Mercy.

Last year, talks began about a new $55 million facility that would better serve the indigent population at Cooper Green. Petelos points to a larger cost savings by downsizing from the old hospital into a new clinic. Now Cooper Green Mercy is 300,000 square feet, and officials believe they need just half of that space.

Petelos said utilities alone cost about $1.3 million annually. He anticipates just $250,000 would be needed in a smaller, energy-efficient building. The county, he said, would also save money on maintenance costs that run higher because of the age of the building.

Petelos said officials are looking at options to keep Cooper Green on the same site or nearby. Whether it moves or stays in the same post, he said, the health care it provides will be available for the poor.

“Cooper Green will always be there,” he said.