The 6-1 vote by the Marion County Hospital District Trustees was not close, even considering that HMA got its share of criticism in the debate leading up to the vote and its rival, Duke Lifepoint, got a healthy share of praise.
Moments after the vote, and after accepting a quick round of congratulations, Health Management CEO Alan Levine launched an offensive to win over critics and, ultimately, a community that reveres its hospital and is anxious about its future.
Levine began seeking out the doctors, Munroe workers and others who had been the harshest critics of his company’s bid to run the hospital.
“Right now my focus is to try to understand the people who didn’t vote for us so I can understand what I need to do to earn their support,” Levine said following a meeting with Munroe executives the day after the vote.
He also turned to those who hadn’t necessarily criticized the company but had concerns about whether its corporate drive for profits would force cuts in needed but money-losing services like labor and deliver.
Among that group were Munroe midwives, who approached Levine in the crowded Munroe Auxiliary Conference Room.
“They said they wanted to hear from me and get my ideas, and I said, ‘Wait a minute, I want to hear your ideas because we have a lot of big decisions to make about capital and how to expend it to improve services.’ ”
Levine also plans to make a splash that the public will notice as a sign of the company’s commitment to improve the hospital.
“Our objective is to make some investments that are visible because we want people to see that we are serious about moving ahead,” he said. “What that investment is, we don’t know yet. We’re still considering that.”
HMA has a sizable pool of money to work with. It has pledged about $284.1 million to improve the hospital and upgrade facilities and equipment.
Other changes will be virtually invisible to the public but will be appreciated by doctors, he said.
Paramount among those is a closer working relationship with Shands Hospital in Gainesville, an HMA property that enjoys a reputation as one of the state’s premier medical centers.
Throughout the year-long courtship between HMA and Munroe, Levine and other HMA executives had emphasized the benefits of a partnership with Shands. But many in the local medical community say they have long had a strained relationship with the massive teaching hospital and that Shands routinely poaches their best patients while refusing to accept referrals for others who need specialized care.
Levine said that will not be the case any longer. Shands has an “always-say-yes” policy concerning referrals from HMA’s 21 other hospitals in Florida, he said. And as a sign of its good faith, Shands will buy a 20 percent stake in the Munroe/HMA partnership, he added.
Marion County Hospital District Trustee Chairman Jon Kurtz said both HMA and Duke Lifepoint offer quality medical services but he believes the opportunity to forge a closer relationship with Shands, as well as HMA’s strong, 22-hospital presence in Florida, tipped the vote in HMA’s favor.
“I think getting someone with an established network like they have could be a benefit to us down the road,” Kurtz said. “When they go into negotiations with Medicare or Medicaid or private insurers on reimbursement rates, they have to deal with HMA. It’s a big company with a lot of clout here (in Florida).
“And as much as we don’t like all the political stuff, they do have clout in Tallahassee as well,” he said.
Levine and HMA are making plans to allay another concern of the local community: that citizens will have no say in the types and quality of services that Munroe provides. Because Munroe is a public hospital overseen by an appointed board of area residents, it has long had the ability to respond to community needs without regard to whether the services it adds are profitable. Some have openly fretted about an out-of-town corporation making key decisions for the welfare of Marion County.
Levine acknowledged that, as a shareholder-owned company, HMA cannot cede financial decision-making to the local community. But he said HMA will create a board of trustees for Munroe, something it has not done at other hospitals it has acquired.
That board will do more than make recommendations to HMA about Munroe’s operations. It will have authority to credential doctors, giving it broad power to shape the quality of the medical staff at the hospital. It will also oversee the hospital’s quality-control efforts, Levine said.
And like the board at HMA’s newest acquisition, Bayfront Medical Center in St. Petersburg, the trustee board at Munroe will be populated with local citizens. The deputy police chief and provost of the local state college, among others, serve on the Bayfront board, Levine said.
“The more you involve the community, the better it is for everyone,” he said. “The accountability needs to be here.”
HMA will also provide an annual report to the Hospital District trustees who hold the lease and involve them in developing plans for the hospital.
One of many issues that likely won’t be resolved until after the deal is consummated, probably in September, is whether the current Munroe executives will remain.
Levine called Munroe CEO Steve Purves, CFO Rich Mutarelli and the rest of the Munroe executives “an exceptional team” and said they enjoy a strong reputation in health care circles nationwide.
“But we don’t know whether the management team will stay in place,” Levin added. “We haven’t had that conversation yet.”