When Dr. Bruce Siegel left New York to take the helm of Tampa General in 1996, he remembers the rumors that he was brought in to sell the struggling public hospital.
Instead, Siegel—now the CEO of the National Association of Public Hospitals and Health Systems—had something else to sell: the idea to change the governance structure of the decades-old facility and turn it into a private hospital. It was an idea with far-reaching implications for the community, given that about 40% of Tampa General's patients come from outside Tampa's five-county area. The idea became a reality a year after Siegel arrived. And without that change, says current Tampa General Hospital President and CEO Ron Hytoff, the hospital would not be as successful as it is today.
Built in 1927, Tampa General became affiliated with the University of South Florida College of Medicine in the early 1970s and currently is the primary teaching hospital for more than 300 residents. The hospital has the region's only level 1 Trauma Center and also houses one of four burn centers in the state of Florida.
According to Siegel, Florida's Hillsboro County changed how it financed healthcare in 1991. Rather than giving up a sales tax to the hospital, the county instead funded an insurance plan for the poor that it paid to multiple hospitals.
“So you had the only county hospital in America that got no direct, municipal support,” Siegel told Modern Healthcare. “It was an untenable situation,” he says, adding that Tampa General was a “very sophisticated place that was starving.”
Back then, the hospital saw between 400 and 450 patients a day, and its payer mix was about 30% Medicare, 30% Medicaid, 25% commercial insurance and 15% uninsured. But the hospital was bleeding money.
“At the time, I believe we were losing $10 million to $20 million a year,” Siegel recalls. “We were substantially in the red. Cash was dropping, the hospital had been losing business for the past decade,” he adds. “The place was on the way down.”
That's when Siegel took his idea on the road, building support at local-area churches, civic organizations, organized medical circles, chambers of commerce and to state legislators in Tallahassee. In 1997, the hospital signed a lease agreement with the county and became private. The agreement required Tampa General to maintain its mission of serving the indigent.
“The access to good care was in danger,” Siegel says. “If Tampa General had gone away, you would have lost the only safety net really in that county and the biggest one on the west coast of Florida.”
After a difficult start, the hospital in the past 12 years has doubled its discharges and spent roughly half a billion dollars to expand its size by 30%, says Hytoff, who served as the hospital's chief operating officer during Siegel's tenure. In 2009, hospital revenue totaled about $9.5 million, according to the hospital's annual report.
“There wasn't a taxing district that gave us $100 million a year,” Hytoff says of the previous structure. “That's one of the reasons Bruce Siegel decided it was better for the hospital to be private because we weren't receiving funds anyway,” he adds. “The board, when it was public, was appointed by the county, so it was political in nature.”
The new structure relieved Tampa General of that restriction, and the board now consists of 15 members, which includes the chief of medical staff at the hospital; the chairman of the Tampa General Hospital Foundation; a member selected by the president of the University of South Florida; and 12 elected members. Hytoff also hired new staff to lead the hospital's human resources and finance departments, the latter of which combed through the hospital's managed-care contracts and re-calculated previous years' cost reports, which Hytoff says were filled with errors.
“I don't think we could have progressed at our current state,” he says, “unless we had been a private hospital.”