Originally created 10/03/00

Funding by board attacked



A special grand jury report issued Monday afternoon derides the Augusta Commission for being uninformed about funding for the city's indigent care program at University Hospital.

But the grand jury - which scolds city officials for not understanding the process whereby money is provided to pay for the medical costs of the poor and uninsured - seems to have some trouble understanding the indigent care issue itself.

The report, released Monday by Superior Court Judge Albert M. Pickett, accuses commissioners of failing to understand how and why county money is used to pay for the treatment of patients certified as indigent.

Commissioners refute the jury's contentions that they have been irresponsible with taxpayer dollars or uninformed about indigent care funds and cite a subcommittee on indigent care, which was formed in February, as an indication of their efforts to reduce the cost to the city.

"We're looking at as many processes as we can to try to find what we can do to offset the cost of indigent care," Commissioner and Indigent Care Subcommittee Chairman Jerry Brigham said.

The report refers to indigent patients from other counties showing up at University for care, without those counties providing indigent care money to University as Richmond County does.

Therefore, "the Richmond County taxpayers subsidize the indigent care for multiple counties." But the certified indigent care program that Augusta contracts with University to provide is open only to Richmond County residents, and those patients are certified by the Department of Family and Children Services.

"There are no Richmond County dollars under this contract that go to reimburse the hospital for individuals from other counties," said J. Larry Read, chief executive officer of University Health Care System. The contract and the amount Augusta pays is renegotiated on a year-to-year basis, and the past few years it has created last-minute budget haggling.

The report also criticizes commissioners' lack of knowledge about the state's Disproportionate Share Hospital program, which comprises hospitals who treat a higher percentage of Medicaid and poor, uninsured patients.

The hospitals send to the state voluntary "intergovernmental transfer" payments, which are used to draw down extra federal money at generally a 60-40 match. The money is distributed through the Indigent Care Trust Fund.

The report questioned whether commissioners knew about a one-time lump sum payment of a net $4.2 million from the indigent care fund to University last year.

"It seems not," the report said. The grand jury apparently quizzed commissioners, and "the result of that questioning showed that no commissioner was aware of the second DSH payment at the time of the initial vote." The lump sum payment, however, was approved in October and was reported in The Augusta Chronicle.

It also was referenced in the budget City Administrator Randy Oliver sent to commissioners last year as one of the reasons he was recommending reducing the county's indigent care payment to University from $2.5 million to $1.25 million.

But commissioners said they could work only with the funding information hospital officials provide.

"It's impossible to have a working knowledge of every funding source for University Hospital," Mr. Brigham said. "... That's the responsibility of the people at University Hospital. It's also their responsibility to be honest about their funding sources."

There may be some confusion about the $4.2 million because that also is roughly the amount University's normal DSH payment was increased last year, part of an overall boost when the state was able to maximize payments. The announcement about that funding increase came Dec. 28 - the same day the commission met for a final vote on indigent care funding.

Without using names, the report apparently refers to an exchange during a Dec. 21 meeting that actually took place at the Dec. 28 commission meeting between former University official Richard Parks and Commissioner Steve Shepard about the increase that University was receiving from the state.

University conceded that Mr. Parks did not answer the question directly and may have been confused by the similar amounts of the two increases, Mr. Read said.

University Chief Financial Officer Robert Taylor said he made two lengthy presentations to the grand jury about the issue.

University officials said they are pleased that the grand jury report supports the need for indigent care funding.

"It just seems like they're challenging the process, and if that's the case that is easily resolved," Mr. Read said.

In addition to logistical errors, the report said Commissioner Bill Kuhlke sits on the indigent care subcommittee, when he does not, and left Commissioner Richard Colclough's name off the list.

The grand jury also accused commissioners of viewing the funding item as "a political decision."

Commissioner Andy Cheek, who serves on the indigent care subcommittee, admitted that there may have been some political motivations behind the funding, but that University officials created that climate by showing up at a budget work session last year with more than 60 supporters who made an emotional appeal to preserve health care for the poor.

"I think we should get out of the hospital business, but University Hospital did a really good job of lobbying the commission (for funds) by bringing the community to the commission meeting," Mr. Cheek said.

Reach Tom Corwin and Heidi Coryell at (706) 823-3213 and (706) 823-3215.

Augusta contracts with University Hospital to provide care for those in the certified indigent program. While University bills Augusta for the care, the amount the hospital will be reimbursed has been capped for several years. Here is a look at the program since 1997.

Year.......Indigent Billing..............Payment

1997........$4,163,863................$2,587,500

1998........$4,299,148................$1,293,750

1999........$3,109,918................$2,503,750

2000........$3,352,133*...............$1,250,000

* - projected.