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Medical Charges Discussed With Hospital Administrator

By Staff | Jun 16, 2009

Just like the ordinary citizen, Palo Alto County Supervisors were looking at medical bills and charges during their June 9 meeting. A discussion over charges for tests and examinations was conducted with the administrator of the Palo Alto County Hospital and the county’s mental health director during the Supervisor’s weekly meeting.

The discussion with Tom Lee, PACH Administrator, Palo Alto County Mental Health Director Maureen Sandberg and the supervisors came about because of medical charges related to emergency mental health committal proceedings.

According to Sandberg, when individuals are committed to the Cherokee Mental Health facility, that facility will not accept individuals unless they have been examined and found to be “medically stable”. In order to make that determination, doctors order various tests during a committal examination to check for any possible drug effects or other medical concerns. Since many committals occur outside of normal business hours during the day, a visit to the hospital’s emergency room becomes necessary for the individual that is being committed. The individual is taken to the ER by law enforcement officers as part of the committal process.

Those charges and costs for tests were the topic of discussion for the board members in their session last Tuesday.

Sandberg started the discussion with the hospital administrator by asking why she was seeing differing charges for emergency room visits by clients in her billings.

“The difference in emergency room charges is dependent on the levels of care provided,” Lee explained. “There are five levels of care provided by the ER.”

Sandberg pointed out that the Spencer Hospital had entered into contracts regarding the costs of such exams and evaluations, and wondered why such a move couldn’t be done locally.

“I talked to the Spencer hospital administration and they told me they wished they had never started that contract arrangement,” Lee replied. “Holy Family at Estherville accepts a payment of $300 for similar situations gladly because in the past, they weren’t getting any payment at all. For me to hold our facility to a charge of say $300 is just unreasonable. Other area hospitals are charging full price for their services and have no contracts.”

When asked if the hospital tried to collect from these individuals, Lee replied that the hospital would try, but usually saw a loss from such cases.

“The problem with all this is that before people can be committed, they have to be medically stable,” observed Supervisor Keith Wirtz.

“I think we need to ask the doctors to order just the very minimum for tests and what it necessary,” said Supervisor Ron Graettinger.

Palo Alto County Sheriff Dennis Goeders, who also sat in on the discussion, was asked if all persons arrested in the county were taken to the hospital to be checked. “We may take them out there for tests to determine if they’re on something like meth, and if they are, they can also be charged for being under the influence, but we pay for those tests.”

Lee was asked if the local hospital could check with Cherokee and Spencer hospitals to see just what tests were needed for mental health committals.

“When you say medically stable, that’s a pretty broad statement,” Lee said. “No one wants to set themselves up for unnecessary risk and liability. The liability issue is the big deal with all this.”

“I do sympathize with the hospital in this,” Sandberg said. “I’m just trying to monitor my mental health dollars, and I’m stuck because the costs are going up and I can’t get any more money to cover them.”

“We’re in the same boat too,” Lee agreed. “Unfortunately, we can’t be all things to all people, but we’ll never be that. As administrator, I have to make decisions that will keep PACH viable for the next 10 to 15 years and beyond, or else I could never live in this community with my family when I retire.”

Lee continued by noting that PACH was going to reduce the cost on individual drug screening tests as a way of trying to help control some of the costs for the county and the mental health fund and that he would try to work with the staff and Sandberg.

“I think you’ve been doing a good job with the hospital and we appreciate you coming in to talk to us about this,” Graettinger said, bringing the discussion to a close