Newspaper Page Text
16-A
. The Summerville News, Thursday, November 3, 1988
‘Reasons For Hospital Losses
Medicare, Medicaid Reimbursement Not Sufficient
from front page
the ho?ital can't be billed for
the difference, he said.
In both cases, Dr. Goodwin
ang. szeit;er :aid. even if t}l:e
atient wants to pay the
goepitd the udflifimar amount,
federal and state regulations
forbid acceptance of the prof
fered money. The onl{ way it
can be accepted is in the form
of “‘a gift,"” they said.
PNEUMONIA
The hospital would make a
small profit on a pneumonia pa
tient who stayed in the hospital
@ a cost of $1,657, Sweitzer
said, after bei:(ficreimbursed for
$1,874 lfi/ Medicare. But with
Medicaid, the payment would
still be only $724.
If the hospital were paid the
full billin’fi(on each patient, it
could break even or make a pro
fit. For example, if the
pneumonit;lpatient who was in
the hospital 15 days could pay
the $7,134 billed for the ser
vice, the hospital would profit
above its cost of $5,850. But
the patient can't pay and
Medicare won't lf)ay anywhere
close to the full amount, the
hosgital administrator said.
atients are covered by
either Medicare or Medicaid —
but not both, he pointed out.
82 PERCENT
The hospital’'s cost for
treating a patient is about 82
percent of what the patient is
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BUCKETS IN HALLWAY CATCH WATER
Leak Developed In Hospital Roof
Begins Nov. 6th and goes through Nov.
9th. Bro. Tom Russell from North Sum
merville Baptist Church will be our
evangelist. The services will begin at 7:00
p.m. nightly. Special singing each night
also. Everyone is invited to come join us
in this revival. Rev. Ken Johnson, Pastor.
The church is located on Subligna Road.
CASCARA SAGRADA
Cascara Sagrada is a bark rich in hormone-like oils
which promote peristaltic action in the intestinal
canal. ft is one of the best herbs to use for chronic
constipation and is said to not be habit-forming. It
increases the secretions of the stomach, liver, and
pancreas and exerts a remarkable action in torpor of
the colon in constipation.
It has been effective to the gall ducts, and in help
ing the body rid itself of gallstones.
Cascara is very valuable whenever there are
hemorrhoids because of poor bowel function.
It helps in painless evacuations and, after extend
ed usa?'e, the bowels will function naturally and
regularly from its tonmic effects. It also i‘:as a
stimulating tonic effect to all nerves that it comes
in contact with. It is very cleansing to the colon and
helps rebuild its functions.
4 %ascara Sagrada contains B-Complex, calcium,
potassium, manganese and other trace minerals.
Cloudland Aloe & Herb Center
P. 0. Box 237 — Cloudland, Georgia 30731
Write or Phone 862-2310 for our brochure and price list or see The Herb Man at Penn
ville Trade Day Tuesdays or Saturdays Until 1:00 p.m. — Mastercard/Visa and/or mail
charged. For exam;fle. Sweitzer
said, if a patient is billed $1 for
a service, the hospital's actual
cost is about 82 cents of that
dollar. The rest is supposed to
be %rofit.
ut it doesn't work out that
way.
Although the hospital
usually profits from patients
who have private insurance, it
doesn’t average 18 cents on the
dollar, Sweitzer said.
A patient sufferi:(f heart
failure recently stayed in the
hospital for 10 Xays. The
hospital charge was $3,242 and
its actual cost was $2,658.
Medicare would have paid on
ly $1,379 or Medicaid only
$724, he noted. Private in
surance and the amount paid
by the patient would have
average(f $2,837. Thaf in
surance figure represents
about 87.5 percent OP the total
amount charged, Sweitzer said.
PROFIT
And although the hospital
would have made a profit of
$179 on the privately insured
patient ($2,837 payment minus
the cost of $2,658 equals $179),
it wouldn’t receive the full
amount billed of $3,242.
Most insurance companies
gay about 80 percent of the
otal charge, the executive
director said, but the patient
doesn’'t always pay his 20 per
cent. And insurance companies
sometimes decide they won't
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LEAK OVER ELECTRICAL BOX AT HOSPITAL
Roof Leaks Near Emergency Room
pay the full 80 percent on a cer
tain item, he noted.
