Sales-tax may yield new health-care model

EAST COUNTY — In the heat of the recession in 2008, the Manatee County Board of County Commissioners scrambled to pay for an increased demand in health care for the indigent.

The costs to cover community care began to outpace interest rates, and the commission transferred the principal from a trust fund filled with money from the 1984 sale of what is now Manatee Memorial Hospital to another account that would be used to cover those costs.

For many years before that, county officials say the county didn’t spend any money from the trust fund, because the interest it collected covered costs.

After the decision to tap into the fund’s principal in 2011, however, the county signed a three-year agreement with Blake Medical Center and with Manatee Healthcare System, which runs Manatee Memorial Hospital and Lakewood Ranch Medical Center, to provide up to $9,033,820 in care annually.

The county spends another $14 million in property-tax revenues to pay for community health care, for a total of $23 million per year.

By the end of 2012, about $25 million remained in the account, down from the roughly $40 million it had in 2010.

Manatee County officials believe the account will be depleted by 2015.

On June 18, Manatee County residents can vote on a half-cent sales tax to pay for indigent health care.
The county hopes a new health-care model — the specifics of which have not been determined — would make the estimated $23 million per year of new revenue raised by the sales tax sustainable.

The Manatee County Health Care Alliance, a group of local health-care providers and public-health professionals, has recommended improving access to primary care though a new delivery model, which would decrease the dependence on emergency room care, the most expensive type of care.

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.

A study by the Health Care Alliance deemed 3,300 of 2011 ER visits in Manatee County as preventable hospitalizations. Poor individuals accounted for a third of that group.

To limit emergency room visits, the county could build community-based interventions, such as accountable-care organizations and patient-centered medical homes.

The Bill Galvano One Stop Center, at which a nurse and two physicians serve indigent patients, already serves as a good community-based model. It provides $200,000 of free care a year.

In the early 1990s, Ed Hunzeker, Manatee County administrator, helped pass a half-cent sales tax for indigent health care in Hillsborough County, where he served as assistant county administrator for 15 years.

Thereafter, Hunzeker, Hillsborough leaders and the medical community ran their hospitals by a mantra: “It’s cheaper to treat a cold in the clinic than pneumonia in the ER.”

“What we would like to do is work with the medical community to figure out a way to get indigent people out of the emergency room,” Hunzeker said. “It’s the same thing we did in Hillsborough. We have to introduce a little wellness to these folks. We first find out who they are and then get some case-management folks to steer them away from the emergency room.”

Hunzeker hopes that spending money on the front end of the health-care continuum will save money on the back end.

To that end, in February 2011, Blake Medical Center bought Pinnacle Medical Group, a clinic with five locations in Manatee County that provides care in family medicine, urgent care, cardiology, neurosurgery and orthopedic surgery.

At the time, Dr. Kevin Boyer, Pinnacle’s president and chairman, said the merger would better provide comprehensive health care to the community.

Even with a new plan, however, there’s no guarantee anything will change.

No one can stop individuals from going to the emergency room. And, there’s the argument that passing the sales tax increasing and replenishing the money for indigent care will encourage people from other counties to get health care in Manatee County.

Hunzeker says that won’t happen.

Patients who get care paid for by the county, the payer of last resort, must prove they live in Manatee County.

The county knows it must spend efficiently the money it provides.

Hunzeker believes Manatee has — and will.

Audit reports by CS&L CPAs of the county’s three for-profit hospitals sought to confirm compliance with the indigent health-care agreement agreed to in 2011.

The audits did not look at the sufficiency of the agreement’s procedures. It simply measured if the procedures, whether good or not, were followed.

A Sept. 30, 2011, audit of Lakewood Ranch Medical Center found the number of indigent-care cases the hospital sent to the county for reimbursement matched the amount the county ended up paying.

An audit from the same day of Blake Medical Center found the same compliance, as did an audit of Manatee Memorial in 2009.

“We have processes and procedures and verification and testing that we’re comfortable we are spending money appropriately,” Hunzeker said. “But our health-care model can be more effective. I’m committed to try and do it differently.”

Contact Josh Siegel at [email protected].