|Ocala, fl -
Published in the Ocala Star-Banner Saturday, September 3, 2011 at 10:49 p.m.
If you're confused by the debate over the future of Munroe Regional Medical Center, don't fret. You're not alone. It's a tremendously complex issue made more complex by the fact that Munroe's governing structure is about as simple as quantum physics.
But understand it we must, because Munroe is a first-rate hospital and its future is in jeopardy because, we're told, its current business model is financially unsustainable. If something isn't done soon, who knows what will become of this most important piece of the local health-care network?
Here, then, is my best attempt at deciphering and explaining this issue.
First, it's important to know that Munroe is different from other hospitals.
Most hospitals are run by private corporations. Munroe is a public hospital, one of only a handful in Florida. Some years ago, the Florida Legislature created the Marion County Hospital District to provide for the health-care needs of the people of Marion County. Munroe is the key piece of that system. That means the hospital and all its assets and debts belong to you.
The Hospital District is overseen by a seven-member board of trustees, each of whom is appointed by the Marion County Commission.
But because the trustees know bupkis about running a hospital, they created a private, not-for-profit corporation called Big Sun Health Systems, which is now called Munroe Regional Health Systems, to manage the day-to-day operations. They then leased the hospital and everything in it to MRHS.
Here's what makes this hospital really different, though. It is what's known as a safety net hospital. That means that, unlike many hospitals, Munroe treats people regardless of their ability to pay.
All hospitals are required to treat anyone who walks into the emergency room. Munroe goes farther. It provides care to poor people in a variety of specialties, even though it isn't legally required to do so.
The other thing Munroe does is provide an array of services to patients whether or not those services are profitable. Labor and delivery services are generally money-losers, for instance, but Munroe provides them.
That is its mandate as a public, safety net hospital, and it is a major reason Munroe is facing financial peril. Even though Munroe receives higher-than-average Medicare reimbursements, that doesn't make up for the tremendous amount of charity care the hospital provides.
Munroe is running in the black for now. But its revenues are trending downward, and if something doesn't change soon, hospital officials say, it will start running in the red consistently in the next few years.
Everyone — the hospital administration, the trustees and the County Commission — is eager to find solutions.
A consultant has said there are three likely fixes: Get an infusion of revenue from a tax of some sort; find partners to help share the financial burden and create new opportunities for revenue; or sell the hospital to a private company.
Which brings us to the present day. Trustees, hospital board members, county commissioners and hospital administrators agree that they need to explore all three options very closely, and quickly.
That's where the agreement ends, however.
While almost everyone agrees that Munroe Regional Health Systems has done a really good job running the hospital under the circumstances, there is disagreement about whether MRHS should figure in the hospital's long-range plans.
If the trustees ultimately decide to go with the nuclear option and sell the hospital or switch management companies, they first have to break the lease with MRHS. Currently, that requires supermajority votes — a majority plus one — of the trustees and the full 13-member hospital board. After 2013, when MRHS's new lease goes into effect, it will take a simple majority to break the lease.
So three trustees want to pick one of the options and decide within the next year whether to renew its lease with MRHS.
The remaining trustees, along with the six non-trustee hospital board members, want to extend the lease with MRHS at least a few years. They argue that committing to MRHS for at least a few more years will offer the hospital and its employees some stability while the trustees explore their options and try to engineer a stronger future.
However, it seems that the lease issue is really not that important.
If, after exploring their options, there is strong consensus that selling the hospital or changing its management is the way to go, the trustees can break the lease with a supermajority vote in the next two years or a simple majority vote after that. Not an impossible feat.
So why the controversy?
Underlying the disagreement is this: The two sides don't trust each other.
Some among the majority trustees and hospital board members — the ones who favor continuing the lease with MRHS — think the other trustees and some members of the County Commission are determined to sell this great community hospital.
And some among the minority trustees — the ones who want to make a quicker decision about the lease — fear that the majority trustees and hospital board members have ruled out selling the hospital and have their hearts set on some sort of a hospital tax.
Here's an idea: perhaps both sides can quit worrying about the other's motives long enough to embark on an exhaustive study of their financial options, the way they said they were going to.
We've been hearing for several years how desperate the hospital's financial situation is growing. Let's get going on a solution.