Originally created 02/16/99

Refund rules skew indigent care costs



The cost of caring for certified indigent patients in Augusta last year turned out to be $500,000 less than first estimated by University Hospital, according to a final report.

But the figure is misleading because it includes refunds to the city when people later qualified for other programs, refunds that amount just to paper changes because the program already doesn't cover University's costs.

And it doesn't change University's desire to seek $1 million more in funding to cover the cost of this year's indigent patients.

The total cost of the indigent program in 1998 came in at just under $4.3 million, a slight increase from the previous year's cost of just under $4.2 million. In September, University estimated a $4.8 million cost based on the first eight billing periods.

But the final figure includes $1.2 million in "refunds" to the city, a complex accounting procedure required by University's contract with Augusta.

A certified indigent patient who later qualifies through a disability program for coverage by Medicaid or Medicare is then subtracted from what the city is billed, said Jack Bearden, director of strategic services.

Because the process can take years and coverage can be retroactive, refunds from past years showed up in greater numbers at the end of this year, and in some periods the refunds were greater than some charges and, thus, lowered the overall bill, Mr. Bearden said.

Without the refunds, the amount would have been about $5.5 million, said Richard Parks, president and chief executive officer of University Health Services and Extended Care.

Mr. Parks acknowledged the difference may be greeted with some skepticism but added that even at the lower amount the city is not covering the cost of the program.

The amount Augusta pays is capped at $2.5 million for this year -- University had asked for $3.5 million -- but Augusta officials had promised to revisit the issue after the first quarter.

The lower figures raised little concern among Augusta commissioners.

"I'm not overly concerned about that because we can't give 'em but what we can give 'em anyway," Commissioner Jerry Brigham said. But it also doesn't mean the extra million is coming, he said. "I don't think the money's there for that to happen."

Mayor Pro Tem Lee Beard said the lower numbers actually are "good news," though there is still an effort to get University what it needs.

"We're going to look for that money at the end of the quarter and whatever we could devote to that, we were going to try to do it, because I think most of the commissioners feel that's an area we have to support," Mr. Beard said.

Tom Corwin covers science and medicine for The Augusta Chronicle. He can be reached at (706) 823-3213 or tomc@augustachronicle.com.