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Midland Memorial Hospital to start new patient payment policy
by Ruth Campbell
Midland Reporter-Telegram
- Elective, outpatient procedures affected.
By Ruth Campbell
Staff Writer
Starting June 1, Midland Memorial Hospital patients will have to pay their estimated out-of-pocket costs for elective or outpatient procedures up-front -- just as they do at physician's offices, President and Chief Executive Officer Russell Meyers said.
Because it is a county hospital, Midland Memorial has to admit emergency patients regardless of ability to pay, but this will affect procedures patients register for that patients' doctors have scheduled.
The move is being made to help increase collections, the board of directors learned at its meeting Wednesday.
Compared to what was budgeted for this year, the hospital is seeing approximately twice as many self-pay patients as it budgeted.
MMH budgeted 7 percent for patients who have no insurance and has seen that percentage rise to 13 percent so far this fiscal year, Meyers said.
"Most physicians and hospitals have emphasized up-front collection of deductibles and co-insurance for many years," Chief Financial Officer Larry Sanz said. "We have put off this change as long as we could, but our declining collections have now made that a necessity."
Meyers said if people cannot or will not pay the estimated out-of-pocket costs, "We'll refer them to financial counseling resources and try to come out with ways to help them meet their obligations."
"Fundamentally," Meyers said, "we're going to expect their out-of-pocket obligations at the time of admission, which we've never done before. We're pretty far behind the curve on that. Virtually all of our doctors do that and most hospitals in the country certainly do that. With a greater percentage of every bill being covered by the patients out of pocket, we have to have a process to assure we get paid what the patient owes."
Medical Center Hospital Chief Financial Officer Robert Abernethy said the Odessa facility has had the procedure in place for several years and collections have doubled. Like MMH, if a Medical Center patient does not have money to pay for a procedure, the hospital has financial counselors that can help qualify patients for assistance.
Costs not paid wind up as bad debt for the hospital. "Just for the month of April, we've booked over $4 million in bad debt. We budgeted about $2 million in bad debt (a month), so that's huge. Last year's total number was a little over $31 million. Virtually all of that is patients' out of-of-pocket obligations that they didn't pay," Meyers said.
If things continue, the hospital will be on pace to surpass that $31 million figure.
"It will take a little time for people to get used to (the policy), but it won't be the first time they've had to pay for what they've purchased up front," Meyers said.
According to the most recent figures available, 24 percent of Midland County residents are uninsured. "It's not just uninsured," Meyers said. "It's increasingly the underinsured that are problematic for us -- people who have big deductibles and big co-insurance obligations who have insurance, but they're going to pay the first $2,000-$5,000 out of pocket.
"A $5,000 out-of-pocket bill for a person with even a reasonable size income and a good job is still a pretty big worry. That's part of our reality," Meyers said. "That's the nation's reality -- that more and more of the cost of health care is being borne by the individual versus an insurance company. We just have to deal with that the best we can."
This is not a decision the hospital came to lightly.
"It's a new expectation from the people we serve," Meyers said. "We're going to have to inform people and explain why we're doing it.
"It's also going to be challenging for our registration people. It's a new skillset they're going to have to develop. They're not accustomed to asking for money assertively and informing people that failure to pay will mean cancellation of their procedure. That's all new. It won't come about easily, but we have to do it. We really don't have any choice about it at this point.
"We're training people now. We expect to be ready to go on Monday," he added.
Board members also got an update on the new patient tower, which is in the design phase. Depending on the shape, the estimated $140 million tower will stand 6 to 10 stories tall. Vice President of Support Services Cory Edmondson said officials are considering six to seven floors.
Eighty-percent of beds in the hospital will be moved into the tower and oldest parts of the hospital shut down. The new tower will be north of the hospital in the Garfield-Ohio street area.
As part of the plans, a new $6 million 450-space parking garage also is being discussed. With the opening of the medical office building, the hospital is at or near its parking capacity, Edmondson said.
However, he emphasized the garage still is a work in progress.
