Uninsured patients who show up for non-emergency care at Grady Memorial Hospital, and live outside of Fulton and DeKalb counties, will have to go through financial counseling and pay in full before receiving services.
On Monday, Grady’s corporate board approved the policy for new, out-of-county patients -- another effort to improve the safety net hospital’s deteriorating bottom line. Grady is on course to lose $23 million this year and faces a projected $13 million shortfall next year.
“It’s not sustainable financially,” board chairman Pete Correll said. “Nobody expects this to be a silver bullet, but it’s simply a process we have to start.”
Patients from Gwinnett, Cobb and other counties account for 10 percent of Grady’s 550,000 visits each year -- costing the hospital roughly $25 million. Fulton and DeKalb counties, which will contribute nearly $65 million in indigent care funding to Grady this year, are the only counties that financially support the hospital.
The hospital instituted a sliding fee scale based on income for out-of-county patients in 2009. Patients were asked to pay a portion of the fee up front but didn’t pay off the rest, spokesman Matt Gove said. Now, patients will have to pay for all fees before scheduling services.
The policy will not apply to emergency department patients with trauma injuries or people who come for unique, specialty services that Grady offers. Existing out-of-county patients will be given options to settle their account balances.
Grady has dealt with a nearly $20 million cut in local and federal dollars to care for the poor and uninsured this year. It has cut more than 200 jobs and closed two neighborhood clinics, among other cost-saving measures.
With staffing down to just over 4,500 full-time employees, Grady chief financial officer Sue McCarthy hopes to avoid another round of job cuts.
The hospital has had a loss of $18.4 million so far this year through the end of July, though the past two months have been more positive, with Grady earning $700,000 in July and nearly breaking even in August, McCarthy said.
“One month doesn’t make a trend but two may be promising,” she said.
The new out-of-county patient policy will take effect Tuesday. Those who can’t pay will be given information about clinics and other options in their own communities, Correll said. Grady spends more than $200 million annually caring for the uninsured.
An identical policy was adopted at Parkland Memorial Hospital in Dallas five or six years ago, said John Haupert, Grady’s new CEO who will take over operations on Oct. 3, but attended Monday’s board meeting. Haupert has served as chief operating officer of the massive public hospital since 2006.
The Texas hospital, which is roughly 20 percent larger than Grady, has been under intense scrutiny by federal regulators, who threatened last month to cut off hundreds of millions of dollars in funding after inspectors found widespread unsanitary conditions and inadequate ER screening practices that put patients at risk.
The hospital said last week it plans to enter into an agreement with the Centers for Medicare & Medicaid Services to bring in outside consultants and implement corrections. Without it, Parkland would lose its Medicare funding on Sept. 30, a spokesman with the federal agency said, adding that the process could take up to a year.
Grady is cutting overtime hours and shortening the average length of stay for patients in an effort to reduce costs. Improvements to the collections process could bring in an additional $11 million.
The hospital recently opened a walk-in clinic as a less expensive option for patients who come to the ER with minor ailments. Grady ER visits have jumped by 11 percent so far this year, compared with a year ago.
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