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HomeMy WebLinkAbout1984 , i F 14 City & Slate, August G, 1984 Will Independent financing cure ills? Coney Island Hospital Hospitals seek funding 4 "Hospitals that can't et the nec• elites or counties have, said Mr, e t By gSTHLIt trtiITjL KUNTZ essary taxpayer support need to Marlon of Merrill Lynch. CHICAGO - More public hospi- find alternative financing," sold With a triple-A rating, public leis are seeking capital financing Fred Kleinman, a vice president In hospitals probably would pny lower Independent of the city or county Moody's Investors Service Hume!- interval rates on revenue bonds a that owns them. pal department. than on general obligation bonds mn Many are asking, "How can we But a heavy burden of indigent issued by the municipal govern- meet our capital needs without tap- care has weakened the financial meat (hat owns them, he noted. A pping city funds?" said Josepph condition of many public hospitals hospital revenue bond financing 1 Aforlon, senior associate in the to The point they can't gel the frees up a city's or county's debt ca. health care finance department at in vest ment-grade credit rating pacity for other projects. he added, Merrill Lynch Capital Markets In needed tosell (heir own bonds, The only catch to the FHA 242 New York. Most public hospitals legally are bond guarantees Is that they won't Elmhurst Hospital Rather than wait In line Tndef- required to care for all indigent pa- actually be available to public hos• inilely for a sliver of the local gov- tionts that seek admission. They pitals until new regulations are C _ ernment's capital budget pie, the can't turn patients away because written, and nobody seems to know a Ili + t t r r e r re 1 tt hospitals are struggling to get caps- the patients don't have the money when that will happen. e s err , r , r: r Of funding on their own to mod- to pay, Mr, Andrulissaid. There sllll could be some road- ornlze and replace facilllles. 'Clearly, Those hospitals having blocks to FIIA insurance for public 1 R R t Many cities and counties don't financial problems are the ones hospitals, depending on how the „ t M M'C have enough funds to rebuild all of that treat a large number of Indi- regulations are written, Mr, Marlon f ; tt their aping Infrastructure. gent patients;' Mr. Kleinman said. said. FHA Insurance for private, t, Hospitals are forced to compete Furthermore, public hospitals nol-for•profll hospitals Is secured with other protects for scarce caps- have been excluded atmosl entirely with a first mortgage lien, (AI revenues, and there isn't from the rovenuv it market be- But a public hospital fneility e " enough money to go around, sold cause feAsibllity consultants and In- often is owned by the city, county Leonard Aubrey, director of fihan- vestment bankers place almost no orstale. f• clef planning with the New York value on state and local Indigent- The hosppltal leases the facility, CI( lien Ith and Hospitals Corp, care subsidies when (hey assess the and therefore, can't mortgage it, But while they wait for govern- debt-carr Ing capacity of a hospl. Mr. Mnrion explained, meet funding, many public hospl- tal. sold Carol B. Emmoll, execu• The terms of FRA Insurance for sumed ownership of Menniee Me- urban satellite hospital in an efflu• tals face eventual loss of accredita• live dlrectarof the California Asso• public hospitals will have to be mortal Hospital In Bradenton, Fla., en( area to offeat any potential lion and closure because the elation of Public Hospitals In San structured differently, or many of in July, Manatee Count yy gold the losses at the main hospital. Of the buildings don't meet safety codes. Marco. The reason is there Is no them will be excluded from the 521-bed hospital to Baptist for $45 hospital acquisition projects Baptist "In general, public hospitals Are guarantee the funds will be appro. program, he said, million In cash plus an agreement Is working on, one of three Is a doing much less eepitnl financing prla(ed every year, aheexpl.dued, New York City Health and Hos• to share wlth the eounty up (o $20 county hospital, sold