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How to address healthcare disparities at safety net hospitals

by Lisa Chamoff, Contributing Reporter | December 07, 2022
By Lisa Chamoff

It’s important to think outside of the box and step outside of the hospital to address the healthcare disparities in vulnerable populations, experts stressed during this week’s RSNA annual meeting.

Radiologists who work with low-income populations in cities and rural areas spoke about the challenges faced by safety net hospitals, which provide care to a substantial share of vulnerable patients, regardless of their ability to pay. The session was sponsored by the RSNA Committee on Diversity, Equity & Inclusion.

Dr. Ronda Henry-Tillman, a breast cancer surgeon at the Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences, who serves as director of health initiatives and disparities research at UAMS said it was important to do work beyond surgical interventions to address healthcare disparities.

“We talk about early detection changing outcomes, but what are we doing about early detection to change these outcomes?” Henry-Tillman said.

Low-income patients need access to earlier cancer screening and interventions.

In Tennessee, the Tennessee Breast & Cervical Screening Program was launched to find cancers sooner. It also included an initiative employing “Promotora” navigators who work to promote cancer screening in the Hispanic community.

“We need to understand the different cultures that our patients might have in order to provide the best care for them that we can,” said Dr. Lucy Spalluto, vice chair of health equity at Vanderbilt Radiology in Tennessee.

Henry-Tillman addressed challenges in rural areas of the country. Many people live far from a hospital. Mobile screening services have helped address this issue.

Dr. Jinel Scott, a radiologist and chief quality officer for NYC Health + Hospitals, spoke about the funding challenges of public hospitals and the importance of advocating for equity.

“If a patient is going to have a vaginal delivery, same insurance, if they go to one of these independent public hospitals, the hospital will get paid about $6,000,” Scott said. “You compare that to $20,000 in the academic private hospital. This is the same patient, same insurance. That's because a lot of our public hospitals do not have the leverage to negotiate with insurance companies as some of these private institutions do, and I think that is unfair.”

Pearl McElfish, director and founder of the Office of Community Health and Research at UAMS, spoke about the importance of community-based research and engagement, filming videos for YouTube and promoting research to the media.

In her area, they have been working with school districts to address the food programs for disease prevention.

“I think it's critical that we, as hospital executives, healthcare providers, and researchers continue to look for those ways to intervene at a policy, systems and environmental level,” McElfish said.

Particularly in urban areas, patients often lack access to affordable housing and therefore support for recovery, Scott said. Public hospitals also are challenged in recruiting staff.

“If we're just trying to have the amount of people employed to run the hospital, then maybe that new CT machine does not get purchased,” Scott said. “This is a huge challenge for all hospitals, but I say that we are on the front lines of the fight for health equity. And I believe that we, the public hospitals, need to be supported because we're doing the work.”

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