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The West Volusia Hospital Authority, AdventHealth and Halifax Health have resumed negotiations over who should pay when West Volusia’s most vulnerable people go to the emergency room.

In one corner is the Hospital Authority, which decided in November 2020 to go its own way, breaking with precedent, and reimburse hospitals only for inpatient and outpatient care. 

After all, according to the Emergency Medical Treatment and Labor Act, or EMTALA, hospitals are legally obligated to see and stabilize anyone, regardless of that person’s ability to pay, if the person ends up in the emergency room.

In the other corner are the hospitals — Halifax Health and AdventHealth — and EMPros, an organization that contracts physicians to work in AdventHealth’s emergency rooms.

The hospital systems are seeking some reimbursement for ER care for those who can’t pay.

After contract discussions fell through in 2020,  the Hospital Authority Board feared the lack of a contract could lead to the low-income people who hold the Hospital Authority’s health care card being saddled with emergency-room bills.

By bringing the hospitals back into the fold, the Hospital Authority hopes to ensure such a thing couldn’t happen.

“We are going to really talk about the situation that has existed recently since the adoption of the rule where we are obligating the local community hospital systems to live up to their EMTALA responsibilities,” Jim Vertino said at the recent negotiation. “We also would like to facilitate this conversation to create a long-term strategy that makes everyone happy and creates a win-win-win situation for the community.”

Vertino is CEO of Employee Benefit Management Services — the third party that works with the Hospital Authority to provide health care to the more than 2,000 people who have  Hospital Authority health cards. 

The health cards are for those individuals too poor to afford health insurance, but too well-off to qualify for Medicaid.

Moderating the discussion, which took place March 18 before the board’s regular meeting, Vertino sought to hear out each side and chart a long-term course of action.

Participating in the dialogue were Halifax Health Director of Patient Finance Steve Mach, AdventHealth CFO Kyle Glass, and EMPros Regional Operations Coordinator Kristin McCabe-Kline.

While obligated under EMTALA to provide emergency care for patients, Glass proposed the Hospital Authority reimburse hospitals for emergency care — in addition to the already covered inpatient and outpatient care — and raise the hospital funding cap from the current $3 million to $4.5 million.

Vertino argued this budget hike was unrealistic. The Hospital Authority is a taxing agency, and increasing its budget to pay hospitals for ER care would likely mean increasing its tax rate, to collect more in property taxes from West Volusia residents.

Halifax Health’s Mach said the hospital system had previously agreed to a funding cap on emergency services. He noted that even if funding runs out, the Halifax emergency room would not stop performing “life-or-limb procedures.” 

Mach suggested the Hospital Authority pursue new options, such as going out on the health care exchange and finding a carrier that would fund health care premiums for health-card holders.

The Hospital Authority’s attorney, Ted Small, pointed out that this is an avenue they have explored, but to no avail.

Another factor is the question of whether a health-card holder might get a separate doctor bill from EMPros, even if their emergency-room bill is covered by AdventHealth’s charity program or Hospital Authority reimbursement. 

Hospital Authority Board Member Judy Craig shared a story of an individual she knew who, while a health-card holder, was billed for medical services by EMPros. That bill later ended up in collections, and served as a roadblock when the individual was purchasing a home. 

Craig argued that truly serving the community means serving the most vulnerable.

“You want to be active in the community,” she said to AdventHealth’s Glass, “Well, your activity in the community means helping us with our card holders, who are at 150 percent of the poverty level.”

Regional Operations Coordinator Kristin McCabe-Kline asked that EMPros physicians be considered specialists by the Hospital Authority, which would allow them to receive compensation at a rate of 85 percent of Medicare costs, as other hospital physicians are. 

Vertino questioned whether the use of EMPros staff in the ER was one way for the hospital to skirt EMTALA requirements, which Glass denied.

“There is a reasonable expectation that if a specialist comes in for consult, a second doctor, that they may be billed for that,” Vertino said. “There is no expectation by the public that the very first doctor they saw who triages them would ever bill them if they were an indigent person in a nonprofit hospital. There is no expectation of that.”

Discussion among the parties was tense. 

After an hour of discussing just who is considered a specialist and whether or not indigent patients can receive bills from individual physicians, the Hospital Authority concluded the workshop and moved on with its regular meeting.

No agreement with the hospitals has been reached as of yet, but the Hospital Authority Board tasked Vertino with continuing negotiations with health systems under the pretense that the Hospital Authority would consider changing its stance on reimbursing for emergency services.

The board did agree, however, to allow Community Legal Services, a partner organization, to take up any collections claims a health-card holder may face.

The hospital contract debacle will return to the agenda at the Hospital Authority’s next meeting at 5 p.m. Thursday, April 15, at DeLand City Hall, 120 S. Florida Ave. 

The Hospital Authority also plans to hold another workshop with the hospitals before their May meeting, May 20. 

While discussions have been tense thus far, Vertino said he is confident the Hospital Authority and the hospitals can reach an agreement on emergency care.

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