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Proposed fee may hurt Liberty care providers

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POSTED: January 26, 2009 10:15 a.m.
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LRMC CEO Scott Kroell

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Expected state and federal budget cuts present added fears for Gail Smith.
The Health Department has been the saving grace for Smith, who depends on reduced-cost prescriptions to help her in her seven-year battle with hypertension.
“The cost of insurance and the job situation, a lot of people lost their insurance, something like this is an alternative for people who are in need,” said Smith, who goes to the department’s office in Hinesville every 90 days to fill prescriptions.
But she’s seeing more out of pocket payments.
“Services used to be pretty much free … but now you have to show your income and you have to judge it by how much your income is,” she said.
The sliding payment scale is a less costly than relying on health insurance for care at a private doctor’s office.
A recent bout with bronchitis that sent her to Savannah brought her insurance situation to light.
“And I had insurance, but that visit cost $4,000,” Smith said. “My insurance only paid $1,000 so that left me with $3,000.”
Katherine Cummings, executive director of the Georgia Rural Health Association, said the trend extends across the country.
“If you look at the growing number of unemployed it means there are bound to be an increase of people who don’t have insurance anymore,” she said. “The demand for services by the uninsured people will go up.”
And Liberty County’s uninsured under age 65 stacks up at 21 percent, two percent higher than the state average, according to Glenn Landers, a senior research associate at Georgia Health Policy Center at Georgia State University.  
“There’s no such thing as free care. Someone is bearing that cost,” Landers said, calling it embedded costs through higher premiums. “That cost is borne across a lot of different payors, primarily the hospital.”
And Gov. Perdue’s administration is proposing a fee on hospitals to help fill a $208 million Medicaid gap.
“If you look at a hospital that’s already very fragile financially and it’s already serving the underinsured and uninsured, to add that additional cost will work a real hardship,” Cummings said.
While the impact will vary, there is possibility of a reduction in services and less staffing, according to Cummings.
The 1.6 percent proposed fee would mean at least $60,000 a year for Liberty Regional, according to LRMC CEO Scott Kroell.
“Without final ruling on the proposed fees, we’re not yet sure of any resulting impact,” he said.
Close to 30 percent of the hospital’s patients pay through Medicaid. 
The public Health Department’s Diversity Health Clinic provides some relief to patient loads, providing primary care for those with low- to moderate-income or no health insurance. The clinics serve
Hinesville and Ludowici.
But with two nurse practitioners, a part-time doctor and an estimated 250-300 residents visiting the clinic each month, the three-year-old clinic is also straining.
“We’re having a funding problem to try to keep everything going,” Diversity board chairman Sandra Martin said. “That’s the major hurdle right now.”
The clinic’s federal start-up grant has been used up and state grants, along with county, city and LRMC contributions are keeping the clinic alive.
The clinic can also bill Medicare and Medicaid.
“These grants we’ve actually been able to get, they’re small grants but we’ve been able to keep the clinic open with the small grants that we have received,” said Connie Thrift, past board chairman, mentioning a grant from the Susan G. Kormen Foundation.
The board is committed to making sure it stays to meet the needs.
“You can walk in there any day of the week and see five to 15 people waiting for service,” Thrift said.
Georgia State’s Landers called the county fortunate because not every area has something like Diversity.
“We try to create access points for people…trying to build free voluntarily federally funded clinics,” he said.
Addressing common, chronic health issues, like blood pressure and cancer, helps nip problems in the bud, according to Cummings. 
Kroell agreed.
“Rather than a tax on non-profit hospitals, we feel a tax on tobacco products…would raise more money, as well as serve as a disincentive for the use of tobacco products which are harmful to health,” the hospital CEO said.
Smith thinks many uninsured people understand the benefits of insurance, but don’t want to pay for a policy if it means having less take-home pay.
“Like Obama said, ‘We need healthcare for everyone,’ ” Smith said. “And the ‘how’ is your tax money. They’re taking our tax money and doing everything else with it.”
“The main thing is we want people to be seen,” Gwen Stewart, board vice-chair said. “We don’t want anyone to go without having their health needs being met.”
 

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