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 FRONT PAGE - OCTOBER 6, 1999 - COMMERCE, GA

LOCAL GOVERNMENT

Nicholson Council Likes Sales Tax
NICHOLSON -- They didn't have a quorum for Monday night's regular city council meeting, but that didn't keep the mayor and two Nicholson councilmen who showed up from praising the proposed special purpose local option sales tax (SPLOST).
Mayor Steve Wilbanks passed around a letter from the Jackson 2005 Committee, the group working to get voters to approve the sales tax Nov. 2, showing that Nicholson stands to get more than a half million dollars if voters approve the referendum.
According to the distribution formula, Nicholson would get $435,464 for water or sewer construction; $43,081 for roads, bridges or sidewalks and $34,215 for recreation.
Those figures are based on the division according to the 1990 Census and assume $35 million in collection. The formula for dividing the money among the county's governments will be changed as soon as the 2000 Census figures are in.
Officials seemed surprised that the town, which has no recreation program, would still qualify to receive funds earmarked for recreation.
"That's what upset so many folks the last time. Most of them (smaller communities) didn't get anything," said Councilman Thomas Gary.
"It's the fairest tax in the world," said Councilwoman Margaret Ward. "If you don't want to pay it, don't spend."
Officials agreed that they could use the recreation money to improve Willard Fouche Field, which is property of the Jackson County Board of Education, or to buy land for future park development.
Gary also pointed out that much of the tax will be paid by tourists or other non-residents shopping in the county.
Ward wanted the council to endorse passage of the referendum, something the council could not do without a quorum.
"Well, I endorse it," she declared.
In other matters, Wilbanks said the trial in a suit filed against the city by Hoyt Smith has been postponed at least until March. Smith sued the city over the end point of a road.
The treasurer's report for September showed that the city had revenue of $7,045 against expenditures of $11,181.


Discounts, Charity, Bad Debts Put
BJC Medical Center In The Red
After losing 42 percent of its income to bad debts, Medicare and Medicaid discounts, charity treatment for poor people and discounts to HMOs and PPOs, BJC Medical Center operated at a $172,300 deficit during the fiscal year ending June 30.
The 1999 audit report shows more than 42 percent of the hospital and nursing home charges were "deducted," a total of $10.18 million out of revenues of $23.998 million. Actual operating revenue for the year was $14.02 million. Less than $5 million came through the nursing home, and the rest was generated by the hospital.
"Not many businesses could stay in business giving away 40 percent," said BJC Finance Director Jim Mertz.
The audit is an indicator of the situation in which most rural hospitals find themselves, decimated by heavy discounts from the federal Medicaid and Medicare programs. This past year, those discounts alone accounted for more than $7.8 million dollars for a system that pays the hospital perhaps 35 cents on the dollar for services rendered. For a procedure that costs a private-pay or insurance-covered patient $1,000, Medicaid and Medicare might pay as little as $350 to $360.
Medicare inpatient fees are determined by a patient classification system based on clinical, diagnostic and other factors; outpatient fees are based on cost reimbursement methodology that at best cover 90 percent of the facility's actual out-of-pocket costs. Often, they don't cover nearly that much, and if Medicare officials believe a procedure that was filed as inpatient could have been done as outpatient, it pays nothing. Medicaid reimbursements are also based on costs subject to a review by Medicaid. BJC Nursing Home charges $93 per day, the Medicaid-based rate.
Fifty-three percent of the facility's patients were either Medicare or Medicaid, and the rest are split almost evenly between third-party payers (insurance) and individuals.
Unless circumstances change, next year's audit report could be similar.
The damning report issued in late July by the Office of Regulatory Services of the Department of Human Resources on BJC Nursing Home has had a tremendous effect.
The hospital incurred expenses for legal counsel and consultants. It changed some personnel, corrected all the deficiencies and got back in compliance with state regulations, but as of last week, the nursing home had 10 vacant beds. Each of those vacancies reduces nursing home income by $2,790 or more per month. Usually, the nursing home has a waiting list of people wanting to get in.
The publicity around the report made it hard to keep and hire staff, which results in the medical center hiring fill-ins from a temporary agency, which increases the costs.
Y2K expenditures also continued in the second half of the calendar year, which is the first half of the fiscal year. But the biggest concern and the area where the medical center can take action is in its hospital inpatient census.
Mertz estimates that the hospital needs to have 14 to 15 patients per day to be financially sound. In the first quarter of the fiscal year, it has averaged around 11 patients per day, although summer is typically a low-census period. The census is the primary reason officials are working so hard to recruit new doctors; the more doctors on staff, the more patients who are admitted.
The 1996 Balanced Budget Act costs the facility more each year in Medicare cutbacks. BJC Medical Center can count on $350,000 to $400,000 less revenue in the current fiscal year than the last.
Administrator David Lawrence notes the challenges, but he also points out that BJC Medical Center has room to operate.
"Under expenses, depreciation ($900,000) is a non-cash outlay," he notes, "so there is still a cash flow. There is still a half million a year to replace equipment."
The focus for the upcoming months remains in attracting new doctors, and Lawrence is optimistic. A dozen doctors are scheduled to visit the hospital over the coming weeks, and a community recruiting team is helping the medical center convince the doctors to locate in Commerce.


DOT Head To Visit To Promote Tax
JEFFERSON -- The retiring commissioner of the Georgia Department of Transportation will travel to Jackson County Thursday, Oct. 14, to help convince voters of the need to approve a Nov. 2 referendum creating a five-year special purpose local option sales tax.
Wayne Shackelford will speak at a public meeting at 6:00 p.m. in the cafeteria at Jackson County Comprehen-sive High School. The talk is sponsored by the "Jackson 2005 Committee," a group headed by Dr. S.J. Shirley to promote the tax.
If Jackson County voters approve the SPLOST, the estimated $35 million would be used to fund water and sewer work (70 percent), roads, bridges and sidewalks (23.5 percent), recreation (five percent) and a fire training facility (1.5 percent).
Shackelford has promised that for every dollar raised by the SPLOST for road work, his department will donate 75 cents in road work. So, if the tax generates $35 million, some $8.225 million would be designated for roads, bridges and sidewalks, which means the DOT match would be as high as $6.168 million.
The DOT match is one of the major selling points of the tax. Another is the projection that 40 percent or more of the tax would be paid by non-residents who shop at the outlet stores, restaurants and other businesses in the county.



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