Still, most hospitals want
as many insured patients as
they can get because the pay
ment amount is usually enough
to make a small profit,
Sweitzer continued. Many
Chattooga residents with in
surance who seek admission to
one of the two Rome hospitals
could be treated as easily at the
Summerville hospital, said
both Dr. Goodwin and
Sweitzer. They would be closer
to home, receive more per
sonalized care and help the
hospital financially at the same
time, they added.
SELF-PAY
The hospital also usually
loses money on patients who
work but don't have insurance,
Sweitzer said. They aren’t
covered by either Medicare or
Medicaid and often have inten
tions to fi)ay the hospital.
A self-pay patient who
stayed in the hospital for seven
da(i;ls for a urinary tract or
kidney infection would average
paying $2,459 to provide that
care, he said.
If the patient had in
surance, the hospital would
receive about $2,624 and make
a slight profit, the ad
ministrator continued. But
Medicare would pay $834 or
Medicaid would pay $724, he
noted.
Of course, indigent patients
pay nothing for their care. If it
cost the hospital $2,827 to
treat an indigent patient with
heart failure for 10 days, the
lfacility just has to absorb the
08SS.
ABSORB COSTS
It appears on the surface
that the Il)lospit;al would never
make a profit on Medicare.
However, that's not the case,
Sweitzer said. A larger hospital
such as Floyd Medical Center
at Rome makes a profit on its
Medicare l;l)atients with
pneumonia, he said, because
there are more patients to ab
sorb the fixed costs.
For example, if the fixed
costs of a hospital are SI,OOO
and it has only four patients,
the per-patient cost would be
$25& If, however, it had 10 pa
tients, the fixed cost per pa
tient would drop to SIOO each.
Fixed costs are such items as
staffing, equipment, utilities
and maintenance.
Dr. Gocdwin also noted
that most Medicare patients
are older and tend to have more
complications in an illness,
meaning they are more likely to
stay in the hospital longer than
younger patients.
UNFAMILIAR
There have also been cases
where doctors haven’'t admit
ted patients to Chattooga
Hospital because nothing more
could be done for them than if
they remained at home, Dr.
Goodwin said. Some of those
patients have then gone to a
Rome hospital and been admit
ted only because the admitting
doctor was not familiar with
that particular case, he con
tinueg. Then the patients get
angry at Summerville's d%c
tors and the hospital, Dr.
Goodwin said.
Larger hospitals are also
reimbursed more per patient
per illness, Sweitzer and Dr.
Goodwin said, because their
costs are higher than they are
at Chattooga Hospital.
Reimbursement by
Medicare and Medicaid is bas
ed on a hospital’s cost report,
Sweitzer said. If its costs of do
ing business is low, then its
reimbursement is low. If the
costs are high, then the reim
bursement is higher.
PENALIZED
In that sense, he added,
Chattooga is penalized because
its costs are low. Also, he
noted, smaller rural hospitals
receive a smaller Eerc.entage of
reimbursement than larger ci
ty hospitals.
Medicare reimbursement is
based on DRGs, or Diagnostic
Related Groups. The %deral
government has determined
that all diseases fall within cer
tain broad categories and reim
bursement is made on what the
government determines is the
averagfie cost and average stay
in the hospital for each of those
DRGs.
Some citizens also can't
understand why Chattooga
Hospital no longer delivers
babies, Dr. Goodwin said. They
point out that he delivered
them and their parents at the
hospital and can’t understand
what resulted in the closing of
the hospital's obstetrical unit.
ECONOMICS
The economics of delivering
babies requires that a large
number be delivered in a day or
the hospital will lose money,
Dr. Goodwin explained. Pro
cedures and equipment have
changed dramatically during
the last 20 years, Sweitzer
pointed out, and it isn’t
economically feasible to main
tain a unit to deliver just a few
babies per week.
‘‘Because people go to
another hospital outside the
area for some things, such as
having babies, they think they
have to go to them for
everything,” Dr. Goodwin ex
plained. *“We have excellent
doctors here and nursing care
at Chattooga County Hospital.
People tell me that the care
they receive here is better than
at Rome ... "
If the community had six or
seven family practitioners, it
could probably support a
general surgeon, Sweitzer said,
and the surgical unit might be
reopened. Ife would neeg to be
able to earn a living and do a
number of surgical procedures
daily, Dr. Goodwin said.
OUTPATIENT
Unlike inpatient care, the
hospital is alf)owed to attempt
to collect part of outstanding
bills from Medicare patients
who use the hospital’'s outpa
tient (emergency room)
facilities, Sweitzer noted.
