BIRMINGHAM, Alabama -- A sharp, sudden increase in the number of uninsured patients seeking help at Birmingham emergency rooms has some hospital executives concerned about medical services for the poor.

Such visits have increased nearly 20 percent at several area medical facilities since the emergency room at Cooper Green Mercy Hospital closed on Jan. 1, according to interviews.

"It's a problem," County Manager Tony Petelos said. "That's why we're getting ready to do a major ad campaign to tell our patients to come back to their medical home. We do not want our patients clogging up emergency rooms."

20 percent increase

Princeton and Shelby Baptist Medical Centers have seen a 20 percent increase since the first of the year in uninsured patients in the emergency departments, said Ross Mitchell vice president, External and Governmental Affairs Baptist Health System.

The UAB Hospital and UAB Highlands Hospital emergency departments have seen a 19.8 percent increase in average monthly emergency department (ED) uninsured- and Medicaid-patient visits since Jan. 1, said University Hospital Interim CEO Anthony Patterson.

Factors that have contributed to the increase include a lack of understanding about the availability of services at the Cooper Green urgent care clinic and a larger-than-normal winter flu outbreak, Patterson said.

However, some hospital officials say they have received patients who thought Cooper Green was closed and did not realize they can utilize the urgent care clinic.

On Tuesday, executives from St. Vincent's, Baptist Health, UAB and Trinity Medical Center expressed some of those concerns during a meeting with Petelos. The meeting was also attended by some members of the Birmingham Business Alliance.

Medical professionals believe that Cooper Green patients who need follow up care can't get it at Cooper Green, and in many cases, without the follow-up care will return to their emergency rooms, according to meeting participants.

Petelos said an "extraordinarily high" percentage of people are going to the emergency rooms "who do not need emergency room care."

"The way Cooper Green patients saw a doctor . . . they just went to the emergency room," Petelos said. "Now they are showing up at hospitals doing that and it's creating a problem for our hospitals."

Major advertising campaign

The county plans a major advertising campaign "to tell our patients they need to come to the urgent care center . . . we do not want our patients clogging up emergency rooms," Petelos said.

Commissioner George Bowman said he believes the problem could have been avoided if a plan was in place before a majority of commissioners decided to downsize the Sixth Avenue South facility.

On Jan. 1, Cooper Green closed its inpatient care unit and emergency room and became an urgent care center with "subspecialty" clinics.

"You have politicians and a consultant trying to patch together a plan and it's not going well," Bowman said. "They want us to think and hope that it's going well, but it's not going as well as they have planned. And now we're hearing the pushback from the other hospitals."

Contracts not in place

Another complication is that a process is not in place to pay hospitals and physicians who care for the county's indigent population. UAB is currently the only hospital with a contract.

Bowman said the "memorandums of understanding" that the county signed with area hospitals in December meant little.

"The memorandum of understandings is not an agreement, that's not a contract," Bowman said. "That's not a definitive plan to care for people."

Commissioner Joe Knight, who voted with Commission President David Carrington and Commissioner Jimmie Stephens to downsize, said a plan was in place, but it's been complicated by negotiations with hospitals on how much to pay for in patient indigent care services. The county also wants to hire more doctors to staff the center and clinics.

"It's an ongoing battle and it's not easily resolved," Knight said. "If we had plan A, B and C in place I still think we would have had problems implementing them."

Petelos said the county is continuing to talk with the medical facilities "to work to develop the system that we are going to have . . . to get this process in place."