Petoskey Hospital Dropped From U.P. Medicaid Program
Mackinac Straits Protests Impact on 600 Patients
By Karen Gould

Opposition over a decision that could force families using MIChild insurance and patients on Medicaid to travel to Sault Ste. Marie or Marquette for specialized medical treatment, including obstetrics, has some Mackinac Straits Hospital board members saying the decision is politically motivated and will add to the financial burden of county residents who can least afford it. They also say increased paperwork demands placed on local doctors and staff will affect access to medical care for approximately 600 people in Mackinac County, mostly the elderly and low-income young mothers and children.

For years, the St. Ignace hospital has referred patients requiring a specialist to Northern Michigan Hospital in Petoskey. Now, Upper Peninsula Health Plan (UPHP) of Marquette, which oversees Medicaid and MIChild coverage in the Upper Peninsula, says beginning March 1, it only will cover care at Northern Michigan Hospital if it is preauthorized, and patients now should be referred to War Memorial in Sault Ste. Marie or Marquette General in Marquette.

A meeting to discuss the matter was held at Mackinac Straits Hospital Wednesday, January 17, and attended by Dennis Smith, CEO of UPHP, Rod Nelson, CEO of Mackinac Straits Hospital, and hospital board members, staff, and physicians.

Board President Ron Mitchell called the decision "unfair" for giving a select group of patients no choice in where they receive specialized care.

He said people in St. Ignace prefer to go to Northern Michigan Hospital and have for years. Now, UPHP is telling those people, who can least afford it, they have to seek care where they do not prefer to, at Marquette General or War Memorial hospitals.

Board member Richard Smith of Epoufette agreed.

"I think when we're talking about the poor, the disabled, the old people, and making it tougher for them to get proper health care in the proper place, I just think it is terribly, terribly sad," Mr. Smith said.

Dennis Smith of UPHP said that the change would not be "tougher" for Mackinac County MIChild and Medicaid patients, because a full time person makes transportation arrangements and the organization has a network of volunteers to drive patients to appointments. The UPHP would be responsible for transportation costs, he added. He estimated the round trip costs associated with travel to Marquette to be $180.

Patients in St. Ignace will travel three hours (160 miles) to Marquette, but less than one hour to Petoskey.

Initially, the change in service was to begin January 1, although UPHP changed it to March 1, to give the St. Ignace hospital staff and patients more time to adjust to the change.

UPHP offers an Upper Peninsula health plan comprised of clinics, physicians, hospitals, and ancillary providers. The company contracts with insurance companies, managed care firms, and government agencies to offer managed health care in the 15 Upper Peninsula counties.

The Marquette insurance provider has more than 26,000 Medicaid and MIChild members in the Upper Peninsula, with 600 coming from Mackinac County. While Medicaid provides medical assistance to those with limited incomes, MIChild is a health insurance program for Michigan's uninsured children. The company says the volume of E.U.P. patients being sent to Petoskey did not warrant retaining the hospital in their plan. He said the Petoskey hospital did not object to the decision.

"Like I said, there wasn't a lot of volume, so it wasn't worth continuing," said Dennis Smith of UPHP.

In the meantime, Mackinac Straits Hospital CEO Rod Nelson will be given the opportunity to convince the UPHP board to get Northern Michigan Hospital reinstated into the network. He needs to get the support of at least four of the six board members. That meeting is scheduled for February 20.

UPHP board members include Chairman Jim Bogan of Portage Health Systems in Hancock, David Jahn of War Memorial Hospital in Sault Ste. Marie, Bill Nemacheck of Marquette General in Marquette, John Stindt of Iron County Community Hospital in Iron River, David Hartberg of Grandview Health Systems in Ironwood, and John Schon of Dickinson County Healthcare System in Iron Mountain.

Mackinac Straits Hospital board member Richard Smith thinks the reason local patients are being forced to seek specialized care at other Upper Peninsula hospitals is a backlash from Marquette General Hospital officials, who were upset when they learned that the St. Ignace hospital was working with the University of Michigan to provide oncology care in St. Ignace. Marquette General is a major stockholder of UPHP and has its own oncology service.

