Once again Peter and Paul visit the county’s budget process

Every year, the county has to pass a budget by the June 30 deadline. And every year, as that deadline approaches, the wants and needs outweigh the available funds. Commissioners start digging around in Peter’s pockets so they can pay Paul.

Traditionally, the Peter in this scenario has been the Medical Center of Central Georgia — now Navicent Health. And, over time, you would have to say the now consolidated commission has been successful in this act of thievery.

In 1999, Bibb County reimbursed the Medical Center $4.75 million for the cost of indigent care services delivered by the hospital. That figure fell to $2.475 million by 2008 and has sunk like a stone ever since to its present level of $451,600. In each of the years, the bill presented by the hospital has been much greater than what the county has paid for its responsibilities. And yes, it is the county’s responsibility to provide for the health and well-being of the people who live here, regardless of their financial condition, even if 28 percent of them live below the federal poverty level.

For fiscal year 2016, the hospital has presented a bill of $15 million in costs — not charges — for Bibb County patients. The county first responded by keeping the level flat at $450,000. Now, some commissioners are talking about finding a Paul in the budget to give that paltry sum to rather than the hospital.

Back in the good old days before managed health care, the hospital could absorb much of the costs through various methods of shifting that cost to paying customers. The good old days are gone and a new era has brought increased competition, managed care and the Affordable Care Act. Couple that with Georgia’s decision not to expand Medicaid and cuts to the Disproportional Share Hospital payments that go to facilities delivering indigent care services, puts the Medical Center and all hospitals in the state in a very different position.

For example, the Medical Center — Navicent Health needs a 4 percent profit margin just to keep the doors open. That does not include investing in new technology that could save lives. What does keeping the doors open mean? Our hospital is a 24/7/365 operation. It is one of only five Level I Trauma Centers in the state. It offers services from cancer to heart to neonatal. Its profit margin fell from 5.68 percent in 2015 to 1.43 percent in 2016.

We don’t expect the commission to understand the intricacies of running a hospital, but one example might give a clue. Possibly two of the single most expensive pieces of equipment the county would have to buy might be a tractor for the landfill or a ladder truck, each costing several hundred thousands of dollars. A new Magnetic Resonance Imaging machine can cost $3 million, and it can’t sit out in the open. It needs a specially-constructed suite that costs hundreds of thousands of dollars more, and oh, you have to have more than one for redundancy and patient flow and you need highly-skilled operators.

Some commissioners point to the Medical Center’s unrestricted reserves of $752 million as justification for their Peter to Paul ploy. From 2015 to 2016 those reserves dropped $12 million, a situation that is clearly unsustainable. And while a half million dollars will not make or break the hospital today, a long-term solution needs to be designed now instead of in a time of crisis.

Macon-Bibb County is an outlier when it comes to support of its hospital and paying for the care of indigents. Columbus taxpayers dedicate 3 mills, more than $12.5 million, to Columbus Regional Health, and it’s not a Level I Trauma Center nor does it offer open heart services. Clayton County allocates $7.9 million to Southern Regional in Riverdale; Southeast Georgia Health System receives $349,772 for its Brunswick hospital and another $36,278 for its Camden campus. Even the 24-bed hospital in Jackson receives $537,600 from government. No need to add Taylor Regional, which receives $228,087, or Stephens County’s $423,016 or St. Mary’s Good Samaritan’s at $360,000.

These communities comprehend the “Golden Hour.” If you’re injured or suffer a stroke or heart attack and you’re more than an hour away from medical attention, your chances of survival drop considerably. Without our public Level I Trauma Center, the chances of our community surviving and thriving drop considerably.

It’s time all the commissioners understood that, too.

This story was originally published June 17, 2017 at 9:00 PM with the headline "Once again Peter and Paul visit the county’s budget process."