The Randolph Leader: News

Like hospitals across the country, Randolph Medical Center is struggling with its bottom line, but recent trips to the Roanoke City Council for money may prove fruitless in these tough economic times.

Even after RMC Administrator Tim Harlin issued a desperate plea for financial assistance the council said it didn't have the funds.

Going into the new year the council still must pass a budget when the new fiscal year started Oct. 1. Mayor Mike Fisher is still waiting on an audit he requested so the council and citizens will know exactly where the city stands.

Fisher said as of right now no city employees will be laid off. He is willing to listen and work with the hospital. When they come back with cuts he is not saying whether the council will or will not put the hospital in the budget, he said.

Harlin suggested he cut $600,000 from the hospital's budget and then come back but the council made no promises. He asked what it would take for the city to put the hospital in the budget and Councilwoman Tammi T. Holley said "revenue."

Harlin asked what it would take to be placed with the other city priorities.

"The deficit year after year will lead to one conclusion--the uninsured will bankrupt the hospital," Harlin said.

Holley said all this has been predicted before. She knew the city couldn't carry the hospital financially. She read minutes from a meeting last year detailing his plans to add services, programs and physicians but said she did not see one time where he said he would come to the council and asked to be placed in the budget.

Harlin noted the things she read that were plans are things that have been accomplished.

Fisher said he thought the previous meeting between members of the hospital board and staff had been productive. He said the hospital and its employees are very important to the city.

Councilman Russ Cummings said since he had known Harlin he had been upbeat, carrying the flag for the hospital. He admitted he did not know the answer to this problem.

Councilman Joseph Roberson, who serves on the board, said he is a supporter of the hospital and he hopes they do everything they can to help it. Having sat on the board he has some insight and this is a hard situation. He is only one vote but hopes they can come to an agreement, he said.

Fisher said he is keeping an open mind and is willing to discuss this and see if there is any way to work it out. They are to the bone on the city budget. The police are certainly important and he doesn't want them riding around in police cars that are not safe but they are not going to get new police cars and new equipment.

All department heads have agreed to cut back for a year. They have managed to cut the city debt by $4,000. The hospital is very important but the city comes first, Fisher said.

Harlin asked what they thought the implications would be to them of the hospital closing. Fisher said, "It'd be a terrible thing."

Holley told Harlin he said he could turn it around.

"With all due respect we have done yeoman's work. We have worked hard with so little and made so much progress," Harlin said. The help they need is to get health care for people. The federal government says they have to care for the uninsured. He added: "They're your people too."

Harlin said he does not have to worry about competing priorities, that his priority is keeping the hospital open to provide care to citizens.

Those in charge have been exceptional stewards of the assets, about doubling them to about $20 million by adding services and improving the quality of care. They have improved the trust of the citizens and done curb appeal to the real change inside. They took a mothballed hall and made Senior Connections, Harlin said, continuing to talk about changes, improvements and grants obtained.

He said there has been no frivolous spending. When Chief Financial Officer Jeff Kirkpatrick came on board he scrutinized everything, renegotiated contracts, evaluated and cancelled leases, whatever could be done to save money.

There has been growth and with growth comes expenses, he said, and for every $1 spent they have gotten $1.40 of additional revenues.

As he had repeatedly said, if indigent care went away tomorrow RMC would be profitable. The hospital has a moral and legal obligation to treat people who are suffering but they are not reimbursed for that.

Medicare and Blue Cross-Blue Shield are cutting costs. RMC has to make $1 million more this year to cover those who do not pay. They very aggressively try to collect on all patients, as well as the uninsured, he said.

They are now concentrating on urgent versus non-urgent care. As fast as they have been running and swinging the past three years they cannot get ahead of this burden, he said. If a non-urgent patient comes in he is asked for the ER co-pay.

RMC had 5,300 patients seen in the past three years who could not or would not pay, he said. RMC employs some 140 people, who are highly skilled, such as R.N.s, physicians and pharmacists. This is the place of last resort for some people, Harlin said.

This is a matter of economics and the council may hear from constituents. If someone shows up in the emergency room who should be treated but it is a non-urgent matter money is needed. This is the most expensive setting in the city to get health care, he said.

Harlin said he took the previous meeting to heart and took it back to his board. He recognizes times are tough for the city as well. This will be a shared sacrifice, he said.

Board member Gary Clark said they know how hard it is to cut and the decisions that have to be looked long and hard at, but it is a necessary process.

Harlin said the board normally meets the fourth Tuesday but they have agreed to meet the second Thursday in January. They should know then what cuts have to be implemented.

To Councilman Mack Arthur Bell's question about whether they tried to get too big too fast, Harlin said the things they are doing are helping cover the uninsured gap. They can make up $400,000 on the Senior Connections psychiatric unit; outpatient services are not uninsured patients and is a way to attract paying customers. They have worked very hard on the cardiac studies, which drives high dollar procedures, he said. At the same time emergency room volumes have remained flat the past three years.

Responding to Cummings' question about other profit centers Harlin said they looked at home health but there is a lot of competition in that area. It will take about three years to see a profit and it will be a small one. Sleep labs is another possible money raiser that could possibly generate $40,000 to $50,000.

Holley returned to the ER remodeling, which was planned to attract patients, and Harlin said the board said money in the USDA loan has not been spent and the board is working on a priority list on that money. The ER was a cornerstone of that loan, he said.

She again asked if they were going to do it and he said if the door closes at city hall it would be prudent to spend that money elsewhere. The ER design is complete and he likes it.

Bell asked if all local doctors are referring patients to RMC and Harlin said he hoped so but didn't know the answer. Some patients might prefer to go elsewhere. He stays in constant touch with the doctors trying to get all their business, he said. They do very much support the hospital in their use of labs, he said.

Harlin said to Bell's question about keeping young pregnant mothers from going out of town that RMC is limited to 25 beds. More than one obstetrician would be needed because otherwise the calls would kill them. Then there are liability costs associated with that practice. A lot of that is paid by Medicaid and Medicaid doesn't pay enough to cover the costs. It was one of the first things the board asked about, he said.

Speaking of a delivery by one of their nurses, he said they do still deliver. ER nurses had rather deal with a heart attack than deliver a baby in the ER but they do it.

Cummings said nobody wants the doors at the hospital to close. They will think on this and discuss it when they hold a workshop on the budget.

The council discussed an about $85,000 payment for legal fees for the hospital that Holley said she did not remember. Bell did not remember either and the other council members were not on the council at the time.

Fisher said CPA David Denton is still working on the audit. Six weeks down the road he does not want to be accused of something that happened eight months ago.

"We have got bills six months behind and I have no idea why," he said. The budget was supposed to be passed by the last council, he said.