"We've been trying to branch this hospital out into some areas that will improve patient care, working with the University of Michigan and things like that," said Mr. Smith of Epoufette. "It was very, very clear that Marquette General was having a kitten about that. I just hope I'm wrong, but I have the sneaking feeling this is coming from Marquette General and it's coming with the idea that they're going to clamp down on Mackinac Straits Hospital, who may be straying from the pack."

At any rate, the University of Michigan radiation therapy plan is now dead, Mr. Nelson announced at a hospital board meeting Monday, January 22. U-M pulled out of the deal, probably, he said, because with Marquette General's objections, there was no apparent agreement on the need for such service in St. Ignace.

Marquette General Hospital, with an oncologist in Sault Ste. Marie, Mr. Nelson told the board, controls how many potential patients would utilize radiation service in St. Ignace.

Other entities that own equity in UPHP include War Memorial and the Sault Ste. Marie Tribe of Chippewa Indians, while Mackinac Straits Hospital is not a stockholder.

Northern Michigan was the only hospital cut from UPHP, said Dennis Smith.

At the meeting, local doctors and staff said that since January 1, they are able to send some Medicaid patients to Northern Michigan Hospital if they can get a preauthorization from UPHP. However, hospital staff said getting a pre-authorization takes hours and they were disgruntled with the additional burden now placed on them to get patients in to see specialists they had already been seeing for years.

Dr. Carl Hawkins at Mackinac Straits said he has Medicaid patients who have seen Northern Michigan specialists for years. He said he should not have to spend time on the phone trying to get approval for visits to doctors his patients have already been seeing. He said after spending 30 minutes or more on the phone, he finds the pre-authorizations sometimes are denied. Another glitch in the system hospital staff said they encountered was the difficulty to get pre-authorization for a Medicaid patient to see a specific doctor at Northern Michigan Hospital, a problem not faced before.

"It does not work," said Dr. Hawkins. "I couldn't resent this system more than I do."

Dennis Smith said the company would set up a work session to explain to Mackinac Straits Hospital staff how to request pre-authorization to send Medicaid patients to Northern Michigan Hospital. He said the company hopes to have the authorization process on line by the end of this year.

Mr. Nelson said that the stockholders of the health plan, which include War Memorial and Marquette General, want to increase their business and see the opportunity to boost patient numbers and their bottom line, at the inconvenience of Mackinac County residents.

"The dollar is the most important thing in some of these decisions made, and not the patient care," said hospital board member Walt North.

Mr. Nelson and staff commented on the lack of specialists and commitment from War Memorial and that getting specialists to come to St. Ignace has been difficult, with one Marquette doctor not willing to travel during four months in the winter.

These issues, he said, should have been discussed with Mackinac Straits Hospital administrators before the UPHP board voted on their decision to eliminate Northern Michigan Hospital from their plan.

"Part of the resentment is that individuals made decisions and did not consult with the provider [Mackinac Straits Hospital] who provide the care," he said. "And I thought that was an oversight on the [UPHP] board's part."

Dennis Smith said he recalls that the driving force for the board's decision was based on War Memorial CEO David Jahn's comments that the Sault Ste. Marie hospital could fill the gap in services, should Northern Michigan Hospital be dropped.

Mr. Jahn will be the pivotal factor in swaying the UPHP vote on February 20, Mr. Nelson said Monday night.

Mackinac Straits Hospital board members include Peter Della- Moretta of St. Ignace, Margaret Doud of Mackinac Island, James Farero of Cedarville, Al Feliksa of St. Ignace, Kathryn Lawnichak of St. Ignace, Walter North of St. Ignace, Donald McArthur of Gould City, Ronald Mitchell of St. Ignace, Fred Paquin of St. Ignace, Patricia Serwach of St. Ignace, and Richard Smith of Epoufette.