Preston V, than private hospitals," said Denats Leto last year, however, Con- plials Corp. plans to apply for FHA million in potential profits during McMurry Jr., executive director. Andrulls, director of research and green opened up a new avenue for Insurance so IT can sell bonds to ay 30 ears. The difficulty of financing public policy for the National Association public hospitals to reach the lax- $700 million of a $1 billion proved The $45 million 1103 been put into hospitals Is making these munick f~ of Public Hospitals In Washington, exempt bond markets without help to renovate five of Its 10 hospitals, a trust fund to pay for indigent polities consider selling (hum, As a result, their facilities are from local government, It voted to The insurance would free up city care; 76% of the interest Income A study of hospitals In the ma- olderon average than thoseof Ihelr extend the Federal Housing Ad• funds for other purposes, Mr, Au- will pay for chority care, and the tIon's 100 largest metropolitan private counterparts, ministration's 242 hospital morl- breysatd. other 25% will be reinvested In the Arens showed they average nearly ` In the past, most public hospitals gage insurance program to public Some municipalities are taking a trust fund, said Bently B, Lang, the $10 to $30 in surplus revenues for t got financing through general obil- hospptints. different tack In solving the prob. hospital's administrator. each day a pallont stays In the hos- gation bonds Issued by the govern- With the insurance. public hospl- lem of capitol fine living for their Under the terms of the agree- pital, Mr, 8111on noted. mentol body that owned them. But tali would be Able to evil revenue public hospitals: selling them to men(, the hospital still is required Pubhe hospitals lose almost $18 taxpayers In many areas have bonds with a triple-A rating from privateownei1, to provide emergency care to all in- per patient day, a voted down referendums to (I. Standard & Poor's Corp., New Baptist Hospitals and Health Sys• digent patients requesting It, Mr. heave hospital building projects in York. lems In Phoenix, Ariz., A not-for- Longnated, Esther Fritz Kuntz is a Chicago the past few years. That's a higher rating Ihnn many profit multihospital system, as- Baptist will build a 142-bed Wb- free-lance writer, u • a T't►/'ti y trend nrrrtrrAlAd, he snid, we have a tremendous volume of ~Y City & State, August 6, 1984 WIN independent financing cure ills? Hospitals seek fundin ConeyislsndHospital g B ESTHRR F hI!aIs that can't el the nec• , Y RITxKUNTZ "Hospitals g cities or counties have, said Mr. , r. essary taxpayer support need to Marlon of Merrill Lynch. ` CHICAGO- More public hospi• find alternative flnoncing," said With a triple-A rating, public ' ` ' tats are seeking capital (Inaneing Fred Kleinman, a vice president In hospitals probably would pay lower independent of the city or county Moody's Investors Service municl• interest rates on revenue bonds that owns them, pal department. than on general obligation bonds tStt Many are asking, "How can we But a heavy burden of Indigent issued by the municipal govern.■ meet our capital needs without lap. care has weakened the financial meat that owns them, he noted, A f In lgon city a7" said Joseph condition of many public hospitals hospital revenue bond financing fund Mar, senior or aesoclate in the to the point they can't get the frees upncky'sorcounty's debt ca- health care finance department at Investment-grade credit rating pacity for other projects, he added. Merrill Lynch Capital Markets In needed to sell their own bonds, The only catch to the FHA 242 New York. Most public hospitals legally are bond guarantees is that they won't Elmhurst Hospital Rather than wait in line Indef- required to care for all Indigent pa- actually be available to public hos- Initely for a silver of the local gov- tients that seek admission. They pllals until new regulations are ernment's capital budget pie, the can't turn patients away because written, and nobody seems to know ,r: t a a -t hospitals are struggling to gel capi• the patients don't have the money when that will ha