The amount of bad debt from patients who do not pay for the care they receive rose 50% since 2015, Wyoming Medical Center officials said Tuesday.

"When the economy is good and people are working then they come and they pay their bills," the hospital's chief financial officer Gary Zmrhal said after meeting with the Natrona County Commission.

"If not, that's the last thing more likely than not that they pay," Zmrhal said. "It's market conditions, it's the population, the aging of the population -- things that all interrelate."

He, Medical Center CEO Michele Chulick and Serena Cobb of the Memorial Hospital of Natrona County board of trustees met with the commissioners to present the semi-annual report of the hospital's lease with the county, with this report including the full 2018-2019 fiscal year.

The report is a requirement of the non-profit Wyoming Medical Center's lease of the Natrona County-owned hospital assets, which primarily are located in the 1200 block of East Second and East Third streets, plus the former Mountain View Regional Hospital on Casper's east side, Mesa Primary Care on the west side, and other properties.

The hospital is required to provide care for anyone who needs it.

Zmrhal showed the numbers and graphs of the charity care -- the care the hospital must provide to those who cannot pay -- and bad debt, collectively called "uncompensated care."

In 2015, the WMC provided $24.6 million in charity care, with 76% of that for Natrona County residents and 34% for patients from outside the county.

That has steadily declined to $18.7 million in fiscal year 2019, with 80% provided to county residents and the rest to patients from elsewhere.

Zmrhal later said more people have insurance. " So as a result through their insurance and through their job position they're able to pay their co-pays and deductibles."

Bad debt, on the other hand, has risen and fallen from $26.4 million since 2015, but jumped significantly in the past two years, with the fiscal year 2019 coming in at $39.0 million.

Nearly 69% of that was from Natrona County residents, with the rest from outside the county.

Commissioner Paul Bertoglio asked why the hospital cannot collect some of the bad debts, and Zmrhal said some patients initially have a payment plan, make a couple of payments and then quit or leave the area.

Chulick added that some people get low-cost insurance with high deductibles, but cannot pay those deductibles when they have a catastrophic injury.

After the meeting, Zmrhal pointed to the economy: "Bad debt is a function of the economy, whether people have jobs or not, moving in town or out of town, what kind of position they have, if they lose their jobs such as the change in the ownership of the mines where people actually didn't get paid for the last several weeks of work, let alone insurance coverage."

Overall, the uncompensated care was $57.7 million for the 2018-2019 fiscal year, compared to $51.0 million for the 2015 fiscal year.

Zmrhal's report included figures for the hospital's provision of prisoner care and involuntary commitments, which totaled $1.4 million -- $1.5 million minus the county's $120,000 payment for prisoner care.

The Wyoming Medical Center also has increased the value of the county hospital assets from a base line of $62.9 million in 1995 by 531% to $334 million, not adjusted for inflation.

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The nonprofit Wyoming Medical Center Inc., was formed in 1986.

Until then, it was known as the Memorial Hospital of Natrona County, which was owned and operated by Natrona County. After the creation of the WMC, the county continued to own the physical plant of the hospital. The WMC leases the property from the county to perform health care. The WMC's rent, in effect, is to maintain the value of the physical plant and provide care for the indigent and prisoners at the county jail.

A five-member board of trustees -- called the Memorial Hospital of Natrona County -- is appointed by the Natrona County Commission and oversees the WMC's lease of the county's property.