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For the first time in more than two decades, the West Volusia Hospital Authority has no contract with any area hospital to provide services to its clients.

The Hospital Authority’s negotiations with both AdventHealth and Halifax Health fell apart over payments for emergency care.

AdventHealth has hospitals in DeLand and Orange City. Halifax has opened a hospital in Deltona. All three hospitals are likely to get emergency and nonemergency patients who are enrolled in the West Volusia Hospital Authority’s health-card program.

The parties all agree that, if a Hospital Authority health-card holder goes to the hospital for nonemergency services, the Hospital Authority will pay a negotiated price for those services.

But, if a poor person shows up at an emergency room, the hospitals are required by federal law to care for that person, without regard to whether the patient can pay, or whether he or she is a Hospital Authority health-card holder.

The Hospital Authority’s position is, if that person in the ER does happen to have a health card, that doesn’t mean the Hospital Authority should pay the emergency-room bill.

There’s no question that hospitals routinely provide care they aren’t paid for.

Halifax Health Chief Financial Officer Eric Peburn told The Beacon in an email that his company’s hospital in Deltona has provided $2.4 million worth of uncompensated emergency care since it opened earlier this year.

Regular Hospital Authority meeting attendee and DeLand attorney Tanner Andrews had strong words for the area hospitals during the Nov. 19 Hospital Authority meeting.

“The hospitals right now are really faced with a choice. They can accept what is an extremely reasonable offer from the board here, or they can try to pursue what lawyers sometimes call ‘blood from stone’ extractions. Our members are typically not going to be able to pay a standard hospital bill,” Andrews said. “The hospitals are looking really, really bad in trying to shirk their federal obligation and shift it onto our West Volusia taxpayers.”

The offer Andrews referred to is a resolution, adopted by the Hospital Authority at the meeting, that will guide the authority’s interactions with area hospitals unless a contract is signed. The Hospital Authority is hoping the hospitals will sign on to the resolution.

It states that Employee Benefit Management Services miCare clinics — one in DeLand, another soon to open in Deltona — will continue to refer health-card holders to area hospitals for nonemergency services the clinics are unable to offer. Payment for those services will be offered at the previously agreed-upon rate of 85 percent of what Medicare would pay, or the amount billed — whichever is cheaper.

However, the resolution does not include a provision for paying the hospital back if Hospital Authority health-card holders end up visiting the hospital for emergency-care services.

If hospitals accept reimbursement from the Hospital Authority, they will, if any choose to sign the passed resolution, forfeit the opportunity to pursue patients for further payment.

But it is just that lack of a signature that worried some board members.

“It seems to be an all-or-none, as if the taxpayers have unlimited amounts of money to pay for the care that the most vulnerable need in our community,” Board Member Dr. John Hill said. “Secondly, the resolution, as I understand, does not obligate either hospital to accept payment in this fashion, because there is no contractual obligation with them. … It really does not hold any real weight, more than the paper it’s written on, if a person receives medical care and the hospital wants to go after them to pay those bills.”

For now, Halifax Health’s Peburn said they would still like to pursue a contract with the Hospital Authority, but that it must be one that reimburses the hospital for emergency care.

Dr. Andrew Murray explained that while there are no formal contracts with area hospitals, there has been no change to patient care. Murray is president of EBMS Inc., a partner with the Hospital Authority. He had been handling some of the contract negotiations.

Halifax, he said, has agreed to accept final payments for nonemergency care provided to health-card holders for October and November.

“Halifax is behaving like our partner,” Murray said. He praised the work of staff at the Deltona hospital for taking care of health-card holders.

He said he remains confident that a formal agreement can be worked out with Halifax, and, possibly, AdventHealth. He stressed that no one should have any reason to suspect that the AdventHealth and Halifax hospitals will ignore their obligations under federal law to provide emergency care.

The Hospital Authority is entering uncharted territory, as the taxing district has had a contract with at least one West Volusia hospital for the past 20 years. While the care offered to health-card holders has not been affected, board members fear without a formal contract or signature on the resolution, West Volusia’s most vulnerable people could be responsible for hospital bills they simply can’t afford.

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