¶ … Ralph Peterson, CMH: There are a number of solutions to the current problem of City indigents frequenting the ED that CMH is now experiencing because of City Hospital's diversion. City cannot afford to treat all of the indigents and neither can we. However, there are a number of steps that we could take to solve this problem. In this memo, I will list and describe these steps. Below is a brief bullet point outline of what I propose.

People who come to the ED regularly go there because they believe it is the only place they can receive primary care. In some cases, it is. This does not mean, however, that CMH must bear the burden of this cost. Even though the problem is that the indigents are unable to pay for their care, there are several options available for relieving this burden and helping these indigents at the same time. Here is a quick list of these options.

Tap into Government MIA programs. These are available, albeit in a limited capacity.

Get the indigents on Medicaid and Medicare. We should be working directly with Medicaid and Medicare staff in the hospital who can assist with the process of enrolling them. Many of the indigents may qualify for support. Enrollment in these programs should be encouraged at the hospital.

3. Take the steps to adopt City's Hospital's model (teaching, etc.) to obtain grants and funding from the State.

4. Appeal to donors for fundraising. CMH has a good reputation with local residents. Wealthy patrons could be a great boon to the hospital and ample time should be given to developing successful appeals to this donor base. Many institutions depend wholly upon the support of donations, such as the local

Our hospital is just as important to the community as classical music and this is a step that should be taken.
5. Support an initiative that will provide primary care centers in the zip code district from which the indigents are coming. It has been shown that most indigents come to the ED because they are not receiving proper primary and preventative care. The problem can be addressed at the root if we establish primary care facilities (Goodell, DeLia, Cantor, 2009).

6. This will not only help to reduce the number of indigents who come to the ED with preventable and/or non-urgent problems, it will also help to serve as a selling point to wealthy donors interested in philanthropic enterprises. Urban activity is appealing to donors.

7. Education. Marketing campaigns are good but the public especially in the city is in need of education so as to raise their standard of living. Efforts should be made to address the problems that indigents face so that fewer of them reach the point whereat they feel the need to become regulars at the ED.

8. Outsource services to specialists. These specialists will be responsible for obtaining their own individual fees for services, thus freeing CMH from the responsibility of collecting debts.

Any number of these steps, some of them, or all of them, may be taken in order to reduce the financial strain of administering to City's indigent patients who are being diverted to CMH's ED. Some of these steps may be taken together. The most important and most cost effective in relieving the strain in the quickest manner may be to kick off a fund drive campaign…