I offer some insights to Mr. Peterson’s recent thoughts about the hospital levy increasing. Hospitals have revenue sources and expenses – and regulations – that make it much different from other businesses. By law the hospital must treat people regardless of the payer source or ability to pay. There aren’t many businesses that start with establishing the cost of doing business only to see the reimbursement from it — Medicare and other federal sources, Medicaid-federal and state, private insurance, and self-pay reduced to a percentage of its true costs.
Critical Access hospitals such as North Shore have a harder time meeting needed income because Medicare and other payers tend to be volume driven. The more units of service to apply to overhead, fixed, and variable costs, the less it costs in individual units to provide care. North Shore doesn’t have the volume – or the service population – to be as cost efficient as would a regional hospital. It also doesn’t offer advanced cardiac or orthopedic or surgical services, which are revenue enhancers, but also increased liability insurance costs and a host of personnel related services, which are also volume driven. The hospital has limited opportunities to really enhance service income under the current payment systems. And, hospitals have been required to become more outpatient service driven, while there is still the need to provide all of the 24/7 staffing and regulatory requirements of an inpatient hospital, with limited inpatient days.
Those of us that enjoy our “little piece of heaven” in the county primarily May through October know we want that access to superb health care. Recently a relative received exemplary care for a true emergency. The contracted ER-trained specialist physician provided excellent care, as did the attending physician and all of the staff at the hospital. Without the availability of this level of local service, our relative would have had critical care delayed by two hours and possibly had serious complications. We’ve had our share of fish hooks removed, ski injuries, and other incidents for which we sought care.
While none of us likes paying taxes, perhaps consider that hospital levy as a contribution for the availability of such excellent local health care 12 months out of the year — and when each of us needs it. It can be very challenging to recruit and retain health care staff under usual circumstances but especially through the long winters there with extreme cold, hazardous travel and a sense of isolation. Those of us that are seasonal residents don’t often experience the difficult work and life of so many that occurs at other times. Blessed are the faithful.
I have observed that the hospital and the newspaper do a very good job in keeping its citizens informed. Perhaps if not done so currently, the hospital could provide some additional annual value metrics like the number of emergency room and inpatient days and therapy units etc. that are provided; and income from federal and state and insurance sources, and charity care write-offs; and full-time equivalent staff positions and annual payroll. That information, partnered with the 24/7 availability should be quite revealing of the service and economic value the hospital brings, and perhaps put that levy tax in perspective. That for me is the real “bottom line.”
As a public hospital, a public accounting firm audits it annually and I am sure the hospital prepares an annual report. That’s public information. Anyone can make an appointment with administration for respectful inquiry.
Tom Hoy
Sioux Falls, S.D.
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