on, 1 i 1 a r i i i! r r r r t t I r j tal funding on their own to mod. to pay, Mr. Andruhs sold, There still couppld be some road- (111 ornlreand replace facillltes. "Clearly, those hospitals having blocks to FHA Insurance for public t R Many cities and counties don't financial problems are the ones hospitals, depending on how the have ennugh funds to rebuild all of (hot (rent o large number of I n& regulations are written, Mr. Marlon t p g {r (hoiroging Infrastructure. gent patients," Mr, Kleinman said. saki, FHA insurance for private, w Hospllnls are forced to compete Furthermore, public hospitals not-for•profil hospitals is secured t' with other projects for scarce caps- have been excluded almost entirely with a first mortgage lion, t X g tnl revenues, and there isn't from the revenue bond market be- But a public hesptlAI faclllly > 1 enough money to go around, Reid cause feasibility consultants and In. often Is owned by the city, county s Leotard Aubrey, director of finan- vestment bankers place almost no or state. clal planning with the New York value on state and local indigent. The hospital leases the facility, Cltyy Health and Hospitals Corp, care subsidies when (hey assess the and (l;erefore, can't mortgage It, I3ul while they wall for govern- debt•carryIng capacity of A hospi- Mr. Marion explained, 1110"1 funding, many public hospi- tat, said CCarol B. Emmott, execu• The terms of FHA Insurance for symed ownership of Manalee Me• urban satellite hospital in an afflu- tals face eventual loss of accredits. tivedirectorof the California Asso• public hospitals will have to be morial Hospital In Bradenton, Fla., ant area to offset any potential tion and closure bvrouse the elation of public Hospitals in San structured differently, or many of In July. MRnatee County sold the losses at the main hospital. Of the build] ngsdon't meet safety codes. Mateo. The reason is there Is no them will be excluded from the 521-bed hospital to Baptist for $45 hospital aequlaltlon projects Baptist "In general, public hosppitals are guarantee the funds will be appro. program, he said. million in cash plus an agreement Is working on, one of three Is a doing much less capital llnancing printed every year, she explained. New York City Health and Hos• to share with (he county up to $20 county hospital, sold Preston V. than private hospitals," said Ik nnis Late last year, however, Con- pitals Corp. plans to Apply for FHA million In potential profits during McMurry Jr., executive director. Andrults, director of research and gress opened up a new avenue for insurance so it can sell bonds to pay 30 yyears, The difficulty of financing public policy for the National Association public hospitals to reach the inx- $700 million of a $1 billion project Tho $45 million has bent put into hospitals Is making these muniei- of Public Hospitals In Washington, ex0mp(band markets without help to renovate five of Its 10 hospitals. a (rust fund to pay for Indigent pelitlesconsider selling them. As a result, their facilities Are tram local government, 11 voted to The Insurance would free up city care; 75% of the Interest ]home A study of hospitals In the no. olderon everage than those of their extend the Federal Housing Ad- funds for other purposes, Mr, Au- will pay for charily care, and the tlon's 100 largeat metropolitan prlvalocounterperts, minlstrallon's 242 hospital (nort- brey said, other 20% will be reinvested In the Areas showed they average nearly In the past, most public hospllala ggage insurance program to public Some muntcipalltios . Ve taking a trust fund, said Hently B, Lang, the $10 to $30 In surplus revenues for got financing through general obli• hospltAla, different tack in solvond The prob. hosphal'sadmfnlAlralor, each day a IIpatlent stays in the hos- golion bonds Issued y the govern. With the Insurance, public hospi• lee of capital financing for their Under the terms of tha agree- pllal, Mr. Slllon noted. mental body that owned them. But tale would be able to sell revenue public hospitals: selling them to mint, the hospital still to required Public hoapllals lose Almost $10 taxpayers In many areas have