The fiscal court questioned Union County Methodist Hospital Administrator Pat Donahue on the hospital's handling of the county ambulance service Tuesday, and is also looking at moving the service's billing and administration to an independent company.
Among the most startling developments in the issue was the disclosure by Donahue that the hospital charges patients $7.75 for a single 81 milligram tablet of baby aspirin.
"I don't understand why it has to be marked up 700 percent," Judge-executive Frank Eiter said. "It seems unconscionable to charge someone that much."
But Donahue said the cost is tied to the hospital's need to meet vigorous standards of quality assurance, and that the aspirin is different than what is purchased over-the-counter.
"The life of the pill is much longer than what is bought at Wal-Mart," he said.
Later he noted that the charge is "very standard" and that the price of healthcare is determined by numerous factors.
"It's unfortunate; healthcare's expensive," he said. "Part of that is governmental induced, part of that is people that don't pay, part of that is insurance companies that don't pay. It's not one reason."
Eiter also asked Donahue how soon-to-expire medications on the ambulances are handled.
Donahue said that because the integrity of such drugs is in question, they are discarded rather than used in the hospital.
In the wake of the ambulance service's considerable debt and because the county is required to pay it, several members of the court met Friday with 911 Medical Billing Services of Madisonville in a first step to consider handing over the billing responsibilities from the hospital to another entity.
Eiter said that the county will likely contact one or possibly two more independent billing companies as it also presses forward with a second audit of Methodist Hospital's books.
He stressed that the ambulance service itself is not under scrutiny.
"We have great (ambulance) service in Union County and we're blessed with dedicated technicians," he said. "It's not the operations we're questioning; it's the billing and administration we're questioning."
Donahue told the fiscal court at its June 27 meeting that the service was $178,000 in debt, an about-face from the $9,300 profit that had been expected.
The court has already paid or agreed to pay about $125,000 of the debt, but wants another audit conducted before retiring the remaining amount. Donahue presented the numbers as part of an audit conducted by McElroy, Mitchell and Associates.
Prior to the presentation, the court had not been informed of the ambulance service's accounting since February. The ambulance service contract between the hospital and the county requires that the hospital give a monthly statement to the fiscal court regarding the operation of the service.
At the court's Tuesday meeting, Donahue provided the missing reports and later said that an "oversight" was to blame for why they hadn't been presented since February.
"We have an interim (ambulance service) director and it was my understanding that those reports were being mailed," he said. He said he plans to begin presenting the reports to the court every month. "The buck stops with me."
Another matter causing Eiter concern is the collection of ambulance service bills.
The contract says that the hospital is to follow its "normal collection procedures" for the ambulance service. Nearly half - 49.5 percent - of the bills go uncollected. Donahue says that figure is similar to the hospital's collection rate on its other bills, but Eiter seems to believe a higher rate can be achieved.
"Under the current contract, there is no incentive to be aggressive in collections," Eiter said. "That's the biggest reason to hire outside."
He said the court has in the past asked the hospital for a study showing how the hospital employee responsible for ambulance service billing divides her time between that and other hospital duties. Eiter said the report has not been provided.
At the court's meeting, Donahue proposed moving the billing operations to the hospital's Henderson campus. He said there are several employees who are up-to-date on Medicare policies in Henderson and that their ambulance service collection rate is higher than Union County's.
Eiter said that 911 Medical Billing Services claimed that they collect 60 percent of their clients' bills.
When asked why the court was already looking to hire another billing service when the second audit of Methodist had not yet been conducted, Eiter said, "We may not get a satisfactory explanation of what happened."
Meanwhile, Adam French, the student appointed by the court to look into the ambulance service records and report what he finds to an accountant for the audit, has been told he cannot see the records in their current state due to Health Insurance Portability and Accountability Act regulations, Eiter said. HIPAA restricts how a person's health information may be used.
Patient names must first be removed from the logs before French can examine the information. Eiter said that the hospital is going to remove the names, but he did not have an estimate as to how long that would take.
