$3 a patient - truth of hospital bills crisis

Health Minister Dr Duane Sands.

Health Minister Dr Duane Sands.


Tribune Chief Reporter


THE Princess Margaret Hospital’s Accident and Emergency Department collected less than $200,000 in revenue for services provided in 2017, according to Health Minister Dr Duane Sands, who said the figure amounted to an average bill of just $3 per patient.

Dr Sands confirmed the Public Hospital’s Authority antiquated billing system could not track medical charges in real time, and was entirely dependent on manual records - an environment that has resulted in an estimated loss of $40m in potential insurance claims per year.

A source told The Tribune in the years 2012 to 2017 as much as $251 million worth of services provided by Princess Margaret Hospital may not have been billed. However, Dr Sands said he had no information on that figure.

Dr Sands said the government was currently engaged in multiple and simultaneous initiatives, which included strengthening the billing and collection programme but also revising the fee schedule.

“The IT system that currently exists is strictly a medical record system. It may be tied to the laboratory or ICE system but it is certainly not connected to any other charging ability,” he said.

“It certainly won’t be automatically recorded so very expensive items may be used which may or may not be recorded on a charge master. So it’s impossible in real time to have a bill so you can’t charge the patient and in terms of insurance charges, you lack ability to verify that what you’re billing is real.”

Dr Sands also said: “So it speaks to a lack of capacity and we estimate, and there is very little way to verify this number, except to say fairly reliable sources would suggest that it’s true there may be as much $40m per year in insurance claims we don’t pursue.

“That’s at least four times what we currently collect across the system – the total revenue of PHA is around $10 million. If we are able to collect that revenue - and this is before you go after cash paying persons who are paying the gazetted fees – you can increase your revenue legitimately by 400 percent.”

Dr Sands said the PHA has received complaints from insurance companies who acknowledge the need to pay claims but have either not received the bill, or it’s not coded properly, or lacks supporting documentation.

The billing system also presented significant challenges for the management of medical supply inventory, he said.

“So ‘John Brown’ is in the Intensive Care Unit and IV fluid bag goes up, it may or may not be recorded. In the operating room, certain expensive devices may be inserted or used in a patient, some of them causing hundreds or thousands of dollars and the charge slips are issued manually.

“The possibility of loss is significant,” Dr Sands continued, “but we also have very limited ability to protect from shrinkage.

“It’s less an issue of drug shortages, than disposable medical supplies. For example, some of these clips that are used for invasive procedures are disposable kits but cost hundreds of dollars.

“It’s not uncommon for health staff to be searching around the hospital for such a kit because there’s none on the ward but no record it has been used at any given time, so you literally have staff walking around the hospital looking.”

The health minister raised concerns over $782 million in unpaid bills on the books at PMH since the late 1980s during his recent budget contribution, along with the limitations of the Billing & Medical Coding Department.

He was contacted by The Tribune to provide an update on the impact of the understaffed department - said to have been reduced from a complement of 50 to five - on revenue collection.

Yesterday, Dr Sands said: “This is a serious challenge of capacity and in the absence of an IT system which is able to relate the patient record to billing, to pharmacy, to imaging etc, then it’s just a random occurrence that you’re going to be able to get a reasonable assessment of charges. You may have been able to do a reasonable task a few decades ago but if you see we now have accounts receivables of more than $780 million then clearly we are not doing a good job.

“We see just under 60,000 patients per year at Accident and Emergency,” he continued, “and in the last fiscal year we collected less than $200,000 for services provided for 2017. That is about $3 per person, these are people suffering from strokes, heart attacks, gunshot wounds, so that gives you an idea of how dismal the collection is. It basically means we don’t even pay the cost of the staff to collect that money.”

Dr Sands added: “Part of it is a system which is not geared to adequately pursue revenue, but another part of it is a cultural unwillingness to pay for medical services and a system that exempts huge segments of the population because they are either too young, too old, or civil servants.”

Dr Sands explained the benefit for civil servants was created before the government began providing health insurance for its workers but now barred the public hospital from cashing in on the $75 million Bahamian taxpayers pay for those insurance premiums.

Yesterday, Dr Sands stressed the issue was not partisan but systemic.

“This is not a PLP or FNM problem,” he said, “this is a systemic problem with inadequate capacity, as well as there has been no political will to fix it. When you have plenty of money and can borrow, the political will is to maintain the view that healthcare is free.

“We have a serious problem fundamentally,” Dr Sands said, “what we have to do is bring billing and collections of our facilities in the 21st century. This is not about making Ava pay more money, this is about ensuring if Ava has insurance and is a private patient, that we can send a bill so the hospital can benefit from that service rendered.