bonds with a triple-A rating from privateowners. to provide emergency care to all In- poVPallentday. a voted down referendums to fl- StAndaod & Poor's Corp„ New Baptist Hospitals and Health Sys- digent patients requesting It, Mr. nonce hospital building projects in York, tems In Phoenix, Ariz., a not-for. Lang noted. the past low years. That's a higher rating than many profit mullthospltal system, ns- Batist will build a 142-bed sub. free-lance turiteKuntt le a Chicago w"~1 A V% 1 trpnd necelernied. besnid. we have a tremendous volume of \`9 1., Medically Indigent adults: a calamity for county hospit AUG 2 7198A r In 1971, California created tho hfedi•Cal Category of better way to do it "medically indigent Adults" (MIAs) to cover the indi. limiting access. AuttI on gent population whose care was previously funded b n the counties, In 1982' As part of the hledi•Cal y don't like (6" changos, the slate returned responalhAlly for the call. By the third quarter of Hein. mated 30000 hllAs-10 percent of the Medf•Cnl 1983, the California A) population-to the counties, along with 70 percent of repolrted ac91 percent n• the funds It estlmated it would have spent on (hem f case e In cou under h4edi.Cal. Of the 68 counties, 34 (all with polio. husphol MIAladml sionaly nations of lest than 300,000) Joined the Count Medi• ~l Y~) cal Services 'Program (CMSP), which was admirals. and an additional 39 per. tered by the state and treated the MIAs much like qcant uartsincrease It the next ous Medl•Cal clients except for reduced eligibility, bone. . Sfmtas' bad ly, Ills, and funding. Since then, five counties have debts i hospitals' bed ( dropped out of CMSP and one has Joined. mullion ( obla In the by $31 Simms: half the utillm• etp E The other 28 ceuntfes developed their own MIA e fourth lion executive programs. Some of the most heavll populated quarter althlone. Carol Emmott, executive ports r, La in f` ties (Los Angeles and San Francisco aongthem) di. 1983, county (hospitals saw a 29 percent increase In rected the MIAs to county hospitals and health facilf• patient days and a 78 percent Increase in outpatient ties. Other counties (Orange, San Diego, and others) utilization, most of it attributable to MIAs. Even with Chose selective program's onfirst effect was tra Ling with providers and brokers private hospitala' bad debts and charity care up by 18 The percent, Emmott says, the nine largest counties ap. sal; "a significant decline In MIA usage," according to post to have lost $138 million on the program. "Under President and CEO Lloyd Hamilton of Sierra Nevada Proposition 13, there are very real limits to how much Memorial-Miners Hosnltal, Crass valley, The sharp drop was fall by and private hospit of these losses the counties can subsidize," Emmott l,uuiir Ala alike, says. "Private providers are carrying $470 to 8480 rail. Paul Simms, de),t.•v •h, ector, physical health services, lion In bad debt and charity care, and county MIA at. San hiego County Department of Health Services, re• locations are already overspent," parts thet "utilization was 60 portent of what we had Roger King, legislative representative for health predteted," find weil'are issues of the County Supervisors' Amocia. In Los Angeles County, the MIA population was di• tion of California, reports that aggregate county reeled to county facilities, whose exporfence would spending overruns on the MIA program are about 14 prove typical of public hospitals, Robert While, for. percent so far. Charles White, senior vice-president of met executive director of the county henlih system, the CIiA, says, "In 1982, county hospitals had about reports that fnpatuent utilization went up about 14 49 percent Medf•Cal Patients, Including MIAs. A year percent and that ambulatory and emergency visits later, they had 36 percent Medi•Cal-and an identical were much hlgher, than predicted. 