New billing policy on hold
By Kevin Huelsmann, Jackson Hole, Wyo.
October 12, 2010
St. John’s Medical Center trustees voted Monday to rescind a letter announcing a change in how patients of the hospital’s physician services offices are billed.
In a brief, early morning meeting, trustees decided to halt the proposed change and to take it up during a meeting later this month.
“We need to get a sense of what options there are and the financial implications of those,” board president Michael Tennican, who participated in the meeting via telephone from southern California, said. “We simply need more analysis before we move on this.”
The policy in question, which was set to go into effect Nov. 1, would have changed the way in which patients of the hospital’s physician services offices — St. John’s Institute of Cognitive Health; Family Health and Urgent Care; Ear, Nose and Throat and Allergy; and Internal Medicine — pay for services rendered in those offices.
The new policy would have required patients to “pay in full at the time of service” if they did not have insurance through a company with whom those offices already have a contract or are not part of the company’s network.
The proposed change was announced in the form of a letter, sent out Sept. 27 to approximately 4,000 area residents, which caused an uproar of public concern and a mixture of confusion and anger among valley residents. The furor quickly filtered back to hospital officials.
“The problem that we’re really looking at is that the letter that was sent out was unclear,” St. John’s CEO Pam Maples said.
The letter was addressed to “SJMC Physician Services Patient” and listed the four offices on the side of the letter, but it did not specifically delineate in the body of the letter that the changes only applied to those offices and not to the hospital.
Maples said the change was simply going to be a return to a system that had been in place when the four offices came under the auspices of the hospital.
Last fall, the physicians’ offices switched to a policy under which they would bill all insurance companies.
Hospital staff, however, said that too often they would be unable to collect in a timely fashion, or at all, money from patients whose insurance company did not already have an existing contract with the physicians’ offices.
Those companies with which the physician’s offices have contracts and will continue to bill are Blue Cross/Blue Shield — both the company’s Wyoming and out-of-state programs — Medicare Part B, Wyoming Medicaid, Idaho Medicaid and First Choice of the Midwest’s network, which covers an extensive list of plans, including Aetna, Assurant Health, Cigna and P5 Health Plan, among many others.
Hospital CFO John Kren estimated the hospital lost between $100,000 and $120,000 last year to noncontract insurance companies. Kerr said the hospital hired two full-time employees this year who spend a large amount of their time trying to track down some of those missing payments.
Trustees last week said they were “blindsided” by the proposed change and had no previous knowledge of it before it was announced in the letter.
To address the issue, trustees decided to call a special meeting — held yesterday — to review the proposal and address any lingering confusion created by the letter.
A majority of trustees at the meeting seemed to be in favor of continuing the current system in which physicians’ offices bill all insurance companies.
Trustee Bruce Hayse did not attend.
“These are meant as a community service,” trustee Emmy Knobloch said, referring to the four physicians’ offices. “We desperately needed an [ear-nose-throat doctor]. We really needed urgent care. When I hear $120,000 and $150,000 is coming out of the hospital’s pocket, it’s a really small amount.”
In reviewing the change, trustees said they will have to balance an obligation to keep the hospital financially viable with the level of service it provides to its patients.
Trustees said they plan to discuss the issue at a finance committee meeting scheduled for Oct. 26.