ATLANTA - Uninsured patients who show up for non-emergency care at Grady Memorial Hospital will now have to pay in full before receiving services if they live outside the metro Atlanta counties of Fulton and DeKalb.

Grady's corporate board on Monday approved the new policy for new, out-of-county patients.

It's the latest effort to improve the hospital's deteriorating bottom line, The Atlanta Journal-Constitution reported (http://bit.ly/oBy6aG). Grady is on course to lose $23 million this year and faces a projected $13 million shortfall next year.

Patients from Gwinnett, Cobb and other counties account for 10 percent of Grady's 550,000 visits each year, costing the hospital about $25 million, officials said.

Fulton and DeKalb counties, which will contribute nearly $65 million in indigent care funding to Grady this year, are the only counties that financially support the hospital.

In 2009, Grady instituted a sliding-fee scale based on income for out-of-county patients. Patients were asked to pay a portion of the fee up front but didn't pay off the rest, spokesman Matt Gove said.

Now, patients will have to pay for all fees before scheduling services.

Patients who can't pay will be given information about clinics and other options in their own communities, board chairman Pete Correll said.

The policy won't apply to emergency department patients with trauma injuries or people who come for unique, specialty services Grady offers, hospital officials said.