Here's a lesson they don't teach in business school: Take an entity that loses $4 million annually and expand it 50 percent.
That's the plan St. Vincent Indianapolis Hospital unveiled earlier this month when it broke ground on a new, larger Primary Care Center serving indigent, underinsured and uninsured patients. That population of poor, mostly Spanish-speaking patients has more than doubled its annual visits since 2000.
St. Vincent officials say the new $4 million center is 10 years overdue. Their current center, across Naab Road from the West 86th Street hospital campus, was designed for 35,000 annual patient visits. It handles twice that number now, and the total is expected to grow to 110,000 in four years.
"Every hospital is in the same situation," said Terry Hamilton, St. Vincent's executive director of finance. "We make our money on the commercially insured patients.
"We lose money on the governmentinsured and the nopay patients, and you hope at the end of the day that you end up ahead."
St. Vincent Hospital, which notched a $60 million profit last year, has avoided red ink so far. But it's spending increasing amounts each year to fulfill its mission of caring for the poor in Marion, Hamilton and parts of Boone counties.
"There's an awful lot of need in those counties that's not being met right now," said Dr. Robert Lubitz, St. Vincent's executive director of academic affairs and research.
Many Indianapolis hospital networks report double-digit-percentage increases in recent years in the amount they have spent on care for the poor. However, because charity-care definitions vary widely, direct comparisons are difficult.
St. Vincent's Primary Care Center focuses mostly on uninsured patients. Patients pay for care on a sliding scale based on their income levels.
A decade ago, the center had no interpreters. Now it employs seven full-time interpreters, including some who speak dialects of Spanish found in Mexico, Puerto Rico and Guatemala, Lubitz said.
Lubitz said that while the center also treats patients who speak only French, Russian or Arabic, it has seen "enormous growth" in its Spanish-speaking population. Many come from the Crooked Creek and Michigan Road areas southwest of the hospital.
In addition to bulking up its interpreter staff, the center has added culturalawareness training. It also employs three full-time social workers and runs a lowcost pharmacy that filled 85,000 prescriptions last year.
That amounts to more than the average 24-hour retail pharmacy, even though the Primary Care Center's option is open only eight hours a day, Lubitz said.
Its staff includes a pharmacist who focuses only on helping patients fill out the confusing forms needed to enroll in drug company discount programs.
"As our population has grown and our challenge has grown, we've expanded these services," Lubitz said.
The new center will include a medical education and research center that offers videoconferencing and distance-learning equipment.
Also on the way are a radiology suite, patient-education rooms and exam rooms large enough to accommodate family members. The St. Vincent Institute on Aging will move to the center, which also will have clinics for obstetrics, family medicine and pediatrics, among other specialties.
The new Primary Care center will sit 150 feet north of the current center, allowing patients to take the same bus lines to reach it, Lubitz said.
The St. Vincent Foundation, the hospital's philanthropic arm, will raise the money needed to build the center.
St. Vincent has seen the total it spends on charity care rise 19 percent since 2003. In the fiscal year that ended in June, it spent $63 million on charity care.
The north-side hospital isn't alone in recording such increases.
Marion County's safety-net hospital system, Wishard Health Services, spent $200 million in 2005 to treat patients without any form of insurance, up 20 percent from a year earlier, Wishard Chief Financial Officer Lee Livin said.
The largest hospital network in Indianapolis, Clarian Health Partners, said its charity-care spending leveled off in recent years, partly because it tightened the definition of what it considers charity care, spokesman Jon Mills said.
Charity care at Community Health Network's four central Indiana hospitals increased 30 percent from 2003 to 2005, said Tom Fischer, the network's chief financial officer.
"I'm sure there's a hundred demographic/socioeconomic reasons for that, but we can't point to one thing and say that caused it," Fischer said.
Some hospitals see a growing indigent patient population because they sit in more mature, poorer parts of the city, said Edmund Abel, director of health care services for the Indianapolis consulting firm Blue & Co.
He noted that St. Vincent's 86th Street location is "looking more urban than suburban, which is what it was when it was originally built" in the early 1970s.
The area around it has seen an increase in people covered by Medicaid and Medicare and in Hispanic immigrants, who typically take lower-paying jobs without health benefits.
Indeed, the Hispanic population in the ZIP codes surrounding St. Vincent grew 41 percent, to 10,284, from 2000 to 2005, according to data from Indianapolisbased consulting firm Health Evolutions. It's projected to grow 85 percent from 2000 to 2010.
Hospital officials don't view caring for that swelling population as purely a financial drain. If St. Vincent's Primary Care Center does more business, that means fewer uninsured patients will wind up seeking more expensive care in places like emergency rooms.
"The better outpatient care you provide, the less likely they are to wind up in a hospital, and it keeps them healthy and
enables them to lead a productive life,"