'Photo was not a Increase in MIAs from 36 percent l0 49 percent, Tboy concomitant Increase In funds, however, and White lost paying pat(onts and got basically unsponsared pa• says, In the outpatient areas, it used to take one to bents in return. Of all bad-debt and charity care In two weeks to get an Appointment; it now takes six to California hospltals, 66 percent of It la now concen• eight weeks, It money la to be saved by rationing care, trated in the county hospitals, if you want to know which Is what this Is all about, there may not be o the future of county hospitals, there it la."-E,h', fah emigres, who had traditionally dfon In revenue it year. If wo had not shine" law" required It). "1 think we been treated at Cedars, the hospital gotten a contract, we would have lost are better off with a negotiated con. arranged to provide Medi•Cel Inpa. something on the order of $80 mil, tract than we be the lien services to them through an Hon-and that's assumblg wo would money Fled be nosaved tih ough an e a agreement with UCLA Medical Con• have kept half the patient load in the acrass•tho•board program," he ae s• ter, a contracting facility, form of emergency services," It has not been A picnic for hoapi• Whllo had to have a contract, and University) of Califotndaarvinothtodl- lode that wen contracts, either. The Guy could not exclude While's systenn cal Center, "the experience Is taking largest Modf•Cal Provider In the and still ptosorve Access la care In Los the form of an (noxorable weakening state, the six-hospital Los Angeles Angeles County. As it reauy, says of our Institution And lessened access County Department of Health Ser• White, "We may have done batter vices, really didn't have much of a than some, but our contract Is for to ere for had co 1 pncreas .Over choice about bidding, Tho sy"fam's $640 a day, old our coat is $084 n She year, we had cost in -ca) raate e of 0 Is to tLon•executive dlrecter (since to. day," W)dte was the only hosplla) of- tho same-and tBut my M-ca) r is roprolents (trod), Robert White, points out ficlal to announce Ilia supposedly se• one-third of my inpatient population. "Medi•Cal provide" ua with $](t0 mll• erm rate (he said that county 'But). We figure we are losing bosing g $ $f000 0 par In. 70 laivrrret inuoo4r r, r~nl 1 ( 1 7e~ i~ ~ ~ ti ' d 6q• r 5' G Q, sF l' , [n r'• J~ag5bO7cJ~ !t0 I!N5 i ion Y ~I t' A .a r ° L g o A ~www Pr cn O r "A E t ~ o [i Er m `~1^ rn y~,~ 0 ~f3! a e4 i f i ss t °f . t {TL.I r r' S J o o+ C d a @ CL J h f ~ ~fl ~ ~'.iri(~ l "'1R' S ~ h r sR A o ~ 5 d 9 ~ C `R~ t d 5 p i` A e ro Tvf 44 o " a+e iJa,~~$ 4 'f' ~ iro ~~~~Y ,a. t ~ i ~'1~~?Y(• f~1T '.f. ~ ~ [ply (Q'j] 1 S1 5 t' f l i n,f', r~ ,6r6f ~ Y•'~ r9 a - d q' A O '•n a rsa Ca n D ~ro A a *1E Y ~ -i~ x ~ g ar, n 491 0B9 1a. ~ g Q a~ o ~d CD Id b' i3 6'i 6, yy YSf o'O eb 10 p d CL yl, °Q b, of 7Jy Joao ro a c 5 O uA'a 5'~ Lq~,EF o " if wJ1 '4 ~ r k - w I i i I ~ & I . I I i ~ - i x CD oil H: g 1a b ,~i, A tgl YJ. p 'p~ d7 ~y Q, h d ,b A -T ,y~NT~' g . r CLLL ff Fit ID n o L1 OD li in OIf, O .N 0 p w n~ n c~ym' U2~ n n'~ n' ~'ri4 b'~;N era n o CON Z ,n a o' ° coo rjr) x x ,yam r+ W CD CA Np' N-0 P O ~d cn~ Ocn w P ~ ~ .r n 1-3 rg 09 p oil 0 o n o D 9 14 t C) Ft g .n FF~++ Ni '~I e*. Aj ` The trend Is par[ of a movement IowaM Road to Recovery Chain Ownership oihaslitalsa»drefle+ctaUte growth of both for-profit and nonpmnl earl. How Ailing f Iospital cents. For•probi, Inveslar•owned chains ate growing especlally rapidly and find taken Of public facilities one way to expand. Gal In South Was Rescued Year, for example, American Atedleal so quired five county hospitals, bringing the to• gal number of hospitals that it owns, mnn• By a F'or- Profit Chain ages or Is developing In the US, and abroad ~ to more than 100, In the year coded; lost Aug, 31, the company had revenues re im Takeover of County 1;iacility billion and net Income of $78.8 mlllior, at 5415 A share, compared with Year•ea,'ller Reflects National Trend; flan u nlies SIA and III,[ of aorestatedllf1.80 a share, s50,a .,all. Patients' Complaint: Bills Acquisition Tare American Medical has an acqulsnfoll learn on the lookout for just such a porlunt- Wine in the Maternity Ward lies as York General. indeed, Ruck Hill, it textile community of 38,000, Is typical of the kind of area that Is targeted by the hos~~ltal i fly JsNNIFka $INalL1i I lit I.I. chains; and a closer look at the acqul5lllan i Stall nilnoNnrofTneWAL,.sr„F.rrJuu„NAG and Ibv aflermatA Serves to Illuslrale how { qo(:y Hffb, &C.