The Marion County Health and Hospital Corporation Board has responded to the Wishard Memorial Hospital budget crisis by planning to cut its budget and increase the cost for low-income patients, all while hoping for a federal fix. What it hasn’t done is ask for a higher tax rate from local citizens.
“We are developing contingency plans that we hope we never have to implement,” said Health and Hospital Corporation President and Chief Executive Officer Matthew Gutwein. “These are difficult choices to make.”
The Health and Hospital Board will hold a public hearing on their proposed budget at 1:30 on Aug. 12 at Wishard, and will vote on the budget on Aug. 22. The tentative budget is for $54.3 million less than last year. Although the Health and Hospital Corporation Board of Trustees has the authority to increase the county property tax rate to make up a portion of that shortfall, HHC management recommends the board decline to do so. “Health and Hospital Corporation is not seeking an increased tax rate,” says Dan Sellars, treasurer and chief financial officer of the corporation. “We are working very hard with our federal and state legislators to create a federal solution for Wishard. We believe a federal solution is more appropriate than an increased tax rate for the citizens of Marion County.” However, low-income citizens of Marion County who use Wishard services will be asked to pay more. Under the current proposal, co-pays will increase, and some patients who do not qualify for Wishard Advantage insurance program will be charged $100 to be seen by a doctor at a primary care clinic site and $150 more if they need to see a specialist. Some advocates and physicians worry that the new fees will stop some working poor patients from seeking necessary care. “This will hurt the poor families and the ones who lost jobs and their insurance with it,” says Loretta Day, chair of the West Side Clinic Advisory Board. “It is a concern, but we know they have to raise funds, and no one wants to raise property taxes right now.” Matthew Gutwein, president and chief executive officer of Health and Hospital Corporation of Marion County, said Wishard’s problems are the result of national trends. “All over the country, hospitals are struggling,” Gutwein said. Gutwein cites three factors as responsible for Wishard’s budget shortfall. First, the cost of health care has increased. This is due to a shortage of medical professionals and rising pharmaceutical costs. Pharmaceutical costs have risen 15 to 20 percent each year since 1999. Second, there is an increased demand of services for the indigent. The Census Bureau reported in 2002 that more than 1.4 million uninsured individuals live in Indiana. The demand for services for the indigent have increased more than 25 percent since 1998. Wishard is the fourth largest provider of outpatient indigent treatment in the country. Third, reimbursement rates from Wishard’s primary payers — Medicaid and Medicare — have decreased. “We have fewer federal dollars to serve our mission,” Gutwein said. “We don’t have the level of support that we need.” Sens. Evan Bayh and Richard Lugar, as well as Reps. Dan Burton and Julia Carson, are backing a provision in a bill to provide emergency funding to Wishard. “We have reason to be cautiously optimistic,” said Ibrahim AlGhani, assistant to Gutwein. “We’ll plan for the worst and work very, very hard for the best.” In the meantime, Gutwein has asked the board to approve a budget that sharply cuts costs but does not raise local taxes. “It’s only wise to be prudent,” said Marge O’Laughlin, a board member. The board has not asked for a tax rate increase since 1992. O’Laughlin said the property tax reassessment will result in more money going to Wishard. Bayh’s provision, if passed, will result in an additional $40 to $50 million. There is also a backup plan. “We are developing contingency plans that we hope we never have to implement,” Gutwein said. According to its published newsletter, Wishard will strive to become more efficient, eliminate administrative costs that do not directly affect patient care, become more strict in ensuring it provides free care only to indigent patients who reside in Marion County and target programs that are not essential to Wishard’s core mission. Wishard will cut services only after accomplishing all this and only if there are not other alternatives. “These are difficult choices to make,” Gutwein said. Olgen Williams, executive director of Christamore House, said he believes Wishard executives are “doing the best they can” to minimize the impact on indigent services. “[The shortfall] reflects the whole country, not just Indianapolis,” he said. “We’ve got to work together.”