In Mar. 27-Apr. 2 issue
By Greg Wells
Times Journal Managing Editor

RUSSELL SPRINGS - Administrators were questioned closely by some of the board members when the Russell County Hospital Board met Thursday night, Mar. 20.

The selection and performance of the hospital's negotiator with the private insurance companies was questioned, as was the amount of financial reporting provided to the board members.

"It is Russell County that has something to lose," Mark Antle pointed out to hospital CEO Gary DelForge and Jeff Buckley with the hospital's management company, Alliant.

He went on to point out that the hospital's reports to Medicare - Medicaid were supposed to be provided to the board, but he's never seen any.

"From my standpoint as the manager of a bank if I had that type of financial results (that the hospital has) I'd be replaced," Antle stated. "Somebody needs to be accountable."

Alliant Vice-President Buckley told the board that in the 30 years he's been in the business he wasn't aware of any board member reviewing a hospital's cost reporting to the federal programs.

He suggested that they wouldn't be able to understand them and suggested they gather for a board educational session to go over them. Open meetings requirements for such sessions are not as clear-cut as those for a board meeting.

Buckley told the board that negotiations were proceeding with Anthem to improve the amount of money that insurance company pays the hospital for patient care.

He said the hospital is focusing on negotiations with the insurance company rather than pushing the idea that if they don't pay more the hospital will stop taking their insurance.

"I'd rather approach them from a good will perspective than to pull that trigger," Buckley said.

Antle asked if the negotiator in the deal was not compensated based on how much he bettered the hospital's position, and stressed that someone needed to be on the hook for it if the hospital did have to "pull that trigger" or did not get a better deal from the insurers.

After the Anthem negotiations Humana is the next group the hospital will be negotiating.

There was also news on the $600,000 that the federal healthcare programs had charged back against the hospital.

At the previous meeting of the board it had been announced that $600,000 that had been paid to the hospital had been dis-allowed and the hospital would have to pay that money back and re-bill using the proper number.

The reason for the problem, DelForge explained in an interview this week, was that the hospital had billed under their previous number, as a Prospective Pay Hospital, after they had begun operating as a Critical Access Hospital.

He said the hospital had been given 60 days to pay back the money, while at the same time they are re-billing Medicare/Medicaid for those patient services.

Kimsal told the board that there is over $100,000 in payments that have been made under the correct billing number for those services and that money has been put away for re-payment to the federal program.

DelForge said he was in hopes that the hospital would be able to re-collect most of that money from the feds before having to pay it back to them.

Essentially the federal program is having the hospital move the payments they made to the hospital from one program to another, manually.

There is however some chance that the amount that the hospital is paid for the services this time could be either less or more than they received under the previous program, DelForge said.

He said they were hoping to finish this process with as little impact as possible on the hospital's cash reserve.

As part of this process, Kimsal told the board that over 1,000 letters had been sent to patients explaining that Medicare/Medicaid has been re-billed for their hospital visit and explained why.

He said the hospital was fielding a number of calls in response to those letters.

He also told the board that other new programs are bringing in revenue and improving customer relations.

Ken Kimsal, the hospital's Chief Financial Officer, told the board the in-house billing and collection program has been seeing good results. He said they have collected more than the previous monthly average and customer relations were improved.

"We're getting a lot of positive feedback," Kimsal said.

He added that the initiative to direct un-insured patients into state or federal health care plans has yielded $40,000 in payments to the hospital that they likely would not otherwise have seen from Medicaid, as well as a significant amount of billing to a state program.

In his financial report to the board Kimsal said the inpatient revenue was 2 percent over budget and out-patient was 18 percent over budget for February.

He said the hospital's operations brought in $11,414 more than it cost to provide the services last month, but for the year operations is still $381,949 in the red.

The bottom line was that the hospital profited $68,785 for last month and that makes the year to date profit figure $86,555.

In other matters considered by the board--

The board approved hiring another division of Alliant to re-work the hospital's master list of charges.

The board was told that under Ephriam McDowell that work had been done regularly under contract but had not been done since the hospital was purchased back by the county.

The bid from the Alliant-related company, Blue and Co. of Louisville, was $16,500 plus expenses for the project.

The bid from a Tampa Fla. company, PRC, was $13,500 plus expenses for the same work but board member Lesa McDonald pointed out that the expenses for several days of work for a team of people from Florida could be more than the savings from the base price as compared to the other offer.

The board was told that the work was done to bring the hospital's billing codes in line with the insurance companies' codes and see that the charges for the work were what they should be.

The board also approved as much as $125,000 to replace one of the hospital's two chillers. The device is a major part of the hospital's cooling system and is about 27-years-old.

DelForge was directed to seek more bids for the 80-ton unit to see if costs could be reduced.

Some of the bills and advertising decisions by the administration were questioned by the board and changes were made.