Hospital requests more county support

Representatives with Alliance Hospital in Holly Springs approached the Marshall County Board of Supervisors Feb. 6 seeking more funding for indigent care.

Bill King, Chief Financial Officer, and Gail Houck, director of nursing, asked to discuss the hospital's indigent care policy and poverty guidelines.

King said Marshall County provides $200,000 a year for indigent care but at one time provided $500,000 a year. He said Alliance wants the indigent care to be restored to the level it was before Dr. Kenneth Williams bought the hospital – at $500,000 per year.

“Every year we exceed $500,000 a year,” King said.

The annual indigent care bill at Alliance runs from $600,000 a year to $1.5 million a year, King said.

District 3 supervisor Keith Taylor said the county pays indigent care whether a person is on the street or in jail.

“The taxpayers are paying two times with the subsidy. We have to pay the hospital bill (and the subsidy),” Taylor said.

King disagreed. “You are talking about people in Marshall County and the area – people who are unable to pay,” King said. “We are talking about a prisoner brought to us from the Marshall County Sheriff's Department.” District 1 supervisor Charles Terry said he thought a person is indigent when they have “zero dollar income.”

“That's not so,” King said. “One size

does not fit all. You have things like Social Security Insurance and family size (to consider).” He said poverty is based on more than one criterion.

“These are federal guidelines stating the poverty level,” King said.

Taylor said if the county gives money the county has to make sure the person is indigent.

“At one time we had several county employees on there (Alliance's list of indigent expenses),” Taylor said. “If you sit in our chair and say people with insurance are indigent...,” Taylor said.

King said there may be some cases that fit Taylor’s description.

He said there are 38 hospitals in the state on the verge of closing.

“Insurance companies have a policy where they try not to pay,” King said. “It gets harder and harder to provide services for the people of Marshall County.”

Terry said some county employees may show up on Alliance’s list who are found indigent.

King said if someone is found not indigent their names will be taken off the list.

“We are looking at sufficient people to justify that indigent cost number,” King said. “The hospital is important to the citizens of the county.”

Taylor said if the names listed by Alliance as indigent are correct he has no problem with it.

District 4 supervisor George Zinn III weighed in on the matter.

“One thing I do know, if the county gave $500,000 30 years ago and at today’s cost of health care, and we gave $200,000, there’s no way that could be in line. The other part, if a name shows up, perhaps the person did not pay a bill. The other side is this - if the county is going to give indigent care, I don’t know why the county needs to micromanage you, if we give it in good faith.”

“There’s got to be checks and balances,” Taylor said. “We have obligations. We need the numbers.”

Houck provided more insight.

She said a daughter or son is not responsible for their mother’s bills and the patient often has no idea of her business.

“A 90 year old does not understand her bill,” Houck said.

“The hospital says we have $1.5 million in indigent,” Zinn said. “I didn’t know we are to question an individual who is on the list.”

“What you are saying about indigent care, is it is a correctable error,” Terry said. “If you sign an affidavit these names are correct, and they are not, it is on you (Alliance). I was interested about federal poverty guidelines, when a person with insurance may fall under indigent care.”

“The legislature and Lt. Governor says every person needs to be within 30 minutes of a hospital,” King said.

“This is a partnership.”

Zinn asked if there are collections methods to get money owed.

“When they come in for admission, sometimes the information is correct and sometimes it is not,” King said. “We get mail back all the time where people give an incorrect address.”

“We need the hospital,” Taylor said. “We want to do everything we can do, but make sure it is legal.”

Zinn asked about the prisoner whose care was billed $13,000 to the county.

“The person was brought from the custody of the Marshall County Sheriff’s Department,” King said.

“If they are a Marshall County resident….” Taylor said.

“There is a possibility that the individual may not be a resident of Marshall County,” King said.

“Also, someone actually sick vs. self-inflicted injury,” Zinn said.

“The individual swallowed a battery,” Houck said.

Taylor wanted to take the request under advisement.

He said another local and private bill may be necessary to raise the level of support to give to a private hospital.

“If at all possible, help us out,” King said.

Next, King brought up the issue of availability of ambulance service to transport patients from Alliance to another hospital - to allow county ambulances to bring acute care patients to Alliance and transport them to another facility.

Houck said if a patient comes in and their care is beyond the scope of Alliance care, a problem arises when the county ambulance service waits up to eight hours or up to three days to get the patient transported to another facility.

“So now, we call 911 to get them transported,” Houck said. “A person came in with two brain bleeds. The (Memphis) Med was going to accept but we couldn’t get LifeGuard. They were in station and would not respond.”

Taylor said the county ambulance service does not transport patients from the nursing home to the hospital and back if there is no emergency.

“If they go to a different hospital and they are on hospice,” Houck said. “We had three patients last year who asked to go to Alliance and was told they won’t do anything. We are taking them to Oxford,” she said. “They lived at Lake Center.”

Zinn asked if the ambulance medics are qualified to make that call.

“Typically, the doctor makes that call,” King said.

“I had an ambulance driver tell me six weeks ago, ‘We want to go to Oxford or Southaven because we can get the fast food,’ ” Houck said. “We had a gunshot victim last week and they were there on the spot.”

Taylor said the main reason the county increased the number of ambulances is because sometimes all three would be off on a run at the same time.