"We’ve been realizing over periods of time that patients are not always getting the care that they receive in the most appropriate place," said Gail Carter, Phoebe vice president for revenue cycle.
Policies adopted Tuesday by Phoebe’s Finance Commitee include referring patients from outside Phoebe’s primary service area back to their home counties if the same medical services are provided there, and out-of-state residents to their home states.
Medical care for which Phoebe billed more than it was reimbursed was up more than $10 million during the fiscal year ending July 31, according to an audit presented to the committee Tuesday. The uncompensated care included $46 million in charges in Dougherty, $6 million in Worth and some $7.9 million in Lee County, according to a chart provided by Phoebe CEO Joel Wernick.
"Oftentimes, the bad debt that we have is really indigent and charity that comes from people who will not take the time to fill out the documented forms ... to show that they are indigent and charity," Carter said.
Medical services that were documented as indigent or charity care amounted to $12.6 million, the audit said.
Other changes approved by the four-member committee included extending the renewal period for the Phoebe Care Card to 12 months for patients whose economic status is unlikely to change, such as the blind and disabled, Carter said.
Families earning 125-200 percent of federal poverty guidelines eligible for Care Card sliding scale discounts will continue to be renewed every six months, unless they owe for previous services.
"Before they get a new Phoebe Care Card, we are going to ask if they can make those payments," Carter said.
Similarly, patients with outstanding balances who seek elective medical treatment must pay half their bill at the time services are rendered, under another policy change.
Another revision will refer "frequent fliers" at Phoebe’s Emergency Room to other providers when it’s more appropriate, Carter said.
Half the ER’s visitors arrived between 9 a.m. and 5 p.m., and 70 percent between 8 a.m. and 8 p.m., she said.
"So many times, people come to an emergency room when they really could come to a doctor’s office," she said.
With additional mid-level staff of Physician Assistants or Nurse Practitioners, the ER can route non-emergency patients, with a coupon, to clinics such as Albany-Area Primary Health Care, which receive federal funding to serve patients lacking the means to pay, Carter said.
Another policy change increases "discounts" applied to charges billed to cash-paying customers who pay in full at the time of service or within 30 days.
The audit, presented by CPA Bert Bennett of Albany’s Draffin & Tucker, revealed hospital total assets to be up slightly to $397 million for the fiscal year. The number of days revenues stayed in accounts receivable was up, to 62, from 53 in fiscal year 2007 and likely due to delays in processing summer Medicare claims, he said.
The hospital’s ratio of long-term debt to capital was 41 percent, higher than 2007 national averages for hospitals with more than 400 beds and for companies with a AA bond rating, he said.
Net operating incomes, excluding investment income, totaled $15.2 million for 2008, "a very positive result," Bennett said.
Phoebe reinvested $50 million in equipment and facilities last year, including the $24.9 million Tower 2, $3 million in room renovations and $2.3 million for open-MRI equipment.
Chairman of the Hospital Board John Temp Phillips III called the audit evidence Phoebe was constant in its mission of nearly 100 years.
"Our fiscal decisions reflect vision and a proactive response to economic challenges, whether it’s offsetting lower state reimbursements, recruiting to offset a growing physician and nursing shortage or providing the best possible health care to meet the needs of all Southwest Georgians," Phillips said.
The audit also reveals more than $101 million in "community benefits" under IRS Code 501(c)(3) for charitable organizations.
Those benefits include $1.9 million for health professions education, $421,000 for health care support services, $1 million for Dougherty’s school nurse program, $1.46 million for community health education, $1.4 million for Dougherty inmate medical care and $704,000 in grants to community health and other organizations.
The benefits also include $4.18 million in losses taken at Phoebe’s outpatient clinics, specialty clinics and residency program, $12.6 million in unreimbursed charity care, $53.2 million in unpaid Medicare reimbursements and $24.3 million in unpaid charges billed to Medicaid.
