By Bridget Levitz and Kelli Yoder
ELKHART -- Almost 60,000 people visited Elkhart General Hospital's emergency room last year. All were treated, regardless of their afflictions -- or ability to pay.
"The hospital and ER serve as a very vital resource, a safety net for people who cannot pay their bills or can't get insurance," said Dr. David VanRyn, medical director of Elkhart General's ER. "It's part of our mission to the community."
Goshen General Hospital's emergency room, which saw more than 27,000 patients in 2007, has a similar mission.
"Everyone expects to be cared for when they walk through the doors of an emergency room -- and they are," said Dr. Larry Brooks, vice president of marketing and fund development.
Being a safety net, however, can come with a price.
Nearly $4.5 million of Goshen Hospital's ER charges were never paid in 2007. And VanRyn estimated more than 50 percent of EGH's ER charges went unpaid, including amounts that went unpaid because of contractual issues with insurance companies.
"You can look at it from a lot of different perspectives depending on your bias," Van Ryn said. "If you're a finance person, you can get bothered by the percent."
The hospital is a business just like any other, he said. When you have patients who don't pay their bills or their full bills, that translates to what the hospital must charge for other services to make up those losses.
"No one coming to Goshen General Hospital is ever turned away, regardless of their ability to pay," Brooks said.
Hospital stats show Medicaid patients or those without health insurance -- who rely on the ER mainly for services a family doctor typically would provide -- account for 16.7 percent and 22.9 percent of the ER's visits, respectively. Similarly, the amount of uninsured admissions to Elkhart's ER is 20 percent, though the percent of Medicaid patients is a much higher portion at 29 percent.
For uninsured ER visits, Elkhart General receives less than 10 to 15 cents on the dollar and less than 20 cents on the dollar for Medicaid reimbursement, a federal and state insurance program that covers 58 million adults and children who are poor or disabled. GGH receives 23 cents on the dollar.
From a hospital standpoint, that's less than it costs to provide care, VanRyn said.
An eight-year study published in November 2007 by researchers at the University of California San Francisco and Stanford University found that these two groups consistently paid the lowest share of emergency room bills.
A review of charges and payments for 40,000-plus emergency department visits in the United States from 1996 to 2004 saw the number of paid emergency room charges drop to 42 percent from 57 percent.
According to that study, reimbursement from all sources -- from programs for the elderly and poor to private insurance -- declined over time, according to the study published on the Annals of Emergency Medicine Web site.
Many emergency rooms around the country have been forced to close their doors because of financial troubles, VanRyn said.
"It's not about collecting money but there always has to be a balance between the mission to provide care and our fiscal responsibility to make sure the hospital stays afloat," he said.
The Centers for Disease Control and Prevention reports the number of emergency rooms dropped 12 percent nationwide in the decade leading up to 2003. During that same period, the number of annual emergency room visits increased by nearly 26 percent.
From 2004 to 2007, EGH saw its emergency department volume increase from 48,534 visits to 54,501. In August, the hospital finished $6 million in improvements, increasing the number of beds in that department from 26 to 37.
Forces at play in the world -- some technology-driven -- have resulted in sicker patients coming to the ER, he said. Years ago, patients would stay three or four days in the hospital to recover from a knee surgery. Now, it's an outpatient procedure, which means if there's a complication at home, patients usually show up in the emergency room.
"The hospital has grown busier over the years and that's provided us with more patients," VanRyn said. "Fifty percent of the hospital's admissions come through the ER. We consider ourselves the front door of the hospital."
Contact Kelli Yoder at firstname.lastname@example.org.
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