Ruth Campbell can be reached at ruth@mrt.com.
By Ruth Campbell
Staff Writer
Starting June 1, Midland Memorial Hospital patients will have to pay their estimated out-of-pocket costs for elective or outpatient procedures up-front -- just as they do at physician's offices, President and Chief Executive Officer Russell Meyers said.
Because it is a county hospital, Midland Memorial has to admit emergency patients regardless of ability to pay, but this will affect procedures patients register for that patients' doctors have scheduled.
The move is being made to help increase collections, the board of directors learned at its meeting Wednesday.
Compared to what was budgeted for this year, the hospital is seeing approximately twice as many self-pay patients as it budgeted.
MMH budgeted 7 percent for patients who have no insurance and has seen that percentage rise to 13 percent so far this fiscal year, Meyers said.
"Most physicians and hospitals have emphasized up-front collection of deductibles and co-insurance for many years," Chief Financial Officer Larry Sanz said. "We have put off this change as long as we could, but our declining collections have now made that a necessity."
Meyers said if people cannot or will not pay the estimated out-of-pocket costs, "We'll refer them to financial counseling resources and try to come out with ways to help them meet their obligations."
"Fundamentally," Meyers said, "we're going to expect their out-of-pocket obligations at the time of admission, which we've never done before. We're pretty far behind the curve on that. Virtually all of our doctors do that and most hospitals in the country certainly do that. With a greater percentage of every bill being covered by the patients out of pocket, we have to have a process to assure we get paid what the patient owes."
Medical Center Hospital Chief Financial Officer Robert Abernethy said the Odessa facility has had the procedure in place for several years and collections have doubled. Like MMH, if a Medical Center patient does not have money to pay for a procedure, the hospital has financial counselors that can help qualify patients for assistance.
Costs not paid wind up as bad debt for the hospital. "Just for the month of April, we've booked over $4 million in bad debt. We budgeted about $2 million in bad debt (a month), so that's huge. Last year's total number was a little over $31 million. Virtually all of that is patients' out of-of-pocket obligations that they didn't pay," Meyers said.
If things continue, the hospital will be on pace to surpass that $31 million figure.
"It will take a little time for people to get used to (the policy), but it won't be the first time they've had to pay for what they've purchased up front," Meyers said.
According to the most recent figures available, 24 percent of Midland County residents are uninsured. "It's not just uninsured," Meyers said. "It's increasingly the underinsured that are problematic for us -- people who have big deductibles and big co-insurance obligations who have insurance, but they're going to pay the first $2,000-$5,000 out of pocket.
"A $5,000 out-of-pocket bill for a person with even a reasonable size income and a good job is still a pretty big worry. That's part of our reality," Meyers said. "That's the nation's reality -- that more and more of the cost of health care is being borne by the individual versus an insurance company. We just have to deal with that the best we can."
This is not a decision the hospital came to lightly.
"It's a new expectation from the people we serve," Meyers said. "We're going to have to inform people and explain why we're doing it.
"It's also going to be challenging for our registration people. It's a new skillset they're going to have to develop. They're not accustomed to asking for money assertively and informing people that failure to pay will mean cancellation of their procedure. That's all new. It won't come about easily, but we have to do it. We really don't have any choice about it at this point.
"We're training people now. We expect to be ready to go on Monday," he added.
Board members also got an update on the new patient tower, which is in the design phase. Depending on the shape, the estimated $140 million tower will stand 6 to 10 stories tall. Vice President of Support Services Cory Edmondson said officials are considering six to seven floors.
Eighty-percent of beds in the hospital will be moved into the tower and oldest parts of the hospital shut down. The new tower will be north of the hospital in the Garfield-Ohio street area.
As part of the plans, a new $6 million 450-space parking garage also is being discussed. With the opening of the medical office building, the hospital is at or near its parking capacity, Edmondson said.
However, he emphasized the garage still is a work in progress.
Ruth Campbell can be reached at ruth@mrt.com.
