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Sunday, March 27, 2011
Hospital Needs To Assure Public
Earlier this month, the Santa Fe County Commission cut by two-thirds the funding it gives Christus St. Vincent Regional Medical Center to cover hospital care for Santa Fe's poorest residents.
That sounds calamitous — as a designated "sole community provider," the hospital is the first and last resort for medical care here in general, and for the uninsured and the poor, for whom the hospital is legally obligated to provide care, in particular. In a recession, it doesn't seem to make much sense to cut funding just as more and more people —as a result of the economic downturn — may become eligible for such services.
In fact, the cut may have less impact on care to the needy than on a variety of other medical services the hospital — in conjunction with the county — has been providing.
The county will give the hospital a little over $2 million to pay for indigent care next year. That will be matched by more than $6 million from the federal government, bringing the total to something around $9 million — probably enough, based on comparison with actual billings, to cover the hospital's costs. (Keep in mind that it isn't just the very poor or the totally uninsured whose bills are covered by the indigent fund. The fund also covers care for people who for other reasons cannot afford to pay the bill, including, for example, bills that insurance companies do not agree to cover.)
In recent years, the county has been giving St. Vincent millions more for indigent care — $6.5 million this year, for example, and $9.5 million in 2009. The federal government matches that funding on a 3-to-1 basis, netting the hospital tens of millions of dollars a year. That's usually more than the hospital actually spends on indigent medical care, as its billings for the current year suggest.
So where does the extra money go? That's the question the federal government has been asking of hospitals around the country as it struggles to rein the amount it spends on matching funds.
In Santa Fe, the answer in part has been that the public funding covers other programs, such as the county's Sobering Center for alcoholics, which the hospital has run for the county using indigent care funding and the federal match. That money also covers county contracts with doctors who advise the fire department or work with medical transportation service providers.
Under new federal rules, indigent funding can't be used for these or other extras. If the county wants these programs to continue, it will have to find the money elsewhere. Whether it will be able to do so is another question — as several commissioners have noted, the county has been spending down its cash reserves to cover budget deficits for the past two years and expects those reserves to be depleted by 2012.
At that point, the county will face hard choices — whether it should continue the sobering program if it means laying off county employees, for example. If and when it comes time to make those choices, the commission and county residents can have that debate.
Meanwhile, St. Vincent has been lobbying not only the county, but also the city, for more money to replace the former indigent fund largesse. The trouble with that is — as several county commissioners pointed out when they voted to slash funding — the hospital isn't saying how it's been spending that extra money.
City and county officials need to have some idea what the additional money is being spent on if they're being asked to approve. It's very possible, for example, that the extra money helps the hospital make up the difference between what federal programs like Medicare and Medicaid pay the hospital for care and what it actually costs the hospital to deliver that care.
That's a legitimate use of taxpayer money in our book — and in the case of Medicaid, it involves care for low-income Santa Feans, just like indigent care. But St. Vincent's honchos need to say so if that's the case. Such assurances could go a long way toward persuading public officials to fork over the additional cash.
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