He displayed actual bills —
with the patients’ names omit
ted — that showed total
charges of $2,172. Of that
amount, $335 was for use of
the emergency room physi
cian's services and $1,837.95
was for hospital services,
Sweitzer said.
The hospital would pro
bably end up with S2OO with
which to pay the emergency
room doctor, he added.
Of the remaining $1,837.95,
Medicare will pay only $532.70,
the hospitalp administrator
pointed out.
But Medicare will allow the
hospital to seek another
$331.25 from the emergenc
room patients, Sweitzer sai({
The full amount is rarely col
lected from the patient.
30 PERCENT
On the average, the hospital
collects about 30 percent on the
dollar from Medicare for use of
the emergency room, the
hospital afministrator sid.
The facility is limited
because of governmental
regulations ang low Medicare
and Medicaid reimbursement,
he said. That problem can be
remedied only by the U.S.
House and Senate and Georgia
legislators, he indicated.
In the meantime, Chat
tooga Hospital will continue to
treat patients who need care
and search for ways to increase
its revenue.
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Shirley Willingham, a bus driver at North
Summerville E%lementary School, is shown
with the students she shuttles back and
forth to school. Friday was bus driver ap
preciation day. According to Alma Lewis,
North Summerville Elementary principal,
Insurance Issue In Federal Court
A Chattooga County couple
is embroiled in a dispute with
an insurance company in U. S.
District Court at Rome over a
fire loss, attorney fees and re
quested penalties amounting
to more than $700,000.
The couple has charged
that the insurance coms)any
won't an a claim resulting
from a house fire last March 6.
The insurance company has
charged that the fire was set
deliberately.
The litigation began when
Alfa Insurance Corp. filed ac
tion in federal court against
Elliott H. Lewis and Leatha L.
Lewis. The couple has since
responded to the suit and filed
a counterclaim and Alfa has fil
ed an answer to that response.
APPLICATION
In its original action, Alfa
said the Lewises applied for in
surance on a home on the
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MR. BAISLEY
Bill Baisley
Promoted
Bill Baisley has been pro
moted to vice president-
Southeastern regional manager
for Peterson Farms, Decatur,
Ark. The announcement was
made by Vic Evans, president
of Peterson Farms at the com
pany’s recent annual sales
meeting.
Living previously in
Dalton, Baisley and his wife,
Maxine, moved to Summerville
in 1987 where he could oversee
the construction and operation
of Peterson Farms’ new
breeder hatchery at Trion.
Baisley joined Peterson
Farms in 1966 as a salesman
for the Southeastern U. S. and
later became district manager
for the same region.
LEADER
A native of Crossville,
Tenn., and graduate of Ten
nessee Tech, Baisley has long
been recognized as a poultry in
dustry leader in Georgia, the
Southeast, and the nation. He
has previously served as presi
dent, senior vice president, vice
president and director of the
Georgia Poultry Federation.
Baisley has been president
of the Dixie Poultry Associa
tion covering Georgia, Ten
nessee, North and South
Carolina. He was Southeastern
Poultry Salesman of the Year
in 1963, and has served as state
vice president to the
Southeastern Poultry and Egg
Association and president of
the Georgia Poultry Improve
ment Assn.
He has also been a member
of the State Advisory Council
on Vocational Education, presi
dent and advisory board chair
man of the John W. Looper
Speech and Hearing Clinic in
Dalton, member of tfie board of
the Chattanooga-Hamilton
County Speech and Hearing
Clinic, president of the Whit
field County, Mental Health
Association, and a trustee of
the Geor%a Sheriff's Boy's
Estate in Dalton. Baisley is a
member of the Summerville-
Trion Rotary Club.
Bus Driver Appreciation
Menlo-Teloga Road and said
they had not had any prévious
losses. However, the company
charged, the couple suffered a
total fire loss on the same
premises in 1980 but failed to
disclose that to the company at
the time the latest policy was
issued. ‘‘(T)he misrepresenta
tion was intentional”’ and Alfa
wouldn't have issued the policy
had it know about the earlier
loss, the insurance company
said.
No specific questions were
asked regarding any prior
losses, the Lewises sai! in their
answer, and claimed that the
agent filed in most of the ap
plication without asking any
3uestions. They also denied not
isclosing that “‘an old farm
house that was on the proper
ti; was lost to fire soon after
the property was purchas
ed..." Alfa knew of the loss
and the Lewises ‘‘did not
misrepresent any facts upon
which they were questioned,”
the couple added.
