River Region hospitals pay millions to help poor

Published 12:00 am Tuesday, February 12, 2008

Startling numbers show how much area facilities pay for uninsured


Staff Reporter

LAPLACE- As the presidential primaries heat up and a number of the would-be presidents debate universal healthcare plans, the economic impact of uninsured patients hits home as hospitals in the River Parishes release reports of lost revenue from 2007 due to caring for the uninsured.

As of November of 2007, River Parishes Hospital in St. John Parish had written off $6.6 million as lost debt for the year due to the treatment of uninsured patients.

Hospital statistics show uninsured patients comprised almost 6 percent of the hospitals overall clientele.

Also in 2007, St. James Parish Hospital provided $3.68 million in free care at 14 percent of their patient charges and St. Charles Parish Hospital provided $8 million in free care at close to 32 percent of their patient charges.

“We do have some funding for taking care for uninsured patients. It’s probably an eighth.” said River Parish Hospital Chief Financial Officer Tim Matney. “It ends up putting the burden of taking care of the uninsured on the hospital.”

River Parishes Hospital is impacted more by uninsured patients than St. James and St. Charles Parish Hospitals because the St. James and St. Charles Hospitals are deemed disproportionate share hospitals (DSH) as part of a Medicare/Medicaid program to reimburse uninsured care.

River Parishes Hospital is too large to be part of the DSH program and only receives a small reimbursement from the state.

DSH’s are provided with a reimbursement from Medicaid/Medicare based on criteria including the hospital’s size, location and the area’s population of indigents.

Although DSH’s are guaranteed federal reimbursement they still feel the effect of the uninsured.

“We are a community hospital. We don’t turn people away,” explained CEO of St. James Parish Hospital Mary Ellen Pratt. “They (the uninsured) use the healthcare resources ineffectively. They use the ER. That is the highest cost.”

In 2007 uninsured patients racked up $3.68 million in charges at St. James Parish Hospital, however, only a portion of that amount will be reimbursed.

In 2006 they were reimbursed at a rate of 58 percent of care charged. Pratt pointed out that the amount charged includes a profit. The amount reimbursed does not allow for profit and is often less than actual cost.

This means despite federal reimbursements St. James Parish Hospital still loses money.

“Everybody in Congress says we can’t afford it (universal healthcare),” said Pratt. “But we are already paying for it. It is being done, but it is so diluted.”

This trend is affecting hospitals around the country that are required by law to handle the burden of patients who are being given care and leaving the hospitals to cover the expense.

Matney considers the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) to be behind the losses hospitals face by providing healthcare to the uninsured.

Enacted by the federal government in response to a number of high profile cases in which patients without health insurance were turned away from hospitals, EMTALA mandates care must be given to individuals regardless of citizenship, legal status or ability to pay.

EMTALA, however, does not provide reimbursement to hospitals.

This is why hospitals like River Parishes Hospital lose the most. They are required by EMTALA to provide care, yet their eligible reimbursement for that care is only a pittance in comparison to DSH hospitals.

According to a study by the Urban Institute said nationwide, hospitals like River Parishes gave $35 billion in uncompensated care in 2001.

This leads River Parish Hospital to deny care more often to people who need care but are not in an emergency situation. If the uninsured person is injured but not facing death due to their injuries they may be turned away.

“Let’s say an uninsured person wants an X-ray,” said Matney. “If they don’t have the funds for it they may get turned down.”

Patients who are turned down are often referred to Earl K. Long Hospital in Baton Rouge or Leonard J. Chaubert Hospital in Thibodaux, both of which are charity hospitals that are an hour away.

In a 2005 document, Frederick Cerise, then secretary of the Louisiana Department of Public Health, said one in five Louisiana citizens is uninsured, and according to national estimates the number of uninsured appears to be growing. A report by the American College of Emergency Physicians said nearly 80 percent of the uninsured are in working families who cannot afford health insurance.

“One, we do have a growing uninsured population in Louisiana. Two, it stresses the local hospitals,” said CEO of St. Charles Hospital Federico Martinez, Jr. “Personally, I believe there can be a single healthcare payer in the hospital system, which would be the federal government as a single payer, but that is my personal belief.

“We have a great system in that there is still a lot of access to care, but depending on where you live.”

Martinez also noted that all of the different billing systems hospitals must contend with makes administration costs significantly higher now than they would be under a universal healthcare system.