Co-payments an obvious money source for TGH

February 06, 2007 11:00 pm

As hospitals, clinics, doctors' offices and pharmacies around the country do, Tuolumne General Hospital requires many patients to pony up co-payments — those out-of-pocket costs most insurance companies require.

So what?, you may ask. Co-payments of $10, $25 or even $100 are hardly a new concept in health care coverage. Patients have been paying them for decades.

But surprisingly, co-payments — or at least the consistent collecting of them before a patient leaves — are a new concept at the Tuolumne County-owned hospital. Requiring that these charges be paid up front just started there last week.

This step came only at the direction of a Texas-based firm hired to overhaul the hospital's previously awful billing and collections practices.

Yes, along the lines of better late than never, it's good that co-payments are now being charged of all TGH patients not covered by Medi-Cal or Medicare.

Tuolumne General Hospital's well-documented financial woes border on legendary — the facility has drawn away more than $23 million from the county's general fund over the past eight years, and county leaders predict the hospital will lose another $7 million in the current fiscal year.

And for as long as the hospital has been deep in the red, its ability, or lack thereof, to collect for the medical services it provides has been in doubt.

But until now, some patients were allowed to leave without having to cover their co-payment immediately because, TGH financial officials say, the hospital staff members there to collect the co-payments didn't always have enough information about what co-payment amount to charge.

Why they couldn't check then and there with the insurance provider by phone — a standard practice with all those other hospitals, clinics, etc. — is unclear.

Instead, the hospital attempted to bill the patient for the co-payment once that amount was known. Not suprisingly, collecting on those bills was not always successful.

No one is suggesting that the new charging of co-payments will cure all that ails Tuolumne General, especially since roughly 70 percent of its patients are on Medi-Cal or Medicare. Low state and federal medical insurance reimbursement rates will continue to hamper efforts to make the hospital even close to being financially stable.

Still, every effort to collect every cent owed for medical services must be taken.

But the fact that TGH is only now consistently asking for co-payments at the time a medical service is provided raises some disturbing questions about past hospital practices — and promises.

Regarding the co-payment rule, two hospital trustees noted that they have urged hospital leaders for several years to launch stricter billing practices.

Trustee Ken Compton further said he had asked for two years that co-payments be collected at the hospital and its clinics — and had been told that they were being collected.

So were the trustees previously just getting lip service whenever they pushed for change? What other better business practices were they assured were under way? And were those changes really instituted?

Did any of the much-lauded 10-step recovery plan introduced in 2004 that then-hospital leaders swore was working really get put into practice?

Even the non-skeptics among us must wonder.

At this point, looking into what was or wasn't really really done in recent years to better Tuolumne General's future is largely water under the bridge.

We can only hope that the firm now charged with getting the hospital on financial track continues its tough-love overhaul and makes sure that even the most obvious money sources — such as co-payments — are tapped.

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Union Democrat editorial positions are formed through regular meetings of the newspaper's editorial board — Publisher Geoff White, Managing Editor Patty Fuller and senior reporter-columnist Chris Bateman.