Out-of-County Charity Patient Numbers Rising

By Staff Writer, Jeanie Riess, The Greenwood Commonwealth

Last year, a patient from outside of Leflore County sought medical care at the hospital in the town where he lived. He was instructed by someone at that hospital to come to Greenwood Leflore Hospital to seek services instead.

According to Hospital Administrator Jim Jackson, the reason for the referral was Greenwood Leflore’s charity policy, one that’s more lenient than others in the region.
As it stands now, the hospital’s charity program covers patients who earn up to 135 percent of the federal poverty level, regardless of where patients reside. It does not require any patient to have previously applied for medicaid, and it is reviewed, per patient, every 30 days.
“Greenwood has made it easy to come here and be seen,” said Jackson. “We try to provide as much access to patients for their care because we do offer a fairly high level and broad menu of services. We make it easy to come in, we don’t ask for pre-payment, even though a lot of hospitals, many close by, do.”
In 2012, GLH saw a 51.3 percent increase in the amount of charity it was writing off. But only 63 percent of the charity the hospital wrote off was provided to patients residing in Leflore County. The 37 percent remainder, said Jackson, went to patients outside of the community.
Though no change has been made to the existing charity policy, Jackson and Greenwood Leflore’s CFO, Dawne Holmes, explained that the number of patients receiving charity from outside of the county has given rise to a discussion of the future of the program.
“We’ve asked the board to consider making some changes,” Jackson said. “And they’ve agreed to consider those.”
One such change would be to  require all patients requesting charity to demonstrate that they have at least applied for medicaid. Patients would not have to have medicaid, rather they would have to have evidence that they were denied it.
In addition to an increase in charity care over the past year, the hospital recognized the need for some changes in light of uncertainty regarding the expansion of Medicaid.
The Affordable Care Act would expand Medicaid to those earning up to 133 percent of the poverty line. That expansion would be paid for by both state and federal governments, and would largely be funded by a reallocation of Disproportionate Share Hospital payments, the moneys allotted to hospitals to cover part of their charity costs.
What will happen to DSH funds if Mississippi elects not to expand Medicaid, however, is still up in the air.
According to Holmes, DSH funds stand to be cut by 75 percent, which would put Greenwood Leflore in a precarious situation as it looks to treat the uninsured.
That possibility prompted another possible change: limiting charity care to those who reside within Leflore County.
Both Jackson and Holmes pointed out, however, that limiting charity access to non-county residents would not be an all or nothing sweep. Instead, said Holmes, the hospital is looking at ways to work with patients  from outside the county to negotiate some alternate forms of payment.
“Initially, it sounds like we’re just not going to give any consideration to anyone outside of Leflore County,” said Holmes. “And that’s not really true. We’re going to continue to treat them like we always have, but we’re thinking that we’ll have to go back to the board to look at some kind of partial consideration for charity.”
Jackson said that he does not think many non-county patients are checking with their own hospitals before coming to GLH.
“And with the anticipated reduction of payment for the cost of treating the uncompensated care, the hospital has to take measures…to provide that care but doing so with even less dollars than we’ve had in the past. And it was even a struggle then,” he explained.
Jackson also said that since GLH is community-owned, the primary responsibility of the hospital should be to residents of the county and city that own it.
Jackson said that although he does not yet have the details, he is looking at other hospitals in the area for examples of successful partial charity policies that could be implemented for non-county residents.
Holmes and Jackson also said they were considering reworking the Emergency Room — which has seen an increase in activity over the past year — to redirect those with sniffles and colds to fast-track medical care, thereby reserving the ER for true emergencies that require serious medical care.
Holmes said that many hospitals already implement medical screenings on arrival by a physician. After the initial screening, a patient would either be sent through the ER or on to a clinic setting.
 According to Holmes, patients would still be presenting to the ER, “but it frees up the ER from the sore throats, the colds, from making it all the way back there and going to a lower cost setting, and a quicker setting for the patient because, who knows who’s back there before you, and what they have going on.”
Paying for the services rendered in the ER is another change the hospital is considering.
“It’s been a very wide open ER,” explained Jackson. “You come here and you get sent to the ER and you’re not asked for payment. Obviously you get a bill later … but we’re looking at a collection process on discharge.”
Jackson said that patients would not be asked for payment at the door, but once services are provided to the patient, he might be asked for some form of payment, whether that be a co-pay or simply a deposit.
Although many of these changes have been considered and presented to the board, both Jackson and Holmes are quick to point out that they are proceeding with caution, and are not sure of any timeline for when the policy shifts would take effect.
“We don’t want to implement it so quickly that we haven’t fully investigated everything and we’re not ready for it,” said Holmes.
• Contact Jeanie Riess at 581-7235 or jriess@gwcommonwealth.com.