The long awaited King 24-hour emergency room (ER) facility will not become a reality, according to Joe McNulty, president and CEO of the entire Pioneer hospital system.
Instead, faced with mounting losses as a result of non-paying self-pay patients and changes in Medicare reimbursements brought about by the federal sequestration the for-profit company plans to close the ER and convert it into an urgent care facility. The change is expected to happen in December or January.
Company-wide Director of Hospital Operations Paul Gardner told the Stokes County Board of Commissioners Monday that the facility had been losing money for some time.
“We are trying to be proactive and address issues before they fester and get bad,” he said noting that close to 30 percent of the patients seen at the King ER did not have insurance. “Anybody that presents to an emergency room, you have to provide them with a medical evaluation. So they come and abuse that to get prescriptions refilled. There are a lot of people who truly cannot pay, but there are a lot of people who abuse this.”
“In the last five years the challenges in health care have continually mounted,” McNulty added. “Last year we were running 20 to 21 percent self-pay and that jumped to 30 percent this year. We have to provide the service and those services include supplies and drugs and paying for professional time. In most cases we can’t even collect a co-pay. In order to continue to provide services for the whole county we had to cut out some of the big gaping holes and this is one of them.”
The answer, according to Gardner, is to convert the ER into a new urgent care facility.
“That will eliminate this large amount of self-pay,” said Gardner. “What we are trying to do is eliminate that bad debt element. We would have the ability to turn patients away because it would be an urgent care facility.”
He said the the change would also dramatically decrease the amount people would have to pay to be seen from current costs of over $1,000 per visit to closer to $100 per visit. He said many patients leave the county for urgent care service because there are no existing urgent care facilities in the King area.
“This will open up a whole new market that is currently going to the ER or out of the county,” said Gardner. “It is not a leak in the dam, it is a gaping hole in the dam and we are trying to ensure that we can provide health care in Stokes County for a long time to come. There are a lot of people out there that abuse the system and this would give us a way to deal with that and force them to pay before they receive treatment.”
He said the ER was also loosing money because of the 2013 sequestration.
“For every Medicare patient, sequestration took the reimbursement to 99 percent,” he explained. “Ten percent of the patients at the King ER are Medicare so now we are only being reimbursed for 99 percent of our cost.”
McNulty said that cut had cost the Pioneer hospital system $6.5 million.
He said the new urgent care facility would likely operate with the same hours as the existing ER, with the only possible change being closing the facility at 11 p.m. instead of midnight.
“We will still be providing services, we just will no longer be doing it for free,” he said, noting that the hospital system would continue to provide 24-hour ER service at its Danbury facility.
Reactions from commissioners and city officials was mixed.
King Mayor Jack Warren and City Manager Homer Dearmin said they did not like the decision, but understood the reasoning behind it.
“They are a great asset to to our community and our county and while we are not happy about them closing the emergency room we understand it and in talking with them I think they will be serving more of our citizens with an urgent care facility,” said Dearmin. “With an urgent care facility and their marketing efforts and their continued efforts to support and serve our county they will end up serving more King folks in an urgent care facility than they will in an emergency room.”
“I really hated to hear it. Did I agree with it, no. Did I like it, no. But I also understand the business decision,” agreed Warren. “I think that more of our citizens would utilize it as an urgent care.”
Warren noted that it was good to finally have a clear plan for the facility.
“Now I know what they are going to do and even though I am not jumping up or down or satisfied with it I think it will be all right and serve our community,” he said. “I am glad they are still here. I would rather see something like this happen than what happened up in Yadkinville where they no longer have a hospital. That would be devastating to our community.”
Both expressed gratitude that the Pioneer officials had stopped by the town offices to share their decision on the facility.
“They did not have to do that,” said Warren. “It showed a great respect for the community and the people to come here and sit down and talk and say this is what we are going to have to do.”
Several county commissioners said they supported the decision if it would make Pioneer more financially viable to continue to provide service in the county.
“You have done exactly what you said you would do,” said Commissioner Leon Inman. “You have expanded satellite centers. You have added more doctors. I kind of guessed where you were going with the ER in King. I think you have come up with a brilliant solution with the urgent care.”
Commissioners James Booth, Ronda Jones and Ernest Lankford agreed, noting that they appreciated the efforts Pioneer had taken in Stokes County in recent years.
“I think you have done the best you can to make lemonade out of lemons,” said Jones. “Most people will be able to handle the change.”
But Commissioner Jimmy Walker, a former mayor of King, said he was concerned about the decision and the impact it would have on those living at the bottom of the local economy.
“I don’t want to shut the door on people who need the service to make your company more profitable,” said Walker. “The issue is you promised them they would have 24-hour emergency service in King.”
“We did,” replied McNulty. “But over the last four years a lot has changed. A majority of what we said we would do we have done. At the end of the day none of this is free, somebody has to pay for it. In our situation, there is a whole lot more good we are doing in the community. We are going to continue to provide services at J.R. Jones, we are just not going to give it away for free. We will not turn them away if they are a clinic patient, we will figure out something, but they have to pay something.”
Walker noted that part of the problem may have been the closing of the county run health clinic in King, and recommended that commissioners consider reopening that clinic.
“If we are are going to take some free care away I think we might need to look at reopening the King health clinic,” he said. “The key to me is to work together.”
Warren agreed, noting he had opposed the closure of the county health clinic.
“I think it would be utilized,” he said. “I do think that we have the population to support that.”
Nicholas Elmes may be reached at 336-591-8191 or on Twitter @NicholasElmes.