02/14/13 — Commissioner questions 'ability to pay' procedures

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Commissioner questions 'ability to pay' procedures

By Phyllis Moore
Published in News on February 14, 2013 1:46 PM

The Health Department is not in the business of providing free services, officials said, but at the same time does not turn away those in need.

The issue came up at Wednesday's Board of Health meeting, when Health Director Davin Madden followed up on a previously discussed issue about health departments serving clients that don't have a Social Security number or the ability to pay.

There are funding guidelines, he explained, that are based upon a consolidated agreement between the state and health departments. Health Departments are required "to make every reasonable attempt to obtain payment," he said, but should not refuse service solely for being unable to pay.

The subject raised questions for one of the board's newest members, Joe Daughtery, representing the county commission.

"In regards to ability to pay, the question is, who's determining the ability to pay, I think is the question," he said.

The bulk of services require the patient to produce some form of identification, preferably a Social Security card. But there are exceptions, such as the maternity clinic, where patients can be seen for up to three months.

Evelyn Coley, director of nursing, said those patients can be seen on a sliding fee basis for the rest of the pregnancy.

"The question that I have, and that is that patients and individuals that we in fact are seeing are able to assist in some of the other costs," Daughtery said.

He admitted that, being new to the board, he was perhaps not as knowledgeable on the subject, but suggested the procedure should go further than simply asking the patient, "Are you able to pay?"

Madden told him there is an eligibility screening process and the Health Department tries "very vigilantly" to recoup its costs.

Ken Stern, administrative assistant for the Health Department, explained that patients are required to show proof of income, which determines what percentage they pay for services.

Ms. Coley added that some patients bring money at the time of the visit and pay when they check out or make arrangements to do so.

"There's an attempt made to get compensation from people the Health Department serves," said board member Robert Cagle III. "There are people that are indigent or cannot pay for whatever reason, and we will not turn them away."

"I think the question here being on the outside coming in, we want to make sure to let people know we have a procedure here at the Health Department to offset some of that cost to people that are unable to afford it," Daughtery said. "It's really just a matter of letting the public know, that we're not willy-nilly handing out services."

Cagle agreed with correcting any misperceptions or misinformation.

"We need to let (the public) know that we are stewards of the public's dollars but also that we are not turning anyone away," he said.

The health director said that because the health department receives funds from state, county and federal sources, every effort is made to collect payments, even to the point of designating an office to better "catch patients" as they leave the office.

"We have a problem with our floor plan with them walking out without paying," Madden said.

"My goal here is to make sure that message gets out and counteract some of the impressions that are in the community that we're handing out free services," Daughtery said. "That's just not the case. I want the public to understand that we are good stewards."

Several assured Daughtery that was being done.

"Didn't we have a smaller debt write-off this year than last?" asked board member Dr. Kim Larson, to which Stern replied "yes."

"Joe, I can appreciate your ideas and thoughts," said long-time board member Tommy Gibson. "This is a good steward of taxpayers' dollars, the Health Department. I think you'll see that."

The health director said, "You should be able to ask the question, Mr. Daughtery, and we should be able to provide answers."

He added that public health departments should ideally be able to provide services and then be compensated.

"Sometimes we do provide services we don't get paid for," he said. "They're not free, but sometimes we don't get paid for them."