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Editorial: One size does not fit all

OUR OPINION

Ocala, FL - January 20, 2012

Published in the Ocala star-Banner on Friday, January 20, 2012 at 6:30 a.m.

From the start, Gov. Rick Scott made no secret that he does not believe public hospitals are the best way to deliver health care to a community. In creating a special commission to examine the continued viability of Florida's public hospitals, the former corporate hospital CEO instructed panel members to "determine if models exist in Florida and other states where local taxing authorities have created innovative programs and access for the poor without operating hospitals."

The seven-member Commission on Review of Taxpayer Funded Hospital Districts issued its report earlier this month without fully answering that question, but it gave Scott and other critics of public hospital districts plenty of fodder to work with.

Nonetheless, after meeting 14 times over the past year, the commission concluded what industry experts had said all along. One, that each public hospital and the community it serves is different in size and scope of services, and one-size-fits-all policies will not work. Two, the "commission could not establish that there is a pattern of higher or lower quality of care in Florida hospital based on ownership." Three, too many rural areas with low populations simply cannot support for-profit hospitals because they cannot provide the patient counts needed to turn a profit. In other words, as Munroe Regional Medical Center CFO Rich Mutarelli put it to us, "When you've looked at one public hospital, you've looked at one public hospital."

Yet, the 41-page report was full of recommendations that could have far-reaching effects on Florida's public hospitals over time. Among them:

Hospital districts and hospital boards should be separate to "ensure checks and balances."

Public hospitals like Ocala's Munroe Regional should not receive higher Medicaid reimbursement rates than privately owned hospitals like Ocala Regional Medical Center.

Hospital district taxing authority should be subject to voter referendum every eight or 12 years.

Changes in ownership or governance should be open, competitive and "ensure a fair and independent valuation process" while also "establish(ing) guidelines to ensure ongoing community benefit from any proceeds generated by the sale of a hospital."

A key recommendation that stood out was that public hospital districts should be turned into indigent health care districts, "a money follows the patient system" in which tax dollars would not go just to the public hospital but equitably to all providers of indigent health care in the community.

Public hospitals, especially those that are taxpayer subsidized, should be scrutinized. And certainly Florida has its share of troubled public hospitals. At the same time, our own Munroe Regional can serve as a model of efficiency and economy. Yes, its boards are considering seeking tax support and looking at possible partnerships for fiscal relief, and those, too, deserve close scrutiny. But all in all, our community hospital is an invaluable community asset that is a minimal burden on the taxpayer and proof that decisions about its operation, indeed its ownership and governance, should be made by local residents and not policymakers in Tallahassee, especially Gov. Scott.

Finding ways to better deliver health care to the indigent residents is a worthy and necessary goal in these times of skyrocketing health care costs. But to suggest that publicly owned and supported hospitals are the problem — well, even a handpicked commission with specific instruction to determine just that could not do it.


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