Billing of self-pay balances will be brought back within the community, as announced by Melissa Memorial Hospital administration at the Tuesday, Jan. 26, East Phillips County Hospital District board meeting.
Continuing problems with the automated outside-party billing system that issues single-statement billing have accumulated to the point where it is more practical to return to the traditional model of separate statements for clinic and hospital services, which can be accomplished without outside services.
“In creating a single statement, it added a lot of complexity to an otherwise simple process,” explained CFO Jason McCormick. He described how the “OK, but not stellar” NextGen billing system used by MMH in combination with staff turnover does not work well when put into an automated system to produce a single statement.
“It’s going to keep breaking down on a regular basis, which leads to embarrassment and frustration for everyone involved,” said McCormick.
Last year’s main problem was delayed statement issuances, which led to complaints over the sudden receipt of expensive accumulated bills for some. This, in turn, led to more complaints of poor customer service from the company that issues the single statements, First Party Receivable Solutions. In the most recent snafu since the last board meeting, about 200 patients were accidentally issued duplicate statements from First Party.
In addition, NextGen has sold the hospital portion of their software to another company, and clinic and hospital billing systems will no longer be as compatible for combination into a single statement.
The news was reluctantly received by board members, who felt frustrated themselves after working so hard to gain the single-statement service for the community. Members felt that despite problems, the simplicity of a single statement had been received well by the community.
McCormick, who has been working in various health care facilities for over 20 years, explained that hospitals and clinics have very different billing systems for their services. Generally, only very large facilities have recently begun issuing single statements. Separate statements is still the traditional model for most facilities.
Despite the loss of the single-statement convenience, several advantages will compensate for the return to writing two checks instead of one, including:
—more accurate information reflected on statements.
—the reassurance that patients will receive their bills in a timely manner.
—better control over billing, as closer attention will be paid by MMH employees than an automated system.
—financial savings, as MMH will no longer be paying for the services of First Party billing.
—in-house customer service regarding billing.
The only cost resulting from the change for MMH will be the hiring of another employee to help handle customer service calls, a cost far outweighed by the savings from no longer paying for First Party’s services.
The transition back to in-house billing will take about two months, during which patients will continue to receive single statements from First Party as they have been. No balances will be sent to collections during this time.
McCormick estimated four months until billing and accounts receivable is back where it should be.
“We greatly appreciate everyone’s patience and feedback as we tried to make the single statement work over this past year,” he said.
2015 shows shifts in patient visits
In other matters reported at the Tuesday meeting, total patient days for the hospital in 2015 were fairly steady overall, down by only 10 compared to 2014 (991 days from 1001). Days for observation were up considerably from 2014 to within 14 days of 2012 and 2013 numbers, and outpatient registrations were up an impressive 418.
Much of the outpatient registration number comes from more people taking advantage of the specialty clinic and imaging.
Clinic visits were down from 7,317 in 2014 to 7,183 in 2015. However, in the month of December an influx of totally new patients was evident.
“We have lots of great nurse practitioners right now that have been received very well,” said board member Angie Powell.
Hospital to consider increase in telemedicine
Besides well-received nurse practitioners and increases in imaging use, MMH could potentially expand services offered even more by taking advantage of telemedicine, which uses cameras and the Internet to essentially Skype with a specialty doctor in another location for assessment without having to travel.
The item was reported as part of the review of MMH Policy 1.1 — Relief from Acute and Chronic Conditions.
The practice of telemedicine is on the rise in health care overall and is more practical than ever considering the amount of technology already involved in monitoring and assessing patients.
One method so common at MMH that it is not even considered “telemedicine” anymore is the sending of X-ray images taken at the hospital to a facility in Cheyenne, Wyo., for analysis.
Another method of telemedicine currently used by the hospital is the Tele Stroke program, in which a person suspected to be having a stroke can be analyzed immediately by a specialist via camera before deciding to life-flight or treat them.
Considering that the damage caused by a stroke increases exponentially with every 10-minute period that passes, but the medicine to treat a stroke would also be extremely damaging if misapplied, there is no time to waste in accurately assessing a patient.
“There is a need for telemedicine, but it needs to be done in a safe and secure manner,” said McCormick of the practice. “It would allow for a higher level of care quicker in a rural community.”
Telemedicine not only helps with faster care in emergency situations but could potentially allow MMH to offer more specialty and sub-specialty services with far less travel involved. Special tools such as stethoscopes that allow both a physically present nurse and a virtually present specialty doctor to hear breathing and heartbeats are also used in such practices.
Lack of EMS personnel a concern
Another item related to emergency care discussed at the Jan. 26 board meeting was the scarcity of emergency medical technicians. Currently, only about five volunteer EMTs are available during the day and only two are available for night shifts, as reported by EMS coordinator Sharon Greenman.
The aid of police and volunteer firemen has been imperative in helping make sure enough respondents are able and available in an emergency situation. When ambulatory help must come from Sterling or Greeley, hours are added to the time it takes to get proper care to a patient after counting the travel time to the scene and back to the hospital.
“We’re hoping for five more from a recent class,” Greenman said, adding that many facilities in the area are suffering from the same lack of personnel, whether paid or volunteer.
New CEO Trampas Hutches responded that there are a few different models of organizing EMS personnel to examine and see what fits the organization.
In other business at the Jan. 26 meeting, the board:
—passed two resolutions, one shifting banking authority to CEO Hutches and Chief Nursing Officer Pat Notter and the other adopting Andrea Calhoon as treasurer, Megan Sprague as secretary and Hutches as president of the MMH corporation.
—approved the reappointment of Kelby Bethards, M.D., to family medicine; Cynthia Grybski, M.D., and Laura Marinello, P.A., to cardiology; Robert Kahn, M.D., Ravinder Sohal, M.D., and Bradley Tipler, M.D., to radiology; Carol Langdoc, M.D., to ear, nose and throat; Michael Stone, M.D., to oncology and Jeffrey Wagner, M.D., to teleneurology; and the regular appointment of James Yakel, M.D., to podiatry.
—heard the MMH Foundation report from Steve Young that Paula Carper, Diana Baeza and Jessie Ruiz are new MMHF board members.
—held a 56-minute executive session to discuss strategic planning and personnel matters.
Holyoke Enterprise February 4, 2016