Texas County Memorial Hospital

Uncompensated care at Texas County Memorial Hospital is more than triple the state and national uncompensated care averages, board members heard at their monthly meeting.

Wes Murray, TCMH chief executive officer, presented data collected and compiled by the Hospital Industry Data Institute (HIDI) showing uncompensated care numbers for the county hospital for 2011, 2012 and 2013. Uncompensated care – both charity and bad debt – is the total amount of healthcare services, based on full established charges, provided to patients who are either unable or unwilling to pay.

“On average, we are writing off a much higher percentage of our net revenue than other hospitals in the state,” Murray said. “It’s frustrating and discouraging, but providing care for everyone regardless of their ability to pay is what we have to do as a county hospital. And we will continue to do so.”

In 2011, TCMH had 14.8 percent in total uncompensated and charity care costs. The state and national averages were 5.5 percent. In 2012, TCMH was at 16.9 percent compared to state and national averages at 5.1 percent. The following year, the hospital had 15.8 percent in total uncompensated and charity care costs compared to 5.1 percent for state and national averages.

“The federal government anticipated that the state expansion of Medicaid services would cut some of our uncompensated and charity care,” Murray said, “and our state legislators have opted to block Medicaid reform in our state.”

Murray said states that allowed Medicaid expansion have experienced 40-60 percent drops in uncompensated and charity care at public hospitals.

“As we have discussed in the past, Texas County has a high percentage of uncompensated care for the level of volumes we do,” Murray said.

In the financial report for the month of June, Linda Pamperien, TCMH chief financial office, reported $572,189.15 in bad debt and four charity care cases totaling $15,135.67.

TCMH has a policy that enables patients that truly do not have the means to cover their healthcare services needed or received to apply for “charity care” which allows the hospital to officially write off the care.

Bad debt is the amount of care that is written off because patients refuse to pay their bill or are unable to pay their bill. Sometimes patients that would qualify for charity care at TCMH do not complete the charity care paperwork, so their healthcare services become bad debt.

“Three-hundred seventy-five thousand dollars of the bad debt came through our emergency department,” Pamperien said. “And several of those patients are so ill they have to be admitted to the hospital as inpatients, incurring additional bad debt.”

Murray said that the HIDI data is provided to the Centers for Medicare Services, which has collected the information since 2010.

“This information will be taken into consideration for future government payment systems,” Murray said.


Murray introduced Ron Prenger with CoxHealth to those present at the meeting. Prenger, senior vice president and chief hospital officer for CoxHealth Springfield and Monett, will attend TCMH board meetings as his schedule allows, taking the place of Dr. John Duff, who retired in May.

“This is a beautiful facility,” Prenger said. “You have positioned yourself well for meeting the healthcare needs of this county.”

TCMH has a longstanding, non-binding affiliation with CoxHealth which provides educational, purchasing and recruiting resources to TCMH from time to time.

Murray has spoken with residents of the Cox Family Medicine Residency program about providing some weekend call coverage at the hospital for a few months.

“Currently, our physicians are on call every fourth weekend, which is too much for some of them,” Murray said. “We want to lessen that burden while we work on recruiting additional physicians to the hospital’s medical staff.”

The weekend physician would provide coverage for hospital inpatients only, admitting patients when needed and handling on-call coverage needs.

Dr. Cory Offutt, a family medicine and obstetrics physician, will begin working at TCMH next summer and will share call coverage with the current physicians. TCMH is also actively recruiting additional physicians to work at the clinics in Houston and in Mountain Grove.

“I have two family medicine physicians that will be here for site visits this month and next month,” said Joleen Senter Durham, TCMH director of physician recruiting.

Both physicians are not available until next summer — one is in the third year of residency and one is doing a fellowship in obstetrics.

“I am hopeful that these site visits will be successful,” Durham said. “We definitely have a need for both of these physicians.”


TCMH experienced drops in volume for inpatient and outpatients, according to the June financial report. Pamperien said physical therapy was the only department without declines.

Pamperien also explained that TCMH is currently paying interest only on the $19.1 million USDA loan, but principal and interest payments begin in August.

“The payment will be about $87,000 a month, which is right where we left off with our bond payments that were recently retired,” Pamperien said.

TCMH ended the month of June with a negative bottom line of $202,193.09 and a negative year-to-date balance of $1,058,436.24.

Present at the meeting were Murray; Pamperien; Durham; Prenger; Dr. Jonathan Beers; Doretta Todd-Willis, chief nursing officer; and board members, Dr. Jim Perry, OD, Janet Wiseman and Omanez Fockler. Board members Mark Hampton and Russell Gaither were not present at the meeting.

The next meeting of the TCMH board of trustees is noon Tuesday, Aug. 25, in the hospital board room.

“It’s frustrating and discouraging, but providing care for everyone regardless of their ability to pay is what we have to do as a county hospital. And we will continue to do so.”


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