Though nowhere near as large or looming a problem as Atlanta's Grady Memorial Hospital's, the system that funds indigent care at Newton Medical Center has set up an imbalance: Newton County ends up paying for the care of patients from outside the county while receiving no reimbursement from the sending counties.

As indigent patients, the economically disadvantaged who do not qualify for Medicaid, will often cross county borders to whichever hospital is nearest to them and counties then find themselves taking care of patients from other counties. Still, in an analysis of area hospitals, it appears that NMC is taking care of far more indigent (impoverished) patients from outside counties than other local hospitals.

According to Troy Brooks, assistant administrator for NMC, from 2004-2006 Newton Medical Center cared for 45,800 indigent patients. During that three-year period, the number of indigent patients steadily rose from 13,672 in 2004 to 16,905 in 2006. Brooks estimated indigent patients make up 7 percent of the total number of patients the hospital sees.

"Indigent care as a percentage has risen," Brooks said. "It is growing, definitely. We see all types of illnesses and we see them in several different ways. A lot of these people are coming to the emergency room."

After Newton County, Walton County, followed by Jasper and Rockdale counties, sent the largest number of indigent patients to NMC for care over the three-year period - 3,916 patients, 3,565 patients and 3,239 patients respectively.

The total number of indigent patients from other counties was 15,108 or approximately one-third of all indigent patients. NMC received no reimbursement from the sending counties for the care it provided to their residents.

"There's never been any discussion or offer to help pay for indigent care from one county tracking their citizens to another hospital," Brooks said.

The hospital is partially reimbursed by the Newton County Board of Commissioners for the indigent care it provides by a 1.2 millage rate assigned to the hospital from county property tax revenues. From 2004-2006, NMC received approximately $8,283,000 from the county, according to Brooks.

NMC also receives some reimbursement from the Indigent Care Trust Fund. The fund was established to provide funding through Medicaid to health care providers who are providing indigent aid to Georgians. Under the program, disproportionate share hospitals, such as NMC, that treat a disproportionate number of Medicaid and indigent patients qualify for federal DSH payments based on the hospital's uncompensated cost of services to the uninsured.

Tracking DSH payments to area hospitals is one way to determine how many indigent patients they serve. According to the Georgia Department of Community Health's FY 2008 summary of DSH payments, NMC was allocated $4.4 million this year in reimbursement for its indigent care, compared to Rockdale Medical Center who was allocated $3.6 million. Walton Medical Center was allocated $484,000 in DSH payments and Jasper Memorial Hospital was allocated $392,000.

After partial reimbursement through the county's millage rate and DSH payments, NMC was still uncompensated for approximately $20.4 million it provided in indigent care during that three-year period, according to Brooks. He estimated the figure came close to 10 percent of the hospital's total operating costs.

Comparisons to Grady

Though nowhere near as dire as the situation Grady Memorial Hospital found itself in last summer, comparisons can be drawn to NMC, which also pays for the medical care of indigent patients from other counties while receiving no reimbursement from them in return.

Matters came to a head for Grady-- one of only four Level 1 trauma centers in the state-- when total operating costs, exacerbated by the hospital's high indigent and Medicaid patient load, far exceeded incoming revenue resulting in a very public $370 million shortfall.

While Grady received some reimbursement for the indigent care it provided from Fulton and DeKalb counties through the Fulton-DeKalb Hospital Authority, it received no payments from Gwinnett, Cobb, Clayton or any of the other metro Atlanta counties that have sent thousands of indigent patients to the hospital over the years.

Matters were somewhat resolved in May when the newly-formed Grady Memorial Hospital Corporation took over responsibility of hospital operations from the hospital authority in exchange for a cash infusion of $200 million over four years, according to a release from the hospital.

Like Grady, NMC, a 97-bed hospital, has gradually come to be viewed as somewhat of a safety-net hospital by surrounding counties because of Newton County's public commitment to funding indigent care.

Unlike NMC, Rockdale Medical Center, a 138-bed hospital, receives no reimbursement from the Rockdale County Board of Commissioners for the indigent care it provides. In 2007, RMC cared for 1,224 indigent patients, 281 of which were from Newton County. Last year, RMC provided $7.6 million in indigent care medical services

RMC is currently in the process of being sold to a for-profit corporation and is going through the due diligence process after suffering from recent revenue losses. According to Marsha Terry, director of marketing and public relations for the hospital, RMC is one of only a couple hospitals in the state that does not receive any tax money from its local government.

"I know that indigent care is important to us and we've done a lot of it, but we don't get any reimbursement from the county as far as tax dollars," Terry said.

Terry estimated that 10 percent of the patients RMC sees are either indigent, charity or bad-debt patients.

What the hospital's commitment to indigent care will be once a for-profit corporation owns it is not known. Should the purchasing corporation decide indigent care is not a high priority, it could result in even more indigent patients from Rockdale being sent to NMC.

Conversely, Brooks said Newton County does not reimburse other counties for the medical care their hospitals provide to indigent patients from Newton.

"There hasn't been any discussion out there between ourselves and Rockdale and Walton and Jasper for that," Brooks said.

Likewise, Terry said RMC is not reimbursed by any sending county for the indigent care it provides to their residents.

Julie Mills, public affairs director for the Rockdale County Board of Commissioners, said the board had no plans at this time to begin providing funding for indigent care in the county.

"There have been some discussions over the years, but the hospital has covered it," Mills said.