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Panel recommendations could affect MRMC funds, oversight

Tallahassee, FL - December 29, 2011
Published in the Ocala Star-Banner on Thursday, December 29, 2011 at 5:07 p.m.

The state panel appointed by Gov. Rick Scott to study the role of Florida's tax-supported hospitals is poised to make recommendations that could result in both reducing the money Munroe Regional Medical Center gets for treating indigent patients and changing oversight of the not-for-profit hospital.

The Florida Commission on Review of Taxpayer Funded Hospitals has met 14 times since May and held its final session here on Thursday. It made some last-minute changes to get all eight members to sign off on the recommendations, which are due in January and which the Legislature will review.

The Marion County Hospital District trustees are appointed by the County Commission. The district leases Munroe to Munroe Regional Health System. The operation of the hospital is overseen by the hospital's board. Some of those board members also are district trustees.

One recommendation from the panel: Hospital districts that receive local tax help should instead become indigent health care districts, focusing their financial resources on local health care programs rather than a single hospital.

The Marion County Hospital District does not get local tax support. If it one day sought such help โ€” and if the state Legislature followed the recommendations โ€” the district would no longer be allowed to own Munroe. Another entity would have to be created to own the hospital, commission Chairman Dominic Calabro said after the meeting.

Calabro said any such local taxes should be used to help patients, regardless of which hospital they choose for medical care.

Calabro said that if the district that owns a hospital also receives local tax help, the district trustees would be inclined to help their own hospital rather than another with that money.

Also affecting Munroe is a recommendation that would stop hospital district trustees from also sitting on their own hospital boards.

Brad Dinkins of Ocala, who serves on the governor's commission, said serving in both capacities is a conflict.

"Board members are loyal to the hospital and trustees are supposed to be people loyal to (the public) who own the hospital," Dinkins said.

Also affecting Munroe is the commission's proposal that the Legislature study how to "reduce inequities in the current Medicaid hospital reimbursement system."

Dinkins said that should lead to hospitals all getting the same Medicaid reimbursement rates. Currently, Munroe's Medicaid reimbursement rate is almost twice that of for-profit hospitals.

Munroe officials argue that their public hospital has a higher percentage of indigent and Medicaid patients and that the hospital needs the enhanced Medicaid payments.

Dinkins counters that Munroe already enjoys tax-exempt status and that the hospital and its doctors are somewhat shielded against high medical malpractice suits โ€” factors that already save the hospital money.

Also new in the recommendations: a suggestion that state lawmakers create a mechanism by which hospitals can temporarily opt out of paying into the Public Medical Assistance Trust Fund tax if they want to use that money for some other medical project to benefit their community.

Calabro said that many of the tax incentives and the financial support that were needed decades ago in rural Florida communities to create and support hospitals were no longer needed or fair.

He said that state hospital oversight should modernize and focus on indigent care rather than a group of hospitals.

Calabro said that it's time lawmakers "recognize things have changed and (people's) needs have changed."

The recommendations are scheduled to be reviewed by the Legislature during its 2012 session and would have to be approved before implementation.


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