Return to Main Menu

Currents At the Feb. 29 communications meeting, Mark Lyles, M.D., assistant professor of medicine and assistant dean for clinical operations, gave an enlightening presentation concerning the uninsured and underinsured patient population. This increasing patient population and the reimbursement reductions resulting from the Balanced Budget Act have had a dramatic effect on the Medical Center's financial situation. Dr. Lyles pointed out that our state constitution does not require the state or counties to provide indigent care. Instead, the constitution simply provides for a more global role of the General Assembly to address health and welfare needs. Other teaching hospitals also are wrestling with this problem. The Medical College of Georgia (MCG) recently reported a dramatic increase in the number of patients traveling significant distances to MCG for care. In most cases, the care provided by MCG could have been provided by community-based hospitals. MCG has asked the state to monitor more carefully where indigent patients are treated and to give hospitals like MCG more money for treating a disproportionate number of indigent patients. The Medical Center will continue with internal cost control tactics for day-to-day management.  Additionally, the MUSC leadership will formulate a plan to achieve a broader based solution to the complex indigent care issues. W. Stuart Smith Vice President for Clinical Operations and Executive Director, MUSC Medical Center Caring for South Carolina's uninsured and underinsured patient populations Mark Lyles, M.D., presented information about underserved patient populations on national and local levels. In 1994, MUSC opened the four-story McClennan Banks Ambulatory Care Center to care for underserved patients. In fiscal year 1999, visits at McClennan Banks totaled 68,000. The center is funded by Medical University Hospital via University Medical Associates. The center also shares some services with Charleston Memorial Hospital. Many patients at McClennan Banks receive subsidies for medical care and prescriptions. As a result, MUSC offers a better “deal” on medical care than the federal government, our state government, other local indigent clinics and private insurers. The Balanced Budget Act of 1997 (BBA) and the resulting decrease in funding for teaching hospitals have presented some significant challenges for academic medical centers across the country. Many academic medical centers have been forced to reduce their work forces, and limit their clinical services and research activities. Of 3,851,000 South Carolinians, 31.5 percent are uninsured or underinsured, and 41.6 percent are uninsured, underinsured or on Medicaid. Of the 564,700 people in the Tri-County area, 17.9 percent are uninsured, while 43.1 percent are uninsured, underinsured or on Medicaid. MUSC's goal is to fulfill our mission of patient care, teaching and research while maintaining financial solvency.  Historically, MUSC has joined the rest of the South Carolina medical community in providing generous support for uninsured and underinsured patients. In past years, a significant portion of MUSC's budgetary surplus was designated to serving this group. The current health care crisis—triggered by the BBA—has dissolved the surplus that supported the care of this population. Currently, MUSC is planning how to address these issues.