County considers new tax

MANATEE COUNTY — Despite the area’s demographics, Lakewood Ranch Medical Center often sees uninsured indigent people revisit the emergency room, where the most expensive form of care occurs.

They often come in with preventable sicknesses and usually leave without the means to buy medicine or follow-up with a physician.

So, Lakewood Ranch Medical admits the person again, and the hospital earns another write-off.

“At some point, giving free care hurts the economy,” said Jim Wilson, Lakewood Ranch Medical chief executive officer.

As Manatee County sees its $40 million funding source for indigent health care dry up, commissioners will consider an ordinance calling for a referendum that asks the public to approve a half-cent sales tax increase to make up for it.

For years, indigent care has been funded by a health trust fund, set up following the sale of Manatee Memorial Hospital, then called Manatee Veterans Memorial Hospital, in 1984 to a private business. Manatee County Administrator Ed Hunzeker says the funding supply will run out by 2015.

Lakewood Ranch Medical will be affected by the lack of funding if new revenues to pay for indigent care can’t be raised.

Providing uninsured care at Lakewood Ranch Medical cost the hospital $3.3 million in 2012, when 12.6% of its emergency room patients were uninsured.

“You’re looking at eliminating services with negative margins, and you’re talking about the viability of services,” said Jim Wilson, Lakewood Ranch Medical CEO. “(A lack of funding) would bring decreased growth potential. Our population is not immune to it. A sales tax is a way of providing that with minimal impact on citizens.”

The county’s three hospitals — all of which are for profit — also pay taxes.

Kevin DiLallo, Manatee Memorial Hospital CEO, says his hospital pays more than $2 million in taxes a year.
Commissioners will consider the half-cent sales tax ordinance at their March 12 meeting, at which time they also will receive a written plan from the Manatee County Health Care Alliance and county staff about how to best dedicate resources to health care’s rising costs.

The vote comes after a Feb. 28 meeting, at which alliance members and local health-care providers and public-health professionals at the University of South Florida presented their findings from six workshops about the local industry during the last 15 months.

Deputy County Administrator Karen Windon and staff members also presented two other options to fund indigent health care: Do nothing and discontinue funding any health care not mandated federally or by the state; or raise property taxes.

The staff supported neither.

Vanessa Baugh, District 5 commissioner, and Betsy Benac, at-large commissioner, voted against the motion, citing insufficient information and poor timing.

The federal Affordable Care Act, a reform of the U.S. health-care system designed to insure 37 million uninsured Americans, set to go into total effect January 2014, hangs over it all.

“It just seems like poor timing to me,” Benac said.

Even Commission Chairman Larry Bustle, who voted for the ordinance, expressed doubt.  

“Who’s going to do this, and who’s going to administer it?” Bustle asked. “People will still be going to the expensive hospital emergency rooms for basic care, no matter whether we pass a referendum.”

Jonathan Fleece, the outgoing chairman of the Health Care Alliance, put the need for care in the starkest of terms. National and state health rankings for 2012 show Manatee County had 8,186 premature deaths compared to a 5,466 national benchmark.

Donna Peterson, dean of the USF College of Public Health, who helped with the study, said the new funding model would help address a shortage of primary-care providers to help preventive care become available to more people.

Her study deemed 3,300 of ER visits in 2011 in Manatee County as preventable hospitalizations. Poor people accounted for a third of that group.

Although Peterson found less people getting insurance through commercial lenders and more through employers and a spike in Medicaid coverage, she did not see increased access to health care in the county.
Peterson and the county’s Health Care Alliance proposed two goals: to improve access to primary care through a new delivery model; and to build community-based interventions, such as accountable-care organizations and patient-centered medical homes.

DiLallo pointed to the Bill Galvano One Stop Center, where two Manatee Memorial residents, a nurse and two physicians serve indigent patients with $200,000 of free care a year, as a good community-based model.

Speakers agreed the new system should also have a new payment model, getting away from rewarding the volume of service provided; feature clinically integrated data systems; and be backed by social marketing to inform providers about changes.

If the ordinance for the referendum passes, Hunzeker said he hopes the public will vote on it by June.

Contact Josh Siegel at [email protected].

BY THE NUMBERS
12.6 — Percentage of patients in Lakewood Ranch Medical Center’s emergency room in 2012 who were uninsured.
3,300 — Number of preventable emergency room hospitalizations in Manatee County in 2012.
3.3 million — In dollars, the cost for providing emergency room care to uninsured patients at Lakewood Ranch Medical Center in 2012.
7 million — In dollars, the average amount Manatee Memorial Hospital receives from Manatee County.