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Cook County to tighten up medical referrals

Sunday, April 15, 2007
Chicago Tribune
by Judith Graham

Thousands of poor patients across Chicago may have a harder time getting specialized medical services at Cook County under a new policy that starts Monday.

Before, private community clinics could refer needy patients with conditions such as cancer or diabetes to Stroger Hospital's specialty clinics via a sophisticated computer system. Apparently, that system is shutting down.

Now, patients from private clinics will be required to go to a single county walk-in clinic near Stroger to get referrals, a move that critics say will aggravate already long waits for care.

The computerized system had streamlined the referral process, relying on medical information from private physicians to approve appointments and rank them in order of urgency. Dozens of private clinics and more than 5,000 patients participated every year.

Two weeks ago, Dr. Robert Simon, interim chief of Cook County's Bureau of Health Services, sent a letter to private clinic operators announcing he was suspending use of the system due to "draconian budget cuts." He said he was creating a task force to examine its future.

That doesn't make sense, complained Dr. Lee Francis, vice president of medical services at Erie Family Health Center on the West Side.

In a letter to Simon, Francis warned that the new arrangement will force patients to arrange consultations with county doctors who have no knowledge of patients' medical histories and who will need to re-order tests, adding to costs.

The health bureau "will incur the expense of hundreds if not thousands of additional ambulatory [visits]," Francis said. The walk-in clinic has been overwhelmed already, after its hours were cut by almost one-third earlier this year, observers noted.

"It's a total waste to ask people to come in and wait in these lines to see a doctor they don't know to recommend what care they should get next," said Dr. Art Jones, chief executive of Lawndale Christian Health Center.

"This is just a way to cut access to the specialty clinics," Jones said. He predicted patients will stay home, wait until their conditions worsen then go to Stroger's emergency room.

A Cook County spokesman did not return calls seeking comment last week.

Experts said they were puzzled by the health bureau's move in light of the recent decision to close more than a dozen county-run medical clinics. Seven of those clinics stopped operating a week ago, and thousands of patients will need to be seen in other settings.

Private clinics can provide basic care to those county patients; in return, they want the ability to refer the patients to county facilities for specialty services, such as MRI scans or orthopedic exams, leaders said. This kind of cooperative arrangement has been in place for years, but clinic leaders worry that it may be jeopardized by upheaval at the health bureau.

"We have worked with the county as partners, and we want to be their partners going forward," said Joan Sheforgen, chief executive officer of PrimeCare Community Health. "But this decision was made without us."



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