|Ocala, FL -
Published: Sunday, September 25, 2011 at 6:30 a.m.
For months, we have been reading about the financial woes at our hospital, Munroe Regional Medical Center, and the various solutions proposed by the County Commission, the hospital trustees and others in our community. But after all is said and done, I would submit the problem is really very basic, and the real solutions are limited and dependent on the public's desire for the future availability of a full-service safety-net hospital in our county. Let me explain.
Today in Marion County, there are approximately 80,000 people who have no health insurance. That's about 25 percent of our population, and a number that, unfortunately, is growing. A few of those people have lots of money, and when they go to the hospital with a heart attack, cancer or delivery, they can pay the bill or work out a payment plan that makes sense for them and for Munroe.
But thanks to modern technology and new drugs, the cost of hospital care in this country is now very high. A bill of more than $10,000 is not unusual for the care patients receive in the emergency department before they go to surgery or the nursing floor for their continuing care. And for the vast majority of people, the total bill may well exceed their family's total income for months, the whole year or even longer. It's a bill too high for them to pay, and too high for the hospital to ever collect.
Some of that "uncompensated care" is legitimate bad debt, and it needs to be pursued. But last year, about $13 million of the care MRMC provided was just plain charity. There was simply no money there to collect.
So, how should Munroe cover that loss? For cover it they must. There are salaries, supplies, drugs and a long list of other expenses that went into that care. Someone has to pay for it. But who?
In the "good old days," hospitals could cross-subsidize the cost of their charity against commercial insurance patient revenues, which were generally higher than the cost of the care provided for those patients. They were a profit provider. But, like Medicare and Medicaid reimbursements before them, the Blue Crosses of the world also have cut their reimbursements so that the margin against cost for the hospital is now very thin indeed — too thin to solve the charity problem.
Simultaneously, the percentage of commercially insured patients has dropped as employers and employees drop coverage because of the high cost of insurance.
But if the commercial insurers won't pay, who will? Ah, there's the rub.
The community could have a big charity drive each year to try to raise the $13 million, but that's not very realistic.
Munroe could refuse to treat patients who can't prove their ability to pay, but as our community's safety-net hospital, that would be unconscionable. That is a major part of why Munroe exists: to serve the health care needs of the people of Marion County, regardless of their ability to pay.
For the same reason MRMC can't just shut down the services that end up losing money when volumes of patients from our community need those services — obstetrics, pediatrics, many general medical services and numerous outpatient testing services. Someone has to provide them, regardless of their profit potential.
But still, the bill must be paid.
Some say our hospital should become more efficient, but Munroe is recognized as one of the highest-quality/lowest-cost hospitals in the country. It sets the bar for efficiency.
It has been suggested Munroe might be leased or sold to a for-profit hospital system, but the question remains the same: Who is going to pay for charity care?
The for-profit hospital system is going to be primarily interested in making a profit to satisfy their stockholders. To do that, it will be forced to either stop treating our residents who can't pay, or cut costs by eliminating services that lose money and/or reduce the quality of patient care. Both courses threaten a loss in our hospital's quality and safety-net ability. We all lose.
What have other communities in Florida done to solve this dilemma? The details vary, but in several counties, recognition that charity care is a problem affecting not only safety-net hospitals but all hospitals and some other health care providers as well, has resulted in the establishment by referendum of an indigent-care funding plan supported by a half-cent sales tax.
In Marion County, such a tax would generate approximately $17 million a year. Much of that money would go to organizations other than Munroe. But because of Munroe's comparatively high cost of charity care, it would receive a significant portion of the total, enough to "save the ship" until our economy recovers and sanity returns to the health care industry.
And this tax would seem to fit the purpose better than most. Munroe belongs to all of the people of the community and the tax would be paid by all, including the tourists who, not infrequently, visit our emergency rooms.
Is this something we should seriously consider? As has been said by others, Munroe is our hospital. It belongs to the people of Marion County, and for more than 100 years, it has cared for us. It is now a premier health care system, perhaps the premier business enterprise in our community, one of our largest employers and the centerpiece of our largest industry, the health care industry.
Do we really want to lose that? I think not.