May 14, 1985 - 7:30 PM - County Board of Commissioners Meeting Minutes (Recessed)

The Johnston County Board of Commissioners I reconvened in regular sessionTuesday, May 14, 1985, at 730 pm, in the Conference Room, Johnston MemorialHospital Annex Building, Smithfield, North Carolina, with the following memberspresentNorman C Denning, Chairman, James W Cash, Howard Benton and JohnM Booker, DVMMember Absent Frank B Holding, Vice ChairmanAlso present at this meeting; Kramer Jackson, County Manager, EleanorN Creech, Clerk to the Board, and W R Britt, County AttorneyThe purpose of this meeting was to meet in joint session with JohnstonMemorial Hospital Board of Trustees and State Legislators to review the issueof indigent medical care at the hospital; specifically in three areas; the MentalHealth Center, the Emergency Room, and the Obstetrical UnitHospital Board of Trustee members present Dr Thomas M Johnson, HermanStewart, J A Creech, Benny Williams, Polly Richardson, Maynard Barnes, MelvinEdwards and Maurice GrissomAlso present; Randy Fowler, Acting Administrator, and Mike DeVaughn,Financial ControllerState Legislators Representative Barney Paul Woodard, RepresentativeGeorge Brannon, and Senator Robert D WarrenHoward Benton, Chairman of the Hospital Board of Trustees and CountyCommissioner, opened the meeting and welcomed everyoneNorman C Denning, Chairman, Board of County Commissioners, calledhis board to orderRandy Fowler introduced Herman Mullins, the new Hospital AdministratorMr Mullins spoke briefly of his background and experience prior to coming toJohnston County He comes to Johnston Memorial Hospital from Franklin MemorialHospitalr`0?0May 14, 1985 Continued;Njr DeVaughn stated that 43 of patients are medicare patients and 7are medicaid patientsHe indicated the hospital had implemented a screening program in theEmergency Room, which had decreased emergency room patients by one third,a 15 decline since the screening program beganIn addressing the OB unit for indigent care the Health Department pays350 per delivery and it cost the hospital based on a three day stay approximately1,000 per delivery Some of these patients have been referred to Wayne CountyUnder the Hill Burton Obligation the hospital is required to providefree care to those patients that meet the poverty level guide lines; it says thehospital will provide care for poverty level patients regardless of ability topayChairman Denning responded the Board of Commissioners appreciatesthis information, he asked why patients are referred to Wayne County, he saidit seems if you had more patients you could spread the cost¦iIsMr Fowler opened the business session statingthey hadprepared datarelative to the indigent care problem at thehospital and need toaddress whopays the uncollectible debts for this careMike DeVaughn, Controller, presenteda summaryof uncollectibleaccounts,charity care and contractual adjustments showinga totalof 4,087,816He statedthis figure respresents 270 of every dollar thehospital chargesfor patient servicesHe further advised, with the recovery of baddebts, Mental Healthreimbursementand county appropriation, the uncollectible amount usuallyends upbeing approxi-mately 1,500,529 The Mental Health Centeris chargedwith 15of the total_bad debt of 288,122; 53 of this figure isrelated toalcohol He reviewed thefollowing data at lengthTotal Annualized Uncollectible Accounts;1,938,360Less Recovery of Bad Debt153, 122Mental Health Reimbursement1841709County Appropriation100,000i11,5007529Made Up of of Total of TotalRevenueBad DebtMental Health 415288, 122Alcohol53152,979Other47153,143IEmergency Room Outpatient2218353,442 OB Del i very Nursery 4112281616Other 70561,068,1601001001,938,340Charity CareHill Burton Obligation264,241Contractual AdjustmentsWorkers Compensation110,066Program for the Blind5,110Vocational Rehabilitation50,738Department of Human Resources25,434Medicare1,4401915Medicaid352,97211,8859235Total of Uncollectible Accounts, CharityCare andContractual Adjustments4,087,816Average per admission 984;Njr DeVaughn stated that 43 of patients are medicare patients and 7are medicaid patientsHe indicated the hospital had implemented a screening program in theEmergency Room, which had decreased emergency room patients by one third,a 15 decline since the screening program beganIn addressing the OB unit for indigent care the Health Department pays350 per delivery and it cost the hospital based on a three day stay approximately1,000 per delivery Some of these patients have been referred to Wayne CountyUnder the Hill Burton Obligation the hospital is required to providefree care to those patients that meet the poverty level guide lines; it says thehospital will provide care for poverty level patients regardless of ability topayChairman Denning responded the Board of Commissioners appreciatesthis information, he asked why patients are referred to Wayne County, he saidit seems if you had more patients you could spread the cost¦iIsMay 14, 1985-ContinuedMr DeVaughn emphasized the health care industry is in a critical situation,it is difficult for the hospital to collect; they are in a situation where theyhave to ask the question; of who pays for indigent care; a medical care facilityhas to be financially