Year, Amount paid by county, # of patient claims paid
2013, $5 million, 14,549
2014, $5 million, 15,363
Unmet medical needs and high uncompensated care costs has some local hospital officials discussing alternative ways to use Montgomery County’s indigent care funding.
Montgomery County provides $5 million annually in reimbursements to local hospitals for treating people who cannot pay their medical bills.
But local hospitals typically provide 50 times more uncompensated care than that each year, said Bryan Bucklew, president and CEO of the Greater Dayton Area Hospital Association.
Hospital officials want to work with the county to evaluate programs that could improve access to free or low-cost health clinics or primary care services for the uninsured, underinsured and people without serious conditions, Bucklew said.
Programs that divert people from the emergency room who do not have urgent conditions could reduce the amount of bad debt and charity care hospitals are incurring, Bucklew said.
“The biggest driver of reducing health care costs and uncompensated care in the region is making sure people have access to the right health care at the right time at the right facility,” he said.
About 10 to 15 percent of residents in Montgomery County are uninsured, according to the hospital association. By law, hospitals are required to provide necessary medical care regardless of the patient’s ability to pay.
Hospitals in the county provide an estimated $252 million each year in uncompensated care, which is the actual cost of providing medical services to people who cannot pay the bills, the association said. The estimate does not include fees or charges.
Hospitals check to see if patients who receive services had insurance coverage or are eligible for coverage. If they are uninsured, and their accounts cannot be collected, local hospitals can submit invoices to the county for indigent reimbursements.
“This payment is for uninsured patients, but the contract calls for hospitals to receive these funds only after all other funding sources or collection efforts are exhausted,” David Miller, chief financial officer of Dayton Children’s Hospital.
In 2014, the county paid 15,363 indigent ill claims. The prior year, it paid 14,549 claims.
The county has provided $5 million annually in uncompensated care reimbursements since 2012.
The indigent ill claims are a last resort payment for people who cannot afford the health care they have been provided, said Tom Kelley, director of Montgomery County Human Services Planning & Development. The hospital invoices are paid on a first-come, first-serve basis. The program operates one year in arrears, meaning reimbursements for 2014 uncompensated care costs will be submitted in 2015.
Most invoices are for emergency room treatment, but some are for outpatient services, Kelley said. Bills can range from a few hundred dollars to hundreds of thousands of dollars.
“This is really the community’s commitment to being the continuum of health care services made available ,” Kelley said.
Kelley said the reimbursement was slightly less than $5 million when he first joined the county in 1992.
The reimbursement level has remained fairly steady since the program’s creation more than 30 years ago. The county’s reimbursements are based on Medicaid rates.
The net cost of uncompensated care provided by local hospitals was around $5 million when the county’s indigent ill program began in 1980s, said Bucklew.
But the county’s reimbursement has not increased to keep up with inflation or skyrocketing uncompensated care costs, he said.
Local hospitals are interested in finding ways the county and health care providers can work together to reduce these costs, Bucklew said.
The Affordable Care Act and Medicaid expansion are changing health care, and there may be some alternative ways the county can help poor and uninsured people get the care they need, he said.
“We are very satisfied with the current Human Service Levy allocation and any potential changes will be done in coordination and in partnership with Montgomery County and The Human Service Levy Committee,” Bucklew said.
Many people who cannot pay their medicals bills head to the emergency room for non-urgent medical issues, even though emergency care tends to be expensive.
Bucklew said local hospitals could benefit from a program that redirects patients with non-emergency issues to urgent care centers or Federally Qualified Health Centers.
Health centers — which can be reimbursed by Medicare and Medicaid — are open to everyone and they charge uninsured patients on a sliding scale, based on their income.
The centers, which must serve underserved areas or populations, tend to have lower per-patient treatment costs.
But Bucklew said the area’s health centers are popular and currently incapable of handling a large increase in usage.
He said the hospitals and county might be able to work together to help expand capacity at the centers.
“There are ongoing discussions about how that program could change in the future,” he said.
Bucklew also said improving citizens’ access to primary care services also could keep people out of emergency departments for non-urgent medical needs.
That might be achievable if clinics could offer longer office hours during the week or add weekend hours, he said.
Kelley, assistant county administrator, said he has not had discussions about changing the indigent ill program.
But, he said, the county, the hospital association and hospitals “are long-term partners in the care of the indigent health population,” and they are committed to healthier outcomes for the community.
Uncompensated care is a pressing issue in the Dayton area, because there is no public hospital, which typically serve as a last resort for medical care for the poor and uninsured, local officials said.
Among the 100 largest U.S. metro areas, Dayton is only one of only 11 that does not have either a university, city or county hospital, said Elizabeth Long, a spokeswoman for the Kettering Health Network.
“Our region’s hospitals have a significantly higher burden of uncompensated care than others because of this,” Long said.
Long said the indigent ill program benefits Montgomery County citizens and all the patients of hospitals in the county.
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