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Health Care Tour: “Seeking Patient-Centered Care”
Wallace Thomson Hospital - Union
The Issue:
- As the only hospital in a county of 28,000 residents, Wallace Thomson Hospital (WTH) faces the challenges of providing quality health care in a rural setting with limited patient volumes, limited funding and limited assets. “Communities are at great risk of losing their doctors and hospitals!” (Dr. Barker).
Findings:
- Limited Volumes and Resources
- Wallace Thomson has the staff and facilities to perform many surgical procedures. However, it does not have the resources, staff or patient volumes to perform specialty surgeries such as cardiac or neurosurgery.
- EMS ambulances transport about 30 patients per month to Spartanburg. About half of these are cardiac assessments sent to Spartanburg Regional.
- While WTH does not have a rehabilitation hospital, a recent change to an “aggressive therapy” approach has raised patient morale significantly, focusing on individual attention, goals and quality of life.
- Hiring and Retaining Physicians - Carolinas Health Associates
- In 2006 WTH was without a radiologist, OB/GYN, and 3 interns.
- Union Hospital District hired Carolinas HealthCare System in August 2006 for their ability to hire and retain doctors in a multi-state region. They have been successful in filling the gaps and building a full medical staff.
- Foreign physicians can be part of the solution to the physician shortage, but many of them are having difficulty getting visas.
- Finances
- Medicare and Medicaid patients make up approximately 77% of WTH’s clientele with insured and self-pay making up only 23%.
- In 2006, WTH experienced a $6 million deficit and had to incur debt. Physicians leaving the area and the resulting limitations on service offerings were a large contributor.
- Carolinas HealthCare System helped hire physicians and saved WTH $1.2 million by using its purchasing power to obtain lower prices for supplies and services.
- Carolinas also uses its volume to negotiate better reimbursement rates with managed care organizations such as BlueCross BlueShield.
- WTH ended 2007 with $615,000 net income. Those funds will be invested in upgrades and technology.
- Charity care (inability to pay) and bad debt (elect not to pay) at WTH amounted to $8.8 million in 2007 in lost charges.
- South Carolina ’s Setoff Debt Collection Act allows hospitals to file bad debt claims with the state. An individual’s state tax refund can be garnished to reimburse the debt to the hospital.
- Nursing Homes and Extended Care
- Medicaid’s Diagnosis Related Group (DRG) payments are based on morbidity codes. DRGs are used to determine the standard length of hospital stay that Medicaid will fund for each patient.
- If a bed cannot be found in a long-term facility in time, a patient remains in the hospital and becomes unfunded care for the hospital. (On the day of our visit, a patient was in WTH for his 15 th day awaiting long-term care.)
- Nursing homes often decline Medicaid patients in order to keep beds open for better reimbursed Medicare or insured patients.
- $132/day reimbursement for Medicaid patient.
- $500/day reimbursement for Medicare patient needing rehab.
- Ellen Sagar Nursing Home is the only active Medicaid facility in the county. All of its 112 beds are licensed for Medicaid with 95 currently holding Medicaid patients.
- RAC (Recovery Audit Contractors)
- WTH expressed about the RAC program being used by the Centers for Medicare & Medicaid Services (CMS) to audit and correct payments from the Medicare Trust Fund. WTH had $313,000 of reimbursements withheld and is appealing the majority of these claims.
- NOTE: Congressman Inglis’ office is working with CMS and each of the five hospitals in the district to resolve RAC issues and concern .
When: March 20, 2008
Where: 322 W. South St., Union, SC 29379
Hosts: Bill Leonard (CEO, Union Hospital District), Andrea Cocovich (CNO, Union Hospital District), Jeff Rush (CFO, Union Hospital District), Susan K. Foster (CCO, Director of Risk Management and Laboratory Services), Frederick Barker, MD, FACS (Surgeon), Tracy Martin (ER Director), Ann Brannan, RN, BSN (Case Management and Health Information Services), Michelle Helton (Director of Human Resources), Nichole Harris (Director of Marketing), Anne Winn (Administrator, Ellen Sagar Nursing Home), Bobbie Jean Lawson (Secretary/Treasurer, UHD Board of Trustees), Grace McBeth (UHD Board of Trustees), Louey Speer (Executive Administrative Assistant to CEO)