Hospital plan would pay for on-call shifts

Hospital plan would pay for on-call shifts

Jan. 29, 2001

By Jim Mimiaga
Journal Staff Writer

The management of Southwest Memorial Hospital gave initial approval Thursday to a plan that would pay a stipend to family-practice physicians for taking on-call shifts.

Under the proposal, which still needs approval from the Medical Executive Committee, a group of eight primary-care physicians would handle on-call shifts for unassigned patients at Southwest.

To compensate for time lost from their private practice, primary physicians on the on-call schedule would be paid $500 for each 24-hour shift, according to the proposal. The Southwest Health System board has agreed to budget $182,500 per year to cover the new expense.

"The doctors had a charge from the board to come up with a solution and I think that they did in a way that serves the community best," said Southwest CEO Bob Peterson.

Unassigned patients are those that enter the emergency room with serious medical needs, but who do not have a regular physician locally to admit them. Covering those shifts has been problematic because they are a distraction from the physician’s regular business, Peterson explained. The compensation plan is seen as a solution.

"This is something that has been ongoing on a national level for a long time," he said. "Again, reimbursement for taking Medicare patients has been lowered by the federal government, furthering pressures on private practice. So this is a way to help alleviate that time away from their practice and to keep access to local physicians."

Peterson said that the invested amount is comparable to hiring one hospitalist, an on-staff doctor that some hospitals use to admit and take care of unassigned patients, thereby reducing overwhelming on-call scheduling.

The medical rules and regulations dictating the responsibilities of physicians with admitting privileges at Southwest must be ratified before the plan can be put in place, SHS attorney Kent Williamson reminded the board. If passed by the committee, the plan would be reviewed after several months to gauge its effectiveness.

The eight doctors signed up in the plan are Hope Barkhurst, Karla Demby, Dianna Fury, Tracy Lippard, Leonard Cain, Kent Britton, Carolyn Johnson and Robert Heyl.

"It’s been a long-standing problem to get resolution on and this is the best we have been able to come up with,"Heyl said.

"It has been difficult to strike a balance. Our patients make appointments and show up like they should, but then we end up having to run over to the hospital, leaving them high and dry."

Family doctors not participating would not be obligated to take unassigned patients while on call, Peterson said.

"I think the board recognized that on-call doctors lose business when they cover those shifts," he said.

Southwest bucks trend, shows profit in 2000, '01

Journal Staff Report

Despite the trend of rising costs and declining revenues for Colorado’s rural hospitals, Southwest Memorial has managed to stay above water.

According to a report by the Colorado Health and Hospital Association, hospital expenses for providing care to patients increased by 11.3 percent from 1999 to 2000.

In addition to the rising costs of supplies and salaries, hospital charity care increased by more than 12 percent from 1999 to 2000 and hospital debt rose by nearly 31 percent, according to the report, Reference Guide to Colorado Hospital Financial and Utilization Data 1999 and 2000.

Bad debt in health care, the report explains, is not like bad debt in commercial fields. People who are ill or injured usually can’t choose whether or not to receive care. Sometimes a person’s ability to pay changes after the original determination is made. For example, a person may find that an illness or injury causes the loss of job and insurance, or puts other severe strains on the family income. The publication therefore reports charity and bad debt together.

Colorado hospitals provided more than $636 million in care that patients could not or would not pay for in 2000. Combined with government underfunding of the Medicare and Medicaid programs, Colorado hospitals were not paid $2.6 billion for care provided to patients in 2000, according to the report.

Overall, Colorado hospitals were financially healthier in 2000 than in 1999, but 25 hospitals — mostly small, rural or urban safety-net hospitals — lost money on patient care in 2000. In 1999, 19 hospitals lost money on patient-care services.

Southwest Memorial in Cortez has been an exception to the downward trend suffered by smaller facilities. The 61-bed, acute-care facility earned $561,000 in profits for 2000, and had a $1.2 million bottom line for 2001, according to Chief Financial Officer George Brisson.

"We just finished the best year we have had," Brisson said. "I attribute it to higher patient volume. I think we have recovered volume lost in previous years."

According to the CHA report, 47 (compared to 51 in 1999) of the 61 reporting entities had a patient-service margin of less than 6 percent, the profit margin national experts say is needed to maintain and update physical structures, new technology costs, new programs and services, reduce outstanding debt, provide charity care and invest in the health-care needs of the community.

Funding of Medicare and Medicaid programs is of special concern to hospitals and the business community, according to Larry Wall, CHA president. "Business continues to be affected by government underpayments because cost must be shifted to paying patients."

Hospitals receive, on average, about 80 percent of the cost of providing care to Medicare/Medicaid patients, the report shows.

Other highlights of the report:

• Hospital emergency departments were busier in 2000 than in 1999. Statewide, hospital emergency departments saw 87,949 more patients, an increase of 7.5 percent. In total, according to the report, 1.2 million people were treated in Colorado emergency rooms in 2000, an increase of 7.1 percent.

• Hospitals admitted 11,107 more patients in 2000 than in 1999, an increase of 2.9 percent that reflects Colorado’s population surge.

• Outpatient surgeries decreased by 11,076 or 7.3 percent compared to 1999. Inpatient surgeries increased by 5.4 percent during the same time. Home health visits dropped by 126,859, reflecting the dramatic decrease in Medicare payment for home health visits.

• Statewide, hospital patient-service margins increased from 3.1 percent in 1999 to 5.6 percent in 2000; however, rural hospitals as a group saw a decrease inpatient service margins from 2 percent on average in 1999 to 0.8 percent in 2000.

• Medicaid payment as a percentage of cost continues to decline: from 89.1 percent in 1999 to 81.1 percent in 2000. Medicaid payment as a percent of cost has declined from 95.1 percent in 1995.

• Outpatient charges ac-counted for 56 percent of total charges in rural hospitals, 35 percent in metro Denver hospitals and 39 percent in other urban hospitals.