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The following are comments from the readers. In no way do they represent the view of mywesttexas.com.
llbmtx wrote on May 29, 2008 8:23 AM:
" No options for a payment plan even??? What good is health insurance even going to be for the underinsured in Midland County? We can now visit our physician, find out what's wrong, and thanks to Midland Memorial, be left to suffer with our ailments requiring surgery! don't get me wrong, I understand the need for MMH to collect payments from patients. I just wonder if they realize that they will end up eating more ER costs due to people not being able to afford to pay "upfront" for necessary procedures. I seriously doubt this policy is going to save money for anyone. Maybe those who sit on the board would be willing to donate part of their salary or kickbacks to help the rest of us who don't have that money just sitting around. Yeah, right. "
Insider wrote on May 29, 2008 1:00 PM:
" What about all the dead weight of our society that clutter our ERs for such things as a script for tylenol, or bring all 5 kids when one only one is sick & want all of them checked out. To top it off they have no insurance, no money, no job, & will never pay a dime. MMH also needs to evaluate the joke they call security to handle visitors that bring 25 to 30 family members with them & turn the waiting rooms into a reunion site. "
Ezra wrote on May 29, 2008 1:23 PM:
" The only problem I see with this is the fact there are many of us living on Social Security and we do not have the means to pay out of pocket expenses for medical treatment. Even though I do have Medicare it does not cover a lot of hospital expenses and this would leave me with a huge out of pocket expese of which I cannot afford.
I do understand the need of MMH to be able to collect monies in order to keep the hosptal going, but I also see where this is going to cause a lot of people in desperate need of medical attention not to be able to get the medical attention they so desperately need.
For example in 2005, when I did have regular insurance and was diagnosed with Hodgkings Lymphoma my hospital bill was over $ 130,000 80% of which was paid by my health insurance. However, after all of the Chemotherapy and everything else required to fight the cancer, the hospital bill would have been over $ 20,000 for me to pay out of pocket. However, after all was said and done, I ended up having to go onto Social Security Disability and there is no way I would have been able to pay the remaining amount out of my pocket. Some where there has to to be a medium point to where those of us living on limited incomes will still be able to receive the medical care we need without being faced with a huge out of pocket expense we cannot aford. "
I do understand the need of MMH to be able to collect monies in order to keep the hosptal going, but I also see where this is going to cause a lot of people in desperate need of medical attention not to be able to get the medical attention they so desperately need.
For example in 2005, when I did have regular insurance and was diagnosed with Hodgkings Lymphoma my hospital bill was over $ 130,000 80% of which was paid by my health insurance. However, after all of the Chemotherapy and everything else required to fight the cancer, the hospital bill would have been over $ 20,000 for me to pay out of pocket. However, after all was said and done, I ended up having to go onto Social Security Disability and there is no way I would have been able to pay the remaining amount out of my pocket. Some where there has to to be a medium point to where those of us living on limited incomes will still be able to receive the medical care we need without being faced with a huge out of pocket expense we cannot aford. "
midlland tax payer wrote on May 29, 2008 5:17 PM:
" let me get this straight "Midland Memorial
has to admit emergency patients regardless of ability to pay, but this will affect procedures patients register for that patients doctors have scheduled" this is ridiculous!!!!! what about all these illiegals getting FREE medical care at Midland Memorial Hospital? they NEVER pay for anything! and the working tax paying home owner citizen has to pay "upfront" for the 20% or so not covered by their insurance!!!!! when does the illegal person have to pay for emergency room care they receive? "
has to admit emergency patients regardless of ability to pay, but this will affect procedures patients register for that patients doctors have scheduled" this is ridiculous!!!!! what about all these illiegals getting FREE medical care at Midland Memorial Hospital? they NEVER pay for anything! and the working tax paying home owner citizen has to pay "upfront" for the 20% or so not covered by their insurance!!!!! when does the illegal person have to pay for emergency room care they receive? "
going down the drain midland wrote on May 29, 2008 6:14 PM:
" midland memorial needs to do something about all those kids that the lazy parents that don't work but can sure take a damn handout keep having. if anyone takes a welfare handout then there needs to be a spay and a neuter done........one man. one woman ........spayed and neutered then they can have their free services that we citizens that were raised to support ourselves have having to pay for the lazy worthless bumbs....
