Hospital struggling with uninsured, underinsured
A month ago, Newton Medical Center officials asked the county to up its millage from 1.2 to 1.5 to help care for ever-increasing numbers of under- and uninsured patients. The county dismissed it, citing a tight budget and a tighter timeframe. The $600,000 that the extra millage would have provided didn’t come through.
Not that it would have made much of a difference. The hospital is losing millions each year, writing off an incredible 71 cents of every dollar billed. In larger terms, the hospital’s revenue in 2014 is projected to be $75,157,000. The expenses? $80,562,000. That’s a loss of $4,405,000.
“It’s insane,” CEO and administrator James Weadick said Tuesday. “It requires us to keep our operating expenses to less than 29 cents on the dollar of operating charges.”
The main problem is the age-old mindset that sees the emergency room as a primary-care doctor. Indigent care to Newton County residents will account for $20,151,00 of the hospital’s expenses, for which the county via its 1.2 mills will provide $2,283,000 in reimbursements.
“Indigent” patients include the unemployed, people with no insurance, and, for example, families of four or five who make less than $25,000, and those who receive coverage from the Health Insurance Mar- ketplace (Obamacare) with its massive deductibles, Weadick said.
“Those people don’t have health insurance, for all practical purposes,” he said. But they still need care, and the hospital is here to give it to them.
One of the hospital’s seeming upsides – it’s right here – is also a negative when it comes to real-world dollars. East of Covington, there are essentially no hospitals until Augusta. That means sick people come here.
The hospital has taken steps to try to cut back on the bad debt expense of 45,000 people who visit the hospital’s ER each year who are not emergent and not insured (that number was just 11,000 in 1993). Everyone who comes to the ER is checked to see if they are medically stable and they don’t need emergency care immediately. Those who need emergency care get it, and right away.
Those who don’t – Weadick cited stomach aches as a common illness – are screened as usual, but then asked to pay a $150 down-payment, insurance co-pay or are advised to seek a primary-care doctor’s services. That practice has been in place for two years.
“It has been helpful,” Weadick said. “It has reduced business volume by about 10 percent, and collections per patient have gone up.”
To offer more help, the hospital launched the Newton Medical Family Practice in the K-Mart shopping center, where Dr. Donna Groover offers primary and follow-up care. It’s another option other than the ER.
The indigent problem continues getting worse, swamping the hospital’s efforts to date. Weadick said the number of unemployed and underinsured continues to grow, and a provision of CMS called the 2-midnight rule isn’t helping. It takes into account only the time a patient is in the hospital when it comes to reimbursements, not the care received. So what to do? Weadick smiled: “Give me $20 million. I know that’s unrealistic.”
Seriously, he would like to see the county up its millage rate for the hospital. It’s been 1.2 since 2004, and that worked to keep the hospital in the black until 2008, when the recession knocked the wheels off. Since then, the value of a mill has steadily declined while the cost of service has risen exponentially.
Weadick said hospital officials have several options to decrease its losses, but declined to discuss specifics until they’re a little further along.
“There’s always going to be a hospital here in Newton County to take care of the people,” he said. “Not just a hospital, but a fine hospital that provides quality care.”