|Ocala, FL -
November 22, 2011|
Published in the Ocala Star-Banner on Tuesday, November 22, 2011
Ocala businessman Brad Dinkins did not believe Gov. Rick Scott was looking for half-measures in helping taxpayers deal with rising health care costs attributable to public hospitals.
So Dinkins has gone all in, proposing that all public hospital districts, including the one that operates Munroe Regional Medical Center, be dissolved and their assets sold off to the highest bidder, be it a for-profit company or a nonprofit group.
Dinkins, named by Scott last March to a special task force studying the fiscal well-being of publicly managed hospitals, told the committee on Monday that Scott and taxpayers deserved a "bold" measure to deal with the financial woes afflicting some taxpayer-backed hospitals.
"I couldn't find one legitimate reason to keep these hospital districts in place," Dinkins said in an interview on Tuesday.
"There doesn't appear to be any need to keep this extra layer of government in place."
"I'm trying to look at what's right for the citizens. I want to return power and authority to the citizens," Dinkins added. And, "I believe the free market can deliver quality care at the best price."
Florida has had public hospital districts, such as the one that has governed Munroe Regional since 1965, for 95 years. In March, Scott, a former chief executive of the nation's biggest hospital company, formed the panel. It is known formally as the Commission on Review of Taxpayer-Funded Hospital Districts.
The commission was formed after one of the biggest public hospitals in the country, Jackson Memorial in Miami, posted more than $200 million in losses last year and was close to bankruptcy.
The overarching mission of Scott's commission was to determine "whether it is in the public's best interest to have government entities operating hospitals," according to the governor's executive order.
Dinkins said he became convinced as the panel met over the past six months that some glaring problems with the current system needed to be rectified.
Topping the list was the idea of "taxation without representation," Dinkins said.
According to the Department of Economic Opportunity, which tracks more than 1,600 special districts for various services statewide, 16 hospital districts have the power to levy property taxes.
Only five of those elect their governing boards. The rest are appointed by the governor or the local governing authority.
That fact, Dinkins maintained, means those communities have "no local recourse" to deal with health care-tax issues.
But other testimony highlighted other matters, Dinkins said.
"We saw a lack of financial accountability, irrational business practices, transparency concerns and severe inconsistencies with the governance models," Dinkins said. "There were so many problems."
Dinkins' recommendation, however, landed with a noticeable thud — as he acknowledged.
"It was not well received, and that's putting it mildly," he said.
According to theflorida current.com, state Rep. Matt Hudson, a Naples Republican and member of Scott's commission, told the committee that he opposed the elimination of all hospital districts.
Another commissioner, University of Florida professor Paul Duncan, an authority on health services research, management and policy, noted that health care needs had changed over the past half- century, the website reported.
"They have gotten worse," he said. "We've got more uninsured people. We have lower Medicaid reimbursement rates. We have things that make the need for these kinds of generally supported hospitals greater than what they were in the past, not less than what they were in the past."
Locally, some of those affiliated with Munroe Regional also doubted Dinkins' plan.
Through a spokeswoman, the governor himself was noncommital about Dinkins' proposal.
"The governor wants to take a comprehensive, deliberate look at all of the special taxing districts in order to determine whether or not they are serving a legitimate purpose, taxing at an appropriate level, are governed in a manner that allows them to be held accountable to taxpayers, are prudently spending taxpayer dollars, etc," said Jackie Schutz, deputy press secretary for Scott.
"There are many issues on the table regarding hospitals and the governor appointed commissioners that he believes can make the best recommendations. He appreciates all comments and he will await the commission's final recommendations."
The hospital is facing money problems in the future, driven in large part by the charity care it provides to uninsured patients and the declining reimbursement rates from the federal programs that fuel more than two-thirds of its revenue. Munroe Regional recently hired a consultant, Ponder & Co., to develop a plan to shore up the facility.
While its report is not due for months, there is a general consensus that the hospital's options will be boiled down to: obtain local taxpayer support, sell or lease the hospital to another company, or enter into "strategic alliances" with other health care providers.
Jon Kurtz, incoming chairman of the Munroe Regional board of trustees, noted that many for-profit hospitals can opt for more profitable services and opt out of money-draining ones — a choice public "safety-net" hospitals do not have.
"Hospital districts have done a very credible job for many years, seeing to the needs of the community, especially with safety-net services for those most at risk financially," Kurtz said. "Munroe has done a very good job with little to no taxpayer support."
Kurtz questioned getting "rid of all aspects of hospital districts without analyzing the ramifications of it."
Another hospital trustee, Joe Hanratty, a proponent of the so-called "non-tax" options for dealing with Munroe Regional's financial woes, said there might be some merit to having uniformity in how hospital districts are set up.
But beyond that, Hanratty said, dissolution seems hasty.
"What are you going to do if the district is eliminated? Absent a detailed proposal for what you do next, it seems like a knee-jerk reaction to me," he added.
"I think that would be very difficult to do, given that all of them are different," Steve Purves, Munroe Regional's president and CEO, said of Dinkins' proposal. "To paint all districts with a broad brush is a mistake."
"Our hospital does not receive tax support," he said, "and we have been very good stewards of our resources."
Purves also questioned where the decision-making concerning the hospital should take place.
"That kind of proposal should be from the local citizens, rather than the Legislature passing sweeping legislation that puts all the districts into one category," Purves said.
Purves added that Munroe Regional ranks third in efficiency of operations among its peer hospitals around the state.
Purves testified before the commission in July.
During that appearance, he pointed out that between 1995 and 2007 Munroe Regional received no taxpayer support, while its main competitor, the for-profit Ocala Regional Medical Center, was provided a total of $12.8 million to cover care for low-income residents.
Yet Munroe Regional, as a public asset, is not assessed property taxes.
In his presentation on Monday, Dinkins pointed out that selling off public hospitals would pump some sorely needed revenue into government coffers.
He also doesn't believe the community would lose much if Munroe Regional were transitioned to another operator.
"It's a tough industry. And all three of our hospitals are doing all they can to protect the citizens and deliver a wonderful product for all the people. I don't think that will change," Dinkins said.
"We definitely will not lose the safety-net services that are provided. Once the services are in place they cannot be removed without the hospital losing its permit to operate. The quality issues are still in place."
And Dinkins believed his plan retains the "sense of community" that public hospitals such as Munroe Regional have engendered over their existence.
"I don't want to rid Marion County of the local flavor and local history, and that should continue," said Dinkins, noting a new operator would want to build on the community goodwill the hospital has created.
Dinkins said he hopes some of his proposal survives once the commission's final report is completed in December.
The report is to be presented to Scott and state lawmakers by Jan. 1, 2012.