Dr Sands said: “So that it can provide new equipment or maintain existing equipment - if you’re providing a service you have to pay for it, and where is the money coming from? You can’t provide a service you can’t pay for, either you raise the fees, reduce services or simply don’t provide the service.”


Sickened 4 years, 9 months ago

Stories like this really brings a tear to my eye. It's like watching a child in a playground fail at something over and over again and the child's parents are standing there watching and doing nothing to help the child. If this doesn't call for ALL of those people at the top of PMH to be fired then nothing will change. It's like super value having only cashiers who are blind and deaf so they can't see what is supposed to be scanned, whether or not they have scanned it, how much it adds up to, how much cash was given to them and how much change they handed out. Lunacy!!!


TheMadHatter 4 years, 9 months ago

If Ingraham had implemented the Freedom of Information Act and if Finance would publish monthly ACTUAL figures in & out online then WE would already know this. None of these silly "Budget" figures which are only pipe dreams and bong schemes.

Secrecy is killing us. Monies going any old place and all kinda citizenship ad in the paper with no picture. No wonder we Bahamians have to wait long for passport.


ConchFretter 4 years, 9 months ago

Unacceptable! And both major political parties are complicit with this failure.


DWW 4 years, 9 months ago

Wait healthcare at PMH isn't free? When did that happen?


Alex_Charles 4 years, 9 months ago

This really makes me sad and angry at the same time. Why haven't they switched to a proper POS system at least? Quickbooks point of sale, while not whollly applicable, would be better and more efficient than what they are using now. IT also would cost less than $250 per month for several terminals. It also allows for inventory management and can keep patient names, ID numbers, prescriptions etc etc.

It's not designed specifically for THAT purpose, but it damn sure can do it. Atlas it would be a stop gap measure until they get some serious funding for a better system. It would also see revenues go up.


sealice 4 years, 9 months ago

“This is not a PLP or FNM problem,” he said, “this is a systemic problem with inadequate capacity, as well as there has been no political will to fix it. When you have plenty of money and can borrow, the political will is to maintain the view that healthcare is free.

You so right Doc #2 and this is why we need some dern foreigners in here to run things so we won't get so many millions and millions of dollars behind in bills. We need big change around here


birdiestrachan 4 years, 9 months ago

What percentage of this includes illegal immigrations? Just curious


Naughtydread 4 years, 9 months ago

I think our government should just hire foreigners to run the country. At this point we are better off with a bunch of monkies trying to run our country. How in the world can a hospital not make a profit?


Sickened 4 years, 9 months ago

Since the PM wants to go to Singapore and check them out I suggest he also go with a sales brochure and get them to buy us. In fact they don't even need to buy us we could just give it to them. I am sure they could turn this country around in less than 10 years.


bogart 4 years, 9 months ago

The Nations Public Hospital not making enough money because of alleged wrong doing should best be a motter of the internal auditor controllers be fired for slackness or people planning, doing what is needed to run the institution to succeed...!!! Internal matters being broadcast why not certakn things are not being done...undermines the efforts majority of those diligent hospital workers...its image ...going forward....instead of airing dese matters publictly.....internal slackness must be dealt with prompltly....not dis like the long drawn drag out story like the patients winding up living at the hospital using up services depriving the needy....deal with the slackness like how doctors cut out the paients bad infected parts an throw the diseased parts out...so da patient can survive..!!!!!!......


CaptainCoon 4 years, 9 months ago

Once again, Baboons running the country for years. Ever since the UBP lost, the jungle took over. SAD!


bogart 4 years, 9 months ago

Doc...Doc.....what I been meaning to also get out is that Hospitals all over having it rough...one medical facility Collins area done close up staff been lookin for money.....even the big one not too far away have millions in Receicables and did put aside like 5m in provisioning......plenty Bahamians scrappin .like VAT at 7.5% done took outta their disposable incone some 2.5 billion dollars 2015 to 2017..some Bahamiams didnt have income....plus now vat 12 .5%.?...plus like some other tings jack up even more....Doc plenty Bahamians worser than before dats fer sure....Doc ....what do you think .....Bahamian population done pay plenty an still payin now more.....or how if Bahamians go to the UN Human Rights people an tells them Bahamians being denied...Human Rights for Medical treatment...cause the govt victimizing dem....do the same things other people doing in Education Ministry......Bahamian pore people who have passport, voter card..parents have passport an voters card too....an 10 people in this house register to vote?. have Human Rights needs for PMH too..!!!....


Missgracielou 4 years, 9 months ago

What happened to the new billing system they say they was getting? A whole new million dollar system. Where the money for that gone?


bogart 4 years, 9 months ago

....computers...nurses...equipment...need funding Actually any govt given unexpected forced expenditures would have to divert monies to meet the more critical demads for good governance.


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