|Ocala, FL -
January 8, 2012|
Published in the Ocala Star-Banner on Sunday, January 8, 2012 at 6:30 a.m
On March 23, Gov. Rick Scott created Florida's Commission of Review of Taxpayer Funded Hospital Districts. I was honored to accept his invitation to serve on the commission along with eight others, including a state senator and a state representative.
The commission's purpose, per the governor's executive order, was to "make recommendations on the role of hospital districts, whether it is in the public's best interest to have government entities operating hospitals, and what is the most effective model for enhancing health care access for the poor."
We also were asked to determine if the hospital districts were acting "in the best interest of the primary shareholder — the taxpayer."
During our hearings, we received oral and written input from hospital trustees and executives, lobbyists, attorneys, health care professionals and statisticians, as well as residents.
Late in the hearings, we began discussing our suggested findings and recommendations. This created some tension among the commissioners — those who were more favorable to a private, free-market approach vs. those wanting to protect the government's control and its ability to tax and raise taxes on local residents.
My goal was to offer bold and creative solutions and to aggressively represent the taxpayers of Florida.
Based on the input we received from across the state, my first major recommendation was to privatize the government hospitals, which is happening across the nation. I submitted this recommendation for the purpose of eliminating unnecessary property taxes, irrational business practices, operational inefficiencies, transparency failures, political abuse, selective favoritism and a lack of sensitivity to concerns of residents.
For those government hospitals that wanted to maintain local control, like our own Munroe Regional Medical Center (MRMC), local investors and current management could participate with a stronger partner through a lease or joint venture.
The privatization recommendation, however, failed to gain traction.
The final report contained recommendations that impact our own hospital district and its lessee, MRMC. Some of these recommendations are, as stated:
1. "To ensure appropriate checks and balances, the membership of district and hospital boards should be separate." Currently all the trustees of our hospital district (who lease the community-owned hospital to MRMC) also serve on the Board of MRMC (a separate corporation which operates the hospital). The commission believes this type of governance is wrong and should be discontinued.
2. The state should work to "reduce inequities in the current Medicaid hospital reimbursement system." For example, a July 1 state report showed that Ocala Regional Medical Center, a private hospital, receives $662.09 per day, per patient, for inpatient Medicaid reimbursement, and MRMC, a public hospital across the street, receives $1,362.46, or more than twice as much reimbursement.
3. In order to increase accountability and transparency, we recommended an annual reporting to the local taxpayers of the dollar value of MRMC's tax exemption benefits. These benefits include exemption from ad valorem and tangible property taxes, state sales and corporate taxes, and federal income taxes, which total many millions of dollars. The commission believed the public should see how much money public/nonprofit hospitals are subsidized with resident tax dollars, as an offset to the hospital's indigent care cost. Private hospitals like ORMC do not have these exemption benefits but, rather, pay all these taxes, plus supplying a generous amount of charity and indigent care to the poor.
4. We asked the Legislature to offer all hospitals relief from payments to the Public Medical Assistance Trust Fund (originally the "sick tax") to help "incentivize economic development and provide a higher quality of health care delivery services." For example, this would allow relief to MRMC, which paid $3.8 million in 2010, so they could use these funds instead for building expansion, medical equipment or important health care delivery services.
There is much more in the final report, which was unanimously approved by the commission and submitted to Scott on Dec. 30. Copies of the final report and details can be found on the commission website at ahca.myflorida.com/mchq/FCTFH/fctfh.shtml.
It is my hope that our findings and recommendations will be used by our governor, Legislature and hospital districts to help produce for the residents of Florida an improved and more cost-effective health care system.
Brad Dinkins is president of Bradford Development in Ocala and also the founder of the newly formed Helping Hands Foundation that assists the needy of Marion County.
Surgeons perform heart surgery in the cardio-cascular unit at Munroe Regional Medical Center in Ocala.