-The patient in need of the chains operate and the changes Ihilt are f{` an X-ray at York General flospllal here is often wrought when public factllnes pan well advised to arrive with magaalnes, h;lo prlvnte hands. newspapers and the fortitude to withstand it Bock Hill Is the largest town in York long, uncomfortable-and possibly danger' County, which appealed to American Medl, dus-Walt. ttqulpment frequently brenks cal for several reasons. York's population of down from overuse, and desks block fire 106,000 Is growing rapidly, and local Inds story corr That idors for lack of space elsnwhere, provides medical Insurance for much of It, York month I to when Carolina addition, charge pingeadWhat of swho( new $28 million facility. The new hospital, to the hospitals' services cost and has no for-. be called the Pledmont Medical Center, mal rale'revlew mechanism, a"lack that al. truasts nn X-ray department twice us !:g as lows hospitals to Increase charges 10 the In* [he present one.; the expanded department surer almost At will. will feature a (,AT scanner and other new The hospital itself was hardy the apple equipment with a total value of $3 million, of American Medical's eye, But II was oper• were hen is the York Gelieralgan ailing omy facility,,vwas the c in flycturning York main rya! grorep taken over by Atnerlcan Medical Interns, ulatlon around and replacing It; ntdertcan; tlohal Inc. of Beverly HMIs, Ulf. Aillerlean ' Medical saK ,ka opportunity to serve wealth.' Medlcut, a for-profit hash lal chain, bought ter, privately Insured residents here whd York General In Mcomber 1960. Since then, have bren going to nearby Chnrlotle, N,C„ ` besides building a badly needed new hospl• for health care. tail the company has helped alleviate a U01l~Yfd DIaRr103es shortage of doctors to the area and, in many other ways, changed the delivery of health York (General Was built with federal core In rural York Cnunly, funds In the I930s. MAY years later, Itie har• Patients' Cgmplalrtts Pilot Is warn out and literally bursting its' These changes, however, aren't unlver• ' scums. "tkcaslOnahy It rains In here," sat) ; t!!y acclaimed by the local t r one doctor, James Maynard, as he points t0 hospital acclaimed by Some local psp u ni Are ncoinr a palch4up place in the wall of the !issue; Idabling about higher costs; the price of a there's The no ro lab om for needs our., As ne, As result, do , do but front and sldokhest X•ra, for ekampte, hart n resulctors yy, aare open delayed tes in making diagnoses all oobled from =18 under the county to 538 um: the wall for testa, any the hew w nngm n" Some a husker rn the overcrowded emergency reouri, cold and tmosphere that fhb d par only 111111 curtalns separate patients, "Year is corporate and a n Ilk the patient, is the important, trhig cult tie to here having a baby with only tar Fnr Its part, , American Medical ing, , to- Curtain between you slid the fellow whop, " had a cur wreck," says physician lNlillttm. ter I's i ptWof ItAt co," And without Grogory, The focal Popep center has pro-: intervuntlon of that company or or another thj~ tested this lack of privacy, buyer for York (General, replacement of the I outdaled faclllly was In serious doubt, Besides living with an antiquated facility,; The situation here Isn't an Isolated one, the Counly was short of prlmary,care physl, With federal funds tight and county CgffeN clans. The regional health-systems aggency; emply, mdrg,ond h~re comrnuntles arr" recommended tevcrai years ago that lli6 getting out of the help let tillable", The 716• county have 40 primary-care doelors byy bed IaospuAI Isaon to be 2731 herein soak. 1980, but Ill 1077 there we're only 28; by 1678, 1111I is line of some 23 public ftosplist$ in the, trial number had dropped to 26, noctorlt U.S. That h6ve bean actlalred by tot to ,1 were simply unw plug to come 10 a epmltipn "Pi M. ,t tb t~14 p~ c hity whose hospital was failing apart, af[ York County reallred it needed an up• li Please ?tire to Ave fn, Colrrtim i The company is also