http://www.dallasnews.com/sharedcontent ... 89b1a.html

Migrant care costing millions
Parkland says price for nonemergency services tops $22M for year



11:55 PM CDT on Tuesday, August 22, 2006
By SHERRY JACOBSON / The Dallas Morning News

Illegal immigrants got more than $22.4 million worth of nonemergency medical care at Parkland Memorial Hospital this year, officials said Tuesday.

The cost estimate was the first time Parkland has quantified how much Dallas County taxpayers are paying for such care for illegal immigrants.

"It's a significant amount of money," said John Gates, the hospital's chief financial officer.

The issue of immigrant health-care costs has been boiling over in recent months, and Dallas County officials even sent bills to Mexico and other countries hoping for reimbursement for their citizens' medical care at Parkland.

Dr. Ron Anderson, Parkland's president and chief executive officer, said the public hospital would appeal to Congress for more federal funding to cover such costs. He noted that the hospital would not turn away sick or injured people, without regard to their legal status, as long as they live in Dallas County.

"If we do what's right, and ... [Congress] knows what the costs are, it's not so much that it can't be addressed by the federal government," he said.

Last year, Parkland was reimbursed $1.8 million by a federal program that covers emergency medical services for people who cannot offer proof of legal U.S. residency.

Parkland's emergency room costs for such patients actually totaled about $5.6 million, which means local taxpayers covered two-thirds of those bills as well.

The $22.4 million in costs were for medical care at the hospital's community and specialty clinics this fiscal year.

"We're going to take it to Washington because we suspect that urban areas carry 70 to 80 percent of the illegal immigrant burden," Dr. Anderson said.

The federal reimbursement program, which began last year, divides $250 million annually among U.S. providers of emergency care for illegal immigrants. The program does not cover the outpatient or clinic care provided at Parkland and other hospitals.

Jim Perry, a vice president of revenue cycle, said about 50 illegal immigrants are treated daily in Parkland's emergency room.

"We're doing a much better job of capturing that information," he told the hospital's board of managers. The average reimbursement from the federal government is about $300 per patient.

Until the federal reimbursement began, hospitals were not asking patients for their legal status for fear of scaring away seriously ill people. But to qualify for the payments, hospitals began checking Social Security numbers to try to determine who was illegally in the U.S.

The hospital has tracked such patients in its clinics by the identification numbers assigned to them in the emergency room.

"We've known they were there, but it's not something we've looked at closely," Mr. Perry said of immigrant care.

For years, Parkland has been reimbursed for the costs of obstetrics patients who were illegal immigrants. They qualify for a special Medicaid program for women who can't prove their legal status. Of the 16,000 babies born annually at Parkland, about 70 percent are to mothers who are illegal immigrants.

Hospital board members said they strongly supported efforts to get more federal funding.

"We're trying to stop Dallas County from paying more than its fair share," said board member Richard Kneipper.

On Tuesday, the board of managers also approved its 2007 budget totaling $920 million – a 2 percent increase over 2006. The Dallas County Commissioners Court also must approve the budget.

Parkland's tax rate would remain unchanged for the sixth year in a row – 25.4 cents per $100 of assessed value. The owner of an average Dallas County home, valued at $146,000, would pay $370 in hospital taxes next year.

Local taxpayers will pay $348 million for Parkland next year, about 38 percent of its total revenues. The remainder comes from Medicaid, Medicare, other government subsidies and private insurance.

The Parkland board also approved a separate budget for jail health care, which the hospital began providing at the Dallas County Jail this year. The $28.3 million cost for 2007 will not increase the countywide tax rate.

Parkland is expected to end fiscal 2006 with a $151 million surplus, due mainly to one-time windfalls: a $13.4 million profit from selling Parkland's old hospital building and a $72.5 million settlement of a lawsuit with the state over inadequate funding of graduate medical education.

Hospital officials have said repeatedly that they do not expect Parkland to have such a positive bottom line in the future. The new budget predicts a $20 million surplus next year.

E-mail sjacobson@dallasnews.com