Greene Publishing, Inc.

By Lynette Norris
Greene Publishing, Inc.
Three major themes of the March 22 Madison County Memorial Hospital board meeting were the financial struggles of small hospitals in poor rural areas, how to create more public awareness of the hospital’s work and get that information in to the hands of Madison County citizens, and of course, the new hospital.
Warren Irwin, a member of the public, addressed the board and asked about the hospital’s bad debt problem and what was being done to mitigate it.
Despite the bad debt problem, the hospital is current on its payroll and taxes, if not on general accounts, said Patrick Halfhill. When it comes to bad debt, the hospital tries for six months to collect before turning the account over to a collection agency. However, in the second poorest county in the state with high unemployment, “it’s a constant struggle,” he said. “We try to get (patients) to go to the health department and sign up for Medicaid, but we can’t do it for them.”
Bad debt is not unique to MCMH, added Hospital CEO David Abercrombie. The entire state of Florida ranks 47th in poor financial performance of small rural hospitals, and Madison County is one of four counties with a “persistent poverty” designation. Small hospitals also have no bargaining power with insurers and other payment providers.
When it comes to indigent care, Board Chairman Ben Harris said, “Our hands are tied. By law, when someone walks into that emergency room, we have to do an evaluation.”
In addition to poverty and high unemployment, the county population also ranks number one in diabetes, stroke, hypertension, and several types of cancers, including colorectal cancer. When discussing whether or not to continue the endoscopy program (providing the vital service of diagnosing colorectal cancer) despite losing money on it, Harris spoke of a decision that was “very easy business-wise, but morally it’s very difficult…we’re caught between the extreme medical and the extreme financial.”

Also, Medicaid now flags 100 percent of endoscopy procedures for review, stretching a two-week pay cycle into three months.
Tommy Hardee from the Hospital Foundation spoke about the need for getting information in front of the public. The Foundation has planned a series of three dinners for three separate groups of up to 100 people in order to get the information out to as many as possible. The youth group of the First United Methodist Church would serve the dinner in the fellowship hall where the Hospital Board would do a PowerPoint presentation of the audited financials and explain the purpose and progress of the new hospital. There was also a suggestion of holding at least some of the monthly board meetings, perhaps one per quarter, in other areas of the county such as Greenville or Lee, giving more citizens a chance to attend.
When it came to the new hospital, Abercrombie presented floor plan drawings and reported that the Agency for Health Care Administration had completed the stage one review and approved the plan. The next stage is working in the engineering components (IT system, nurse call system, HVAC system, etc.), a process expected to be completed in June.
The new facility would focus on family care and treating the whole patient. It will have a physical therapy department that could in the future expand to other types of therapy such a respiratory therapy.
Abercrombie then said that one thing that might help with the immediate cash flow problem was the new electronic record system; it would mean fewer dropped or lost charges for services, as well as getting invoices out to patients in a timely manner. The hospital will switch to the new system over a period of five days beginning April 1, and the board expects the new system to pay for itself in the first three months. Further into the future, the new facility would be reimbursed for 100 percent depreciation for every square foot devoted to patient care, bringing in more money once the new facility is up and running.
Also in the works is a joint luncheon meeting between the MCMH board and the County Commission, where the board will present the PowerPoint presentation and fill the commissioners in on what the hospital is presently doing. The meeting is planned for April 6 at noon, but the location has yet to be determined.