collecting payments from Paller(s as soon as possible. harry Do. Vinney, a part-time paramedic for York General, says, "1f a person Is on a stretcher and they can talk, they'B be asked how they 10 1'11V WALL s,rRF.ET JOURNAL, Friday, January 28, 1983 can pay." Mr, 1linple replles: ,%Vhat we try to do Is get enough financial Information to gel the process going. We don't badger Road to Recovery, HOW a Hospital someone r a stretcher, but we are con. cerned about eollectlou," Many Paramedics are Ignoring new Was Rescued by a For-Profit Chain charges for supplies and waiting time, Those and other services were Included In a a base rate of about $70 for an ambulance run h under the county; they now are extra and Coofnn,c,l F'ron, First Banc Increasing Charges the base rare is $96, dated hospital eight years Ago, But In 1974, The company profiled despite those addl. James Chapman, another York General voters rejected An $8,6 million bond Issue for Itonal expenses by increasing charges, Ilips, paraml!dle, says he cut the walling•tlme a hospital addillon; another $13,6 mlllfon Ilenl charges rose 35`70 In fiscal 1932, "fn charge in half on a recent ambulance run to bond Issue for a new hospital was rejected leans of what AM] has done to (he pricing 9 Charlotte hospital, The patient was un In 1979, The county council was then forced structure, lire change has been drarnafic," older woman whose husband was retired, 70 to sell the facility. Five companies bid for it says Ihe represenmtive of one local em. Just couldn't see charging them some E370 and American Medical won, paying $3.4 mil. Ptoyer, which Provides medical coverage for for 34 hours of wlilting time," Mr, Cliap. Icon for [lie old hospital operation, exclusive, Its workers That's ih0 most understated man explains. "We were Just up there goof- of land and building, plus $5,4 million tof term I ran tl iak or. Jag around," lease the facility while it built u new one The current room rate at York General' Ir an elfoH to cut costs, American MedlA The county received almost $9 million an for a semiprivate Is $130 a day. The fisr;d eat is cutting man-hours, Staff workweeks the promise of a new hospital from Ihe' Isrl room rate of tits was below that of wore 4ked order the county. Now, all do. sale. J most hospitals in the slate, according to partmebts'are flexibly slaffed according to indigent care was a crucial issue in tho9 Hine Crass; but that Insurer reports that the the patient load, or census, expected that j bidding contest and Is a current bone of con. average charge per admission for supplies day' gmPloyees are sent home and obits (enlion between the county and the com• i Jumper 13317a from 1930, under the county, to closed when the Pafienl Count Is low. The Parry. The county Is supposed to pay Arnett. the first hall of 1932, under the Compaq, ; cOMPany Is also reducing labor costs can Medical up to $160.000 a year for Ihls (The average loin] Increase in Blue Crees k attrition of Its some 500 foll-ame care, wilh funds to come from Interest on charges for all haspuals during this period be pk) ees, a relief to many who expeclea ~o the money received from the sale. However, was about 31V0 i the company claims it spent $735,900 on Jig. Supplies were Included In Ihe room rate I leavesnhem short; SAY lPTsched.'Int gent care In fiscal 1982, while the co fowl under the County. Now Items such as syrln "They try to to says It only awes $2GI+ sus, Catheter plugs and gauze pads have Ihe maxhnum amount of work from ~to The source of the disparity is the( the coded charge slickers on them that go an least amount of P~PIe," one nurse says, cowl yy and the company define "Ind]gant" Patients' bills, Of 70 South Carolina hospitals There's no way to predict the consul, e yen In dlfferenl ways; the county exempts Medh ranked by Mile Cross, York General was folrwrroW. This ;nurse says At (here rs care, Medicaid and privately insured pa. 19th most expensive In auF,ply charges (or five people taking care of 39 psilents aI tlents from the classification, even 11 pay. 1982, compared with 36th In 1980. of her recent ahlfls and that leer call to ments are