Tavaras, FL - Dec. 20, 2011 - Florida Governor Scott's Commission on Review of Taxpayer Funded Hospital Districts just published their almost final report draft.
This affects Lake County, because we have two hospital districts, the North Lake County Hospital District, and the South Lake County Hospital District.
This blog has published numerous articles on local efforts to reform the North Lake County Hospital District.
The Draft report, 30 pages long, includes several objectives that had been included in Rep. Larry Metz's reform bill recently approved by the six member Lake County Legislators Delegation (5 to 1).
The Commission recommendations included:
- Qualified hospital district board members should be
- Board members should have "financial expertise and experience operating successful. larger businesses (i.e. not a filling station owner who likes hospitals).
- Special hospital districts (like our North Lake one) should become "indigent health care districts based upon local priorities". (It doesn't say, but implied is NOT to subsidize Medicare or other expenses of the hospitals).
- Millage rates should be adjustable (not fixed like North Lake) such as allowing a millage rate anywhere from ZERO mills to ONE mill (which is a change that is in Rep. Metz's Bill).
- "Indigent care funding models that are based on a money follows the patient system provide a more equitable distribution of funds for indigent care and allow local communities to establish funding programs that reflect unique local needs." (In otherwords, you don't just hand over cash for any use like our North Lake County Hospital District does).
- Amend applicable statutes to REQUIRE that each District have an EIGHT year sunset provision and a voter referendum is required to continue the District. (Local Hospitals and other corporate welfare supporters didn't want any sunset, or actual fought to have a referendum).
- Special hospital districts should "develop transparent, thorough and consistent mechanisms for reporting on their activities to both local taxpayers, stakeholders and to the state government". This is in Rep. Metz's bill.
- Many other recommendations were related to Districts like South Lake that have partial or full ownership of hospitals. That is not the case with our local North Lake District. Read the actual report if you want that information.
Separately, in a phone call yesterday with a manager of the Legislator's Audit Committee, which approves audits for the Auditor General, I was told that after the first of the year, there might be a requirement for performance audits of Hospital Districts. YEAH!!!
However, the report did not specifically address oversight responsibilities, but used generic statements. So, who actually would be responsible to conduct performance audits of these Hospital Districs? (In addition to the to the routine CPA type financial audits).
BELOW is an article on the report from a newsservice (Thanks to Bob McKee)
Vance Jochim
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HOSPITAL PANEL SET FOR YEAR-END REPORT
By JIM SAUNDERS
THE NEWS SERVICE OF FLORIDA
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THE CAPITAL, TALLAHASSEE, December 20, 2011.......... Facing objections from public hospitals, a panel appointed by Gov. Rick Scott could call next week for revamping local hospital-taxing districts --- including turning them into "indigent health care districts."
The Commission on Review of Taxpayer Funded Hospital Districts discussed a draft report Tuesday that also could lead to local votes on district taxing powers and call for more oversight of the sales or leases of public hospitals.
Commissioners, who have been studying hospital districts since May, likely will finalize the recommendations Dec. 29, as they meet a New Year's deadline for sending the report to Scott and lawmakers.
"The real work is going to happen on the 29th,'' said Chairman Dominic Calabro, president and chief executive officer of Florida TaxWatch. "I think we're going to bang it out on the 29th.''
A key part of the draft would re-label districts as "indigent health care districts" and try to prevent tax dollars from getting funneled to only certain publicly funded hospitals. The basic concept is that money should be able to flow to wherever indigent patients get care, whether that is public hospitals, private hospitals or other types of providers.
"I think we're looking at moving more towards a focus on providing indigent health care,'' Calabro said.
But commission member R. Paul Duncan, a health-policy expert at the University of Florida, said he is concerned that such a change could lead to creation of a "kind of charity hospital system" that only would serve low-income and uninsured people.
Duncan said public hospitals would not have as much money to buy equipment and modernize facilities to compete with private hospitals. As a result, he said insured patients might drift to the better-equipped private hospitals, leaving behind low-income and uninsured patients --- and, ultimately, affecting the quality of care at public hospitals.
Hospital-industry officials have closely watched the commission's deliberations, though it remains unclear whether lawmakers will act on the recommendations during the 2012 legislative session. Scott recently said such action might wait until 2013, as redistricting will dominate much of the upcoming session.
Nevertheless, Scott, who made a fortune as chief executive of the Columbia/HCA hospital chain, has made clear he would like to see changes in public hospitals. In a March executive order creating the commission, Scott said in part that the panel should determine whether it is "appropriate to convert government-operated hospitals to different governance models (and) what the process should be for such conversion.''
During Tuesday's meeting, representatives of public hospitals objected to several parts of the draft report.
For example, Jim Zingale, an official with the Safety Net Hospital Alliance of Florida, questioned the accuracy of some of the report's findings. He said they might have been true for individual hospitals but were presented as applying to the broader array of hospital districts --- which are set up and operate in varying ways.
One part of the draft report that drew heavy discussion Tuesday calls for setting up a "sunset" process to review district taxing authority every eight years. Local referendums would have to be held to again approve the taxing authority.
But William Woeltjen, chief financial officer of Sarasota Memorial Health Care System, said such a requirement could harm the ability of public hospitals to issue bonds to make improvements. That is because bondholders would not be assured that tax dollars would be available in the future to pay off the debts.
"That is really going to impede the ability of hospitals to finance their operations and finance their programs,'' Woeltjen told the commission.
Calabro acknowledged that the final recommendations likely would have to address the potential effects on bonding. He said, however, that the commission thinks voters should be able to review taxing authority.
The draft report also touches on a legislative controversy about putting new requirements on the sale or lease of public hospitals. A lobbying battle erupted last year about bills that would have required such deals to be approved by circuit judges --- a battle that again is expected to play out during the 2012 session.
The draft does not provide detailed proposals for addressing the issue, but Calabro said it is important to make sure sales or leases are in the public interest.
At least part of the issue stems from the botched merger of Volusia County's public Bert Fish Medical Center with the non-profit Adventist Health System. That deal was scrapped after it was disclosed that the Bert Fish board violated the state's open-meetings law in discussing the merger.
"What you want to make sure is it's not an inside job,'' Calabro said.
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12/20/11
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