Elderly patients, patients without insurance and those having a tough time meeting co-payments got a break last week when UNC Healthcare officials–under pressure from UNC system President Erskine Bowles–agreed to modify recent policies that health care advocates say send the message that if you can’t pay, don’t go to UNC.

Bowles, who took over as president in January, won praise this week from leaders of a petition drive who charged UNC Healthcare with veering widely from its mission to the state in pursuit of higher profits–a major concern since the health care system was given greater financial independent in the late 1990s.

The petition, presented to Bowles by Dr. John Hammond, a retired medical school faculty member, and Dr. Florence Soltys, an associate clinical professor of social work and medicine, outlined several concerns about how poor, uninsured and elderly patients are being treated.

“The commitment of UNC Hospitals to the people of North Carolina is increasingly disregarded,” the petition reads. It also lists a number of grievances, including lack of access to certain specialty clinics, a sharp drop in employee morale and a “worsening nightmare” in the hospital’s emergency room.

Among the 1,100 signatures (online at www.ipetitions.com/petition/Restore_UNC_Healthcare_Mission) are those of medical school faculty, hospital staff and Orange County legislators Sen. Ellie Kinnaird and Reps. Joe Hackney and Verla Insko.

Hammond and Soltys say Bowles’ quick and firm response and his willingness to hold UNC Healthcare chief Dr. William Roper’s feet to the fire appear to have brought results.

After first denying there was much of a problem–he told The News & Observer in mid-August that the notion the hospital had in any way moved away from its mission was “wrong, wrong, wrong”–Roper changed his tune last week. At an Aug. 29 meeting with Bowles, UNC-Chapel Hill Chancellor James Moeser and top hospital and university administrators, Roper outlined several changes to address the concerns.

Bowles said he’d made it clear to Roper that he took the petition seriously and wanted real changes immediately. In a not-so-subtle opening to the meeting with Roper and Moeser, Bowles noted that Roper’s contract ends May 1.

Like Bowles, Hammond and Soltys say the key is follow-through.

“It’s a beginning,” Soltys, a longtime advocate for better geriatric care, says of the plan. “We’re going to be monitoring it, though.”

Hammond agreed.

“We need to be watchful of things,” he says. “Tone and tenor does seem different.”

The hospital, which uses recorded messages to remind patients of appointments, has changed a section at the end that used to tell patients they had to pay any outstanding bills and be ready to cover a copay up front. It was a way of saying, “If you don’t have any money, don’t come,” Hammond says. The new recording includes information about financial aid, and Roper has promised to modify the collections system so that people eligible for financial assistance won’t be turned over to collection agencies.

Soltys, a 24-year veteran of the medical school, says the impact of staffing cuts and policy changes have deeply affected patient care as well as the work environment.

“They’re running a Wal-Mart model,” she says. “They have cut back so much.”

By cutting back on social workers and more highly trained staff to save money, older patients in particular have borne the brunt of the changes, she says. A planned geriatric unit was scrapped, and elderly and often frail patients were being sent home without anyone contacting the family first. “It’s pretty sad,” Soltys says.

Roper has had a longstanding goal of squeezing another percent of profitability out of UNC Healthcare’s expanding enterprise, building incentives and bonuses in for managers to tighten margins. It didn’t help the new efforts to shore up the health care system’s image, though, when the N&O finally won a document battle and word got around last week that the system doled out $1.5 million in 2005 for incentives to top brass–including $84,000 for Roper.

A bigger, more profitable system has been a part of UNC Healthcare’s focus since well before Roper took over in 2004. But the former Prudential executive and head of the Centers for Disease Control kicked that effort into overdrive after he commissioned a 2004 study by Navigant Consulting that led to a private-sector style plan for improving the bottom line.

Hammond says one result of the effort was a more aggressive collection program.

“There’s nothing wrong with trying to collect from people who just won’t pay,” he says. “What’s wrong is trying to collect from people who can’t pay.”

While making the cuts and cracking down on patients who couldn’t pay, UNC Healthcare, which receives roughly $40 million from the state annually, continued to project an image of a teaching hospital with a sense of mission to North Carolina.

Hammond says one of the most aggravating bits of spin used is how UNC Healthcare cites an automatic 25 percent discount for the uninsured as one way it is living up to its mission. But it’s 25 percent off the “list price,” he says, and almost nobody–not the insurance companies, the HMOs and certainly not Medicare and Medicaid–pays the list price. A typical hospital’s chargemaster–the schedule of rates for procedures and treatments broken down for each insurer as well as Medicaid and Medicare–includes discounts far deeper than the much-touted 25 percent break for the uninsured.

The focus on the system isn’t likely to let up anytime soon. Soltys says there are hundreds of hospital employees pushing back against the changes and calling for the UNC system to become more involved.

“I think the Board of Governors has got to deal with this,” she says.