minlmal-a practice that the supervisor for more help was Yarned company calls loo restrictive, pending rasa Mr, Maple, the adminlstratOr'Ot the hos, I don't mind It being a business; but 11 1 lotion of the dispute, American Medical Isn't Pita' says Co lyd. char gea wort, far beloW a business, we're not getting any profit hunt turning Indigents away; but Morris Maple, what they should have boon for a hospilal It." site Comfitalns, [he hospital's administrator, says indigent he size of York General. And average American Medical Is conducting a mar. care has Increased costs and therefore osplgtalspln (he'sllalo Prmain trecausePlpatlentst ututtioncarounld. oturnYork Gee el'sr#]s charges to paying patients, patients, For American Medical's greatest advantage Clays are short. (That Isn't surprising since Improved "hotel services," Including new to Rock Hill Is Its access to cap}lei, The now most moneymuklrg procedures are par, menus and a has less system to help Incapao•, hospital [hat county adminlslralors debated 'formed In the first three days" ullienla` listed patients. The company also slatted A` for eight years is being built at 17 menthe slays; most hospitals have little Inc", .lvo to' "stork Program," Providing slunk dlnnery and [he company Is spending $9 million on' keep patients utter that.] complete with candlelight and wino, for noti new equipment for the (acuity, I York Generals balance sheet has Parents, The company has helped recruit 13 new changed with its new for•proul status. Pot out It may be some time before commu. doctors and three specialists to this commu• one thing, Medicare reimbursement (o to. nily attitudes change. Many people hate are Illy. Many probably wouldn't have come veslor•owneu nospitals Includes a rolurn oh crllteal of Rock Hill's physicians, ,people{ without the into of the row hospital, and eqully that Isn't Paid to nonprofits. Return to to Charlotte because they feel the t American Medical also offered some linan• on equity Is mean( to reimburse for-profit 4 clot incentives, berods Gettelfinger, a neu operotors for their cost of capital, which in. botte 'treatment from their daeleta lull !'ologisl, says that when he came to Rock crudes providing a return for Investors, At area ;lull a dollar sign walking:! 00 doo Hill last May, the health-care chain paid his York Genera), return on equity meant an ex. ,says •fennifer Vickery, a 16W reo moving expenses And first six months' office tra $111,000 10 Medicare reimbursement, or dent, rent, It also provided Ur. Geltelfinger with a 37o of the (otat Medicare bill, for the year "Over, York llereral's occupahoy ale low-Interest loan and guaranteed his first six ended April 30, 1982 Is UP )tom county levels, and some o,~hlklha rtlonlhs salary, Nurses (let Notes heare anBing.Onelocalbetelomployae American Medlead's Profit Margins posting a profit means keeping track at ter y away from he county ospft I 40 seeing dead people tieing who I General In fiscal 1982 were compareL a charges, and American Medlcat is pressor- thM4h the materttll York y lased. Howev¢p, to the countyy's, though the company had ex. Ing employees to do just that, They are 110 eaya he would go to York General h ppaeuses In Ihe flscal year that the county longer allowed to run free lab les(a for each wodld use the new facility Lecause of tspta i hedn'I had, Including least, payments, a sal- other, and nurses gel notes saying, "Our enl• an edlcah ary adjustment obuvo annual increases and sties are pall by pallenle who pay their errAA say they woWd welearod the taxes totaling $870,000, South Carolina also bills Remember, AMI Is it bualllties, pit ase ph000 It they didn't cast So,tndch, Thg rut back Medicaid coversge that year in, conti nuo to keep up With our chhrg0 01r 'ItePresentative, of one local employer isn't creasing costs, flowever, her, Maple irs Ors." lrlpeeseed by the stork program or the 530 bullding expenses for the new hospital 11110 a year Ibat American Medical Is spend, weren'! Included In fiscal 1982 figures, ` Ing on public relations. "tl-s icing on the Cake," he says. "ft's getting so tv0 can't sF fond the icing-or even the cake,"