RMC aims to make costs clearer

Patients coming to the Regional Medical Center for care will be informed of their financial responsibilities for the care upfront under a program implemented by the hospital last month.

“Our goal is to increase as much as we can transparency between the clinical and the business side of the operations,” RMC Chief Financial Officer Dennis Pettigrew said.

“To do otherwise is unfair to the citizens in our community,” he said.

Under the law, RMC is responsible for providing care to all patients that come through its doors, Pettigrew said recently.

Medicare, Medicaid and insurers such as Blue Cross, Aetna and United have rules and regulations on what costs they’ll cover.

Pettigrew said the RMC is stepping up its efforts to make sure patients better understand what their insurance providers will cover and what the patient is responsible for paying.

“We are looking at other ways to make certain that we can continue to provide high-quality care and continue to provide growing services in the community,” Pettigrew said. “We do not provide service in order to charge. We charge in order to provide service.

“Our goal is to take care of our community, but at some point we have to raise enough funds to be able to pay all the bills.”

While RMC is obligated to provide care, insurers look at various factors to determine if they will pay for the care.

“Medicare, Medicaid and other insurers say that it is great you provided the care, but it was not medically necessary or you may have provided too much care, meaning the care may have required two days length of stay as an inpatient but they may have stayed for five days,” Pettigrew said. “The three days get denied. We pay the cost for those additional days.”

Under Medicare rules, Pettigrew said if a patient has already been admitted, the hospital will provide the patient and their family a notice of non-coverage letter. The notice will inform the patient and family that the care that was necessary was completed for the patient and that the patient is ready to be discharged.

“The letter says if you want to stay in the hospital you can, but it is your cost,” Pettigrew said. “The cost to stay in a hospital is quite expensive.”

For patients receiving outpatient services, the hospital will issue an advanced beneficiary notice of noncoverage informing the patient of services that insurance will not cover, Pettigrew said.

“The more we do that and implement these changes, it is going to be a change for a lot of community members but as we do that, it will help the hospital perform better,” RMC President and CEO David Southerland said. “It will be little uncomfortable in certain situations, but we will get there.”

Pettigrew said about 20 percent of the care the hospital provides is denied or not paid for by the insurance company and ends up being the responsibility of the patient.

Pettigrew said the 20 percent denial rate is the “highest I have ever seen” and says the goal is to eventually get the denial rate down to 5 percent or right about at the hospital industry norm.

He says the 5 percent denial rate will be reached by managing resources and educating the public about the importance of preventative health care in order to reduce the need for admissions.

Pettigrew said the reason for the high number is a combination of clinical staff implementation and a culture of care in the community.

“We do have a number of patients, to be honest, who are used to using the emergency room as a primary care office,” Pettigrew said.

In order to make sure patients are aware of their share of the cost and to reduce hospital expenses, Pettigrew says the hospital has reintroduced a physician advisors program.

Pettigrew said the program has been implemented at the RMC over the years but has had its starts and stops. The program engages doctors to make sure the care provided is appropriate for what the patient needs.