midland memorial hospital is as big a coward as the police are when it comes to doning anything about these bums..
fi the bums don't have to pay for the services at the hospitals then we all need to stop paying........
this is making the hard workers that were raised with some thought of responsibility forced to cover the worthless bums.
midland memorial needs to go after all these people sitting in the waiting room wanting to see a doctor and have not intention of ever paying ......
THIS IS JUST ANOTHER EFFECT WE SEE FROM NOT CLOSING THE BORDER AND SECURING IT......PROSECUTE AND DEPORT ALL ILLEGAL,,,,,,ILLEGAL ALIENS.
GET THE PICNICS AND THE FAMILY REUNIONS OUT OF THE WAITING ROOM OF MIDLAND MEMORIAL HOSPITAL......
have you gotten your notice of your taxes going up agan......
they are going up...... "
midland memorial hospital is as big a coward as the police are when it comes to doning anything about these bums..
fi the bums don't have to pay for the services at the hospitals then we all need to stop paying........
this is making the hard workers that were raised with some thought of responsibility forced to cover the worthless bums.
midland memorial needs to go after all these people sitting in the waiting room wanting to see a doctor and have not intention of ever paying ......
THIS IS JUST ANOTHER EFFECT WE SEE FROM NOT CLOSING THE BORDER AND SECURING IT......PROSECUTE AND DEPORT ALL ILLEGAL,,,,,,ILLEGAL ALIENS.
GET THE PICNICS AND THE FAMILY REUNIONS OUT OF THE WAITING ROOM OF MIDLAND MEMORIAL HOSPITAL......
have you gotten your notice of your taxes going up agan......
they are going up...... "
J R wrote on May 29, 2008 6:26 PM:
" I have had cancer also. I'm retired and on a pension and if I ever have to face more hospital expenses I don't know what this will mean to me. I tried once to get the lonestar card. I couldn't but in the waiting room were younger people that were not white or black and they all had cell phones talking on them. If they need help from the lonestar card then why can they afford the cell phone. I see people in the waiting rooms in the ER that have cell phones and I doubt they are going to pay for their hospital services.
Maybe MMH is in cahoots with the insurance companies. If we cannot pay up front and dont live as long as we might have then the insurance companies are saving from not having us as such a long term expense either.
I agree, we all need to just go to the emergency room and dont give any insurance information.
I have heard one can just give a third party name and address and Midland Memorial will bill them and the patient is free from any bills because MMH did not go after the patient....they go after the person that has no idea of who he is being billed for...... it his responsibility to fix MMH's mistakes....
Guess that is what we will be doing with this. We will be fixing MMH's billing problems because they are irresponsible and do not control what goes on in the emergencies.
We can all just start having our own pizza parties and family reunions at the emergency room of Midland Memorial Hospital.....
Guess the funeral homes will be getting busier...
Isn't this something to be proud of about the hometown of GWB.......
If you are a bum you can get emergency room services.....IF you are a hard working responsible individual.....well. There goes the middle class.... "
Maybe MMH is in cahoots with the insurance companies. If we cannot pay up front and dont live as long as we might have then the insurance companies are saving from not having us as such a long term expense either.
I agree, we all need to just go to the emergency room and dont give any insurance information.
I have heard one can just give a third party name and address and Midland Memorial will bill them and the patient is free from any bills because MMH did not go after the patient....they go after the person that has no idea of who he is being billed for...... it his responsibility to fix MMH's mistakes....
Guess that is what we will be doing with this. We will be fixing MMH's billing problems because they are irresponsible and do not control what goes on in the emergencies.
We can all just start having our own pizza parties and family reunions at the emergency room of Midland Memorial Hospital.....
Guess the funeral homes will be getting busier...
Isn't this something to be proud of about the hometown of GWB.......
