The University of Chicago's Health Care Desertification Plan

Since we posted on the prospect of Hyde Park's Impending Health Care Desert in June 2008, the health care situation has evolved considerably. It is now safe to say that, as a result of the subprime blowout, consequent credit crisis, and related global recession, the recently announced budget cuts at the University of Chicago Medical Center will leave Hyde Park without easily accessible primary care for everyone.

In particular, the 47th Street, University-run clinic will be closed entirely in March or April, instead of being sold to a private, federally subsidized medical group as originally planned. The tax-exempt Medical Center is transforming itself into a science colony inconveniently located among an under-insured population, with access to its basic services increasingly restricted to the original colonists.

While the issue of Chicago's ER sending low-priority patients to surrounding clinics or hospitals has been in the news recently, ("University of Chicago ER Sends Kid Mauled by Pitt Bull Home," Chicago Tribune, February 13, 2009) other changes strike closer to the heart of preventive, family primary care for Hyde Park residents.

If you have a doctor at 47th Street, they will be moving to DCAM (Duchossois Center For Advanced Medicine).

If you want to get a doctor there, too bad. No new adult patients are being taken.

And from the word on the street I understand that it will be extremely difficult for newcomers to the neighborhood, even those with insurance that allows the University of Chicago and don't mind fighting their way into the heart of the massive Duchossois Center for Advanced Medecine, to get anything other than walk-in service from rotating residents.

Like the idea of a family doctor who tracks your case history over years and knows your kids? The kind of medicine that can spot problems before they become the kinds of "complex" issues that the University prefers to treat?

Consider living in a different neighborhood. Until you need a liver transplant, that is, or you have a child who needs special treatment at Comer.

I felt at the time of the first post, and even more so now, that a community like Hyde Park needs a family health clinic accessible within the neighborhood by everybody -- not just faculty and staff, but anyone who can pay their bills and takes the chance on locating a family in this community.

While the University demonstrated a commitment to getting a decent supermarket in the neighborhood to replace the moribund Co-Op, by closing the only conveniently located clinic in Hyde Park they are leaving dozens of families without local options for health care. This is a vastly more consequential decision that has received much less attention. While it is now much more enticing for people to shop locally for their groceries, it will soon be much more difficult for them to shop locally for a doctor.

Many families and individuals have already adjusted to this reality. In the comments to the original Hyde Park's Impending Health Care Desert post, it became clear that a large group of people had either resigned themselves to migrating north for primary care, have satisfied themselves with neighboring South Side, Federally Qualified Health Clinics (FQHC's), or somehow see physicians at DCAM for regular primary care.

It should be clear that the last option is not a reliable one in this neighborhood unless you are already in the system, and even then, it's not clear how many physicians will be retained.

A recent promotional brochure for the U of C had this to say about Hyde Park health care options:

U.S. News and World Report consistently selects Hyde Park's own University of Chicago Medical Center as one of the best hospitals in the United States...Also under the Medical Center umbrella are the Duchossois Center for Advanced Medicine, an outpatient facility; clinical training programs of the Pritzker School of Medicine; and several health care locations throughout the Chicago region.

The "clinical training programs of the Pritzker School of Medicine" are what you get as a walk-in from medical residents at DCAM, and there is no mention of a primary care health clinic in the neighborhood.

Ready to move your kids cross-country for that faculty job, knowing that the resident who treats them at DCAM will be gone in a few years and replaced by another?

The University of Chicago can do everything imaginable to encourage retail in Hyde Park, it can do a magnificent job coordinating the redevelopment of Harper Court, but if the families who chose to buy homes, pay property taxes, and volunteer at the local school can't see a doctor without having to travel many miles away from the coming $700 million medical center, then the University will undermine virtually everything else it accomplishes in terms of making Hyde Park a desirable place for people to settle and live.

[This post also appears at Hyde Park Progress]

Comments

[sciphy]

It has long been the mantra of Lawrence Furnstahl, Chief Financial and Strategy Officer and treasurer of the University of Chicago Medical Center, that patients from the local zip codes are much less preferred. This "zip code" data is very closely tracked. Recent zip code information has been used to suggest that because local patients see other health care providers as frequently as the University of Chicago Medical Center that this signifies that these local patients do not really want to come to University of Chicago. This has been used to justify the patient diversion activities ongoing in the emergency room. Good luck trying to get in as a patient.
The patient diversion program, also known as the Urban Health Initiative, has caught the attention of the American College of University of Physicians as noted in the Chicago Tribune.
http://www.chicagotribune.com/business/chi-biz-university-of-chicago-emergency-room-feb19,0,2937923.story
While this program was initiated by Michelle Obama. In her absence, it has morphed into something very distasteful.

[David Hoyt - Huffpost Blogger]

"Recent zip code information has been used to suggest that because local patients see other health care providers as frequently as the University of Chicago Medical Center that this signifies that these local patients do not really want to come to University of Chicago."

Considering primary care for a moment, and not the ER, I wonder if this zip code data was factored into the decision to close U of C's pediatric clinics. There are plenty of families in Hyde Park who go to the North Side for all or some component of their health care, including my own. But all of them would greatly prefer more locally convenient health care options. So you could read this data -- again, assuming it applies to primary care/pediatrics as well as to the Chicago ER -- as a sign of the problem, not an arrow to the solution.

I have sympathy for the situation that U of C Med Center finds itself in regarding the ER, and think it is reasonable to divert non-emergency cases out of an overburdened ER, but of course find abhorrent the prospect of cost accounting getting carried away, as seems to have happened with the kid mauled by a pit bull who was "at risk of infection" had surgery been performed. Huh?