DENIAL
Alfa denied the couple’'s
claim regarding the application
in its response.
The insurance company
also said the March fire “‘was
intentionally set by the use of
an accelerant,” claiming that
the Lewises had a motive for
the fire. “‘Because the (Lewises)
intentionally set the fire which
destroyed the . . . house, or had
it set, this policy is void and
they cannot recover anything
uncfer the policy,” Alfa said.
The Lewises, on the other
hand, have denied that the fire
was intentionally set by use of
an accelerant and said that it
was a ‘‘fire of unknown origin.”
Alfa, in its latest response,
denied that ‘‘the fire was of
unknown origin and show that
it was set on (the Lewises’)
behalf.”
CONTENTS
Alfa said in its original suit
that the Lewises made a claim
in excess of $169,000 on the
contents of the house and of a
nearby mobile home. A “‘large
number”’ of the items cited was
not in the house or mobile
home, the insurance company
said, and ‘‘misrepresentations
as to the presence of these
items was made intentionally
and for the purpose of collec
ting insurance proceeds.”’
The mobile home wasn’t
covered or meant to be
covered, Alfa added. The
Lewises said that the mobile
home was covered by another
company for $11.(¥00 plus
$4,000 in contents. They said
in their counterclaim that the
second company advised them
to file the mobile home claim
against Alfa because the fire
that destroyed the mobile
home had started at the house
insured by Alfa.
NOTIFIED
Alfa was notified last July
12 that the claim on the mobile
home was being withdrawn
and being filed with the other
company, the Lewises said in
their answer.
In their counterclaim, the
Lewises asked for $350,000 in
the loss of their home, a net of
$138,998 for the loss of con
tents, living expenses of
$2,400, plus a $122,299 penal-
WSS NS S S SSSD SS S S S eS 5 G S S SS S S
POOR CIRCULATION:?
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b oot This Information Is Intended to Educate, Not to Prescribe.
"1-—-’7-1«*;: - Clip and Save This Coupon Good for $5.00 Off Mera-Chel
R % T Through November 12, 1988,
P. O. Box 237, Cloudland, Ga. 30731. Ph. 862:2310. Send for brochure or see the Herb Man Tues. and Sat. .
! 'til 1 p.m. at Trade Day. He’s there rain, sleet or snow.
Mrs. Willingham deserves the apprecia
tion. Before running her afternoon route,
Mrs. Willingham said she spent her day
helping at tie in-school suspension pro
%ram at Chattooga High School. (Staff
hoto By Rich Jefferson).
ty against Alfa and an
estimated SIOO,OOO in attorney
fees. They are seeking $711,297
plus interest and costs of the
suit,.
The suit was filed for the
Lewises by the Summerville
law firm of Westbrook and
Vines.
Alfa responded that the re
quested “‘bad faith penalties
and attorney’s fees is insuffi
cient in fact and in law" and
the counter-claim should be
dismissed.
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SEE MY AD ON PAGE 7-A
OF OCT. 27 ISSUE
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BEST WORK — BEST PRICES
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PHONE 734-7197
Sex Tapes
Seized By
Officers
A quantity of alleged sex
ually exrlicit video tapes and
zhoto albums seized from a
‘hattoolfil County residence
Monday by the sheriff's office
will be turned over to the
district attorney.
Information about the raid
will be submitted to Dist. At
ty. David L. *‘Red" Lomenick
“for what action the district at-
Lorneg deems necessarx."
Sheriff Gary McConnell said in
a written statement dated
Monday. '
Lomenick couldn’t be reach
ed Tuesday or Wednesday by
The Summerville News.
MecConnell said the material
was seized after a search war
rant was executed at the home
of a teacher, who was identified
in the release. The sheriff
noted, however, that no
charges had been filed.
Joel Cook, chairman of the
Chattooga County Board of
ducation, said Tuesday night
that he would have no com
ment on the matter and any
statement would have to come
from Carlton Vines, attorney
for the school panel.
Vines said ‘Bednesday that
he could not discuss the mat
ter pending further
investigation.
Don Hayes, school
superintendent, had no com
ment on the case.
CRYING TIME
A newborn baby cries more
often during the late afternoon
and early evening and in
creases over the first six weeks
of life. Researchers have found
that the more parents carry
their infants, -the less the
babies cry, say human develop
ment specialists with the
Georgia Extension Service.