sound to provide quality patient careDan Ahart of HMC, says that paying patients are paying 125 a dayover and above their cost to compensate uncollectible accounts; uncolIectibleaccounts average about 11,000 a day; it was emphasized that health care costcan no longer be shifted as it use to beIn response, the County Manager said the hospital can not shift thecost of indigent care to the county ; the hospital needs to get more paying customers,collect more money; the county is not in a position to pick up more indigentcare cost, paying the debt service should be the countys share of this cost;and further the county spends many dollars through various county agenciesand services you do not see directlyThe Board of Commissioners was told the hospital has added new equipmentand new doctors to offer more and better medical care However, a hospital boardmember indicated the purpose of this meeting was intended to attempt to showthe complexity of the hospital situation as it stands at this timeCommissioner John M Booker stated tothe group, the hospital has problemsand it will continue to have problems, weare really talking about money; weare not thinking of a poor quality hospital,we expect a general hospital thatwe can go to if we need medical care and it needs to be addressed in that mannerCommissioner Booker continued that the countyis looking at a long term problemHe pointed out the customer is not you andI, but the physician that uses thehospital, if the hospital does not have enoughphysicians it will not have patients,the need is more physicians using the hospital He continued, the county hasspent a lot of money on capital improvementsand equipment that did not changethe image of the hospital; this presents aproblem that has to be dealt withtoday He stated there is a need for group practice in this community, ifwe are going to compete; we need to competewith those who have been successful,the doctors have to get people to come back to the hospital, instead of goingelsewhere, the people have to have confidence inthe doctorsIt was also brought out that liabilities for physicians and hospitalshave got to be reduced; it causes increased cost in hospital careHoward Benton, Commissioner and Hospital Board Chairman, stated thatwe all recognize the perilous position the hospital is in; the hospital is in dangerof reduction of revenues which will reduce health services Commissioner Bentonquestions how far county government can go and says unless something is donehospitals will get into such condition they can not render quality health careA solution would be state and federal assistance Commissioner Benton asked thestate legislators what they thought might happen in RaleighRepresentative Barney Paul Woodard responded that all hospitals havethe iproblems that Johnston County is experiencing; there is a liability problem;he hopes the State will address the liability situation He continued that it isa state wide problem, with no solution at this time, however, the representativesassured this group they will be seaching for a solutionUpon a motion by Commissioner John M Booker, duly seconded by Com-missioner James W Cash and carried, the board recessed until Monday, May 20,1985, at 730 pm, to meet in the Commissioners Room, Johnston County Courthouse,Smithfield, North CarolinaNorman C Denning, ChairmanEleanor N Creech, Clerk to the BoardCommissioner Booker in closing stated, myearnest desire isthat ourcountyprovide better medical service which wehaveavailable today,we haveall gotto work toward this; the county can notpayfor indigent care,I thinkwe payour fair share; but I am not saying we willnotpay a little moreDan Ahart, HMC, responded that he agreedwith CommissionerBooker;and heis correct in saying that the medical staff istheanswerIt was also brought out that liabilities for physicians and hospitalshave got to be reduced; it causes increased cost in hospital careHoward Benton, Commissioner and Hospital Board Chairman, stated thatwe all recognize the perilous position the hospital is in; the hospital is in dangerof reduction of revenues which will reduce health services Commissioner Bentonquestions how far county government can go and says unless something is donehospitals will get into such condition they can not render quality health careA solution would be state and federal assistance Commissioner Benton asked thestate legislators what they thought might happen in RaleighRepresentative Barney Paul Woodard responded that all hospitals havethe iproblems that Johnston County is experiencing; there is a liability problem;he hopes the State will address the liability situation He continued that it isa state wide problem, with no solution at this time, however, the representativesassured this group they will be seaching for a solutionUpon a motion by Commissioner John M Booker, duly seconded by Com-missioner James W Cash and carried, the board recessed until Monday, May 20,1985, at 730 pm, to meet in the Commissioners Room, Johnston County Courthouse,Smithfield, North CarolinaNorman C Denning, ChairmanEleanor N Creech, Clerk to the BoardDetailsAnnotationsEntry PropertiesModified11192013 23924 PMCreated4162003 14810 PMTemplateMinutesFieldsMinutes - TypeRecessedMinutes - Date5141985Book17