If you are a bum you can get emergency room services.....IF you are a hard working responsible individual.....well. There goes the middle class.... "
SHELLEY wrote on May 29, 2008 6:42 PM:
" how ridiculous, i understand the point of the policy but the practicallity is not great! people do not have "extra" money to pay upfront. i think the policy needs to be rethought and changes made to help the middle class working americans that are carrying the load for all those that are illegal ailens or on government help, that do not really need to be, and those that are elderly and are on fixed incomes they cannot afford such things they are already having to decide whether to eat or pay for their prescriptions. thank God that i won't be using that hospital anytime soon... "
midlander wrote on May 29, 2008 7:53 PM:
" Please read the article..."Meyers said if people cannot or will not pay the estimated out-of-pocket costs, "We'll refer them to financial counseling resources and try to come out with ways to help them meet their obligations."
The hospital is not going to turn away patients who need life or death surgery...this is for elective or outpatient procedures.
If you cannot pay, they will help you figure out a way to pay. Read the article again before getting crazy about things. If the hospital continues losing money like it is, no one will get the care they need: elective surgeries, indigent ER care, or life saving cancer treatments. "
The hospital is not going to turn away patients who need life or death surgery...this is for elective or outpatient procedures.
If you cannot pay, they will help you figure out a way to pay. Read the article again before getting crazy about things. If the hospital continues losing money like it is, no one will get the care they need: elective surgeries, indigent ER care, or life saving cancer treatments. "
midlander wrote on May 29, 2008 7:59 PM:
" Ezra, how do you suppose the rest of your hospital bill was going to be paid? The out of pocket expense is there whether you pay before the procedure or after. MMH is simply telling patients that they must pay ahead of time for the procedure rather than after. It is not adding expenses to medical costs, just that patients pay before rather than after. I would also think that for a $20,000 bill that some arrangement would be made, read Mr. Meyer's quote in my post above.
Paying for care above and beyond what your insurance pays is not MMH's idea, that is between you and your insurance company. "
Paying for care above and beyond what your insurance pays is not MMH's idea, that is between you and your insurance company. "
Azzana wrote on May 30, 2008 1:25 AM:
" It is sad that inspite of having health insurance, one still needs to be concerned with having to pay the out of pocket immediately prior to medical care. This is especially true when the patient may have had an excellent payment history but no longer receives the credit he or she may so desperately need. "
citizen wrote on May 31, 2008 7:36 AM:
" get the free loaders out of the hospital. get the kids out of the waiting rooms.
get the lazy fat sleepers off the couchers in the waiting rooms.
get the lazy fat freeloaders to use the waste baskets.
let the freeloaders pay up front. that is where the problem is comming from.
every working middleclass person that is paying his way thru life needs to go to the emergency room waiting room and just sit and watch. you would be suprised what you see go on. "
get the lazy fat sleepers off the couchers in the waiting rooms.
get the lazy fat freeloaders to use the waste baskets.
let the freeloaders pay up front. that is where the problem is comming from.
every working middleclass person that is paying his way thru life needs to go to the emergency room waiting room and just sit and watch. you would be suprised what you see go on. "
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Property Owner wrote on May 29, 2008 7:17 AM:
Now Screw the responsible citizens.
MMH needs to tell these NON emergency people sitting in the emergency room to go to a doctor..... The emergency room should be used for emergencies onlyl
MMH needs to STOP taking 3rd party billings with out verifying with the 3rd party FIRST that they have agreed to pay someone else's bills.
In Midland maybe the responsible patient with insurance should just NOT USE their insurance at MMH.
MMH has needed better management for a long time.
Children should not be allowed in waiting rooms. It is not a family reunion or a picnic area. IT is a hospital .......
Refer these irresponsible parents to baby sitter.
IF GOING TO MMH.....DO NOT USE YOUR INSURANCE......
You've paid taxes for it's use if you are the property owner in Midland Texas.
OR better yet... go to Odessa where the doctors are better and the hospital is safer. "