Claiborne
County Hospital
Continues to “Bleed”
Published: Claiborne Independent
April
1, 2009
by W. Lee Brame
County hospital finances continued to bleed red ink during the month of
February. Overall, hospital operations lost over $130,000 dollars for the
month. Despite the initiation of several measures to improve finances, a
huge bill for medical services provided by the hospital to hospital
employees wiped out the organization’s potential profitability for the
month.
While many small companies and partnerships cannot afford to provide health
benefits to employees, most people assume that large companies or hospitals
don’t have any difficulties in providing medical benefits. But unexpected,
serious illness can happen to almost anyone or any organization. In
February, medical costs for employees and family members covered by the
hospital medical coverage exceeded expected (budgeted) costs by over
$300,000 dollars.
The financial report detailed that the hospital itself operated in the black
during the month but that all other operating areas lost money. In general,
some of these losses reflect a change in accounting procedures as well as a
change in patient volumes. Emergency Medical Services and Home Health
volumes were down for the month and the Nursing Home and is now being
charged for its share of the hospital’s laundry service and food service
bill.
Departments also started to write-off bad debt.
Analysis of bills also showed that hospital utility bill has increased by
$53,000 over expected costs for the year.
After much discussion, the financial report was accepted by the board’s
attention turned to measures to improve hospital finances. On March 10,
Mercy Health Partners brought in a Revenue Cycle team to inspect financial
operations in every department.
This paper will not subject its readers to all the details of the
twenty-some proposals and procedural modifications that will be implemented
by the hospital during the next three months. Many, such as the procedure
coding audit, clinical documentation initiative, and Home Health billing
oversight changes will be entirely invisible to hospital customers.
However, many of the changes will be immediately visible to hospital
customers and patients. In many doctor’s offices, patients usually see signs
that indicate that insurance co-payments are due before leaving the office.
Many insurance plans are established with the requirement that patients pay
their co pay to the physician or provider at the time that the service is
provided.
As of May 1, patients at
Claiborne
County
Hospital
can expect to be asked for their insurance co-pay when they register.
The hospital board also approved a proposal to contract with Med Assist to
provide expertise in determining if hospital patients are eligible for any
governmental or private medical coverage and to help the patient complete
the forms and applications for that medical coverage. While hospital staff
is familiar with TennCare, Med Assist contractors are also qualified to help
Virginia
and Kentucky residents who choose to use Claiborne County Hospital
complete paperwork for those states Medicare programs.
Med Assist staff also has expertise in completing medical claims forms
related to workers compensation and hopefully, school accident insurance.
Internal hospital billing processes are also due (perhaps overdue) for a
change. Ancillary Service Departments (Labs, Radiology etc) will be required
to provide charges to the billing Department much faster. The Revenue Cycle
Review team expects that patients and insurance companies will start getting
their bills quicker – and hopefully the hospital will get paid quicker.
Billing related to Home Health will transition from a manual system (which
currently takes two months to produce a patient bill) to an automated
system. The hospital board approved purchase of an automated system designed
for Home Health Care use. Home Health providers should be trained and
equipped with a hand held device that they will use to document their
services by the middle of summer.
The board also approved a decision to stop an unsuccessful test of an
alternative billing software used by the Nursing Home and return to a
previous system that was more accurate. The billing process used by
emergency medical services will also be standardized to mirror hospital
billing procedures.
The work by hospital staff, Mercy Health Partners, and board members in
review of these financial plans made the board meeting run abnormally long.
In other business, the board advised the hospital that an in-house patient
rehabilitation project would have to be publicly advertised and bid. The
board also approved a proposal to accept a lower bid by
Wausau
to provide workers compensation coverage.
By the time the agenda items were covered, there was little energy left to
discuss the resignation of Hospital Administrator Dan Colón. Or perhaps the
discussion of financial management improvements, several of which had been
discussed, but never implemented during the previous year, made the
conversation unnecessary.
One point that was provided in passing was that the hospital failed to make
timely payments into the Tennessee Consolidated Retirement System on three
separate occasions during the previous year. As a result of these late
payments, the hospital paid penalties to TCRS in December 2008, January
2009, and February 2009. Employee TCRS contributions appear to be up-to-date
at this time.
Mayor Joe Tyler Duncan received assurances that the former hospital
administrator was not being paid severance pay by
Claiborne
County
Hospital.
