By Annie Goeller, Daily Journal of Johnson County staff writer
Patients who owe a Franklin hospital money someday might be turned away if they aren't having a medical emergency.
An expansion at one hospital has been delayed and another could be, depending on how the sluggish economy continues to affect local people.
And at hospitals throughout the area, more patients are being asked if they qualify for Medicaid, supervisors are cutting overtime for employees, and officials are looking ahead to when deeper cuts could be needed.
At the three hospitals serving Johnson County and the southside, more patients are coming in who don't have insurance and can't pay their medical bills.
Hospital officials said the increase in patients who don't or can't pay and cases where the hospital covers all or some of patients' medical bills has them looking for ways to cut costs and cut their profit expectations.
Cuts have been big and small.
They have renegotiated contracts with suppliers to cut costs, tried to get more patients qualified for Medicaid to help with costs for their care, limited overtime for employees and been hesitant to fill open positions that are not directly related to patient care.
Earlier this year, St. Francis Hospital and Health Centers delayed finishing construction on a six-story, $265 million patient tower at its southside hospital, due to concerns in the economy.
"We looked at our priorities. The best way to spend the money we have is on serving the community," St. Francis vice president of finance Greg Anderson said.
At Johnson Memorial Hospital, officials decided last year to close the skilled nursing unit at the Todd-Aikens Health Center, which had been losing money, totaling a deficit between $400,000 and $500,000 in recent years.
Hospital officials in all three networks said they want to continue avoiding layoffs and strive to focus on maintaining standards of patient care and community assistance.
"Everything is on the table for assessment as long as it doesn't affect patient care," Anderson said.
But they have back-up plans.
At Johnson Memorial, officials have discussed putting off an expansion of the medical office buildings in 2010, requiring patients to pay up-front, instead of their current policy to request payment, and turning away patients for non-emergency care if they owe the hospital money, chief executive officer and president Larry Heydon said.
They also will continue to review services that are not profitable, although Heydon said he couldn't identify any right now.
At Community Hospitals, officials want to look at ways to integrate more services into their hospital network, such as the recent cardio services that were added. And they want to look at how to get rid of inefficiencies and review all their costs to look for different processes that can save money, Community Health Network chief financial officer Tom Fischer said.
And, though it's a worst-case scenario, hospitals someday may need to limit charity care, officials said.
Currently, the hospitals have been able to cover costs for all the patients who need it, officials said.
Patients who qualify must be below 200 percent of the poverty level, or make less than $44,100 for a family of four.
But in the future, such as if the unemployment rate were to continue to skyrocket, that may not be possible, officials said.
"Up to this point, we have been fortunate to have had the ability to fully fund charity care. But as we go forward, we may not have that privilege," Anderson said.
But the situation would need to significantly worsen to reach that point, he said.
For example, he expects the unemployment rate would need to be five times its current levels.
And hospitals will make every effort to avoid that, officials said.