A special commission created by Gov. Rick Scott on Florida public hospitals is recommending that local taxing districts create more transparency, start paying providers other than hospitals, and develop publicly accountable ways to sell government-owned healthcare facilities.
Fla. panel recommends diminished role for public hospital districts
The Florida Commission on Review of Taxpayer Funded Hospital Districts, headed by Florida TaxWatch CEO Dominic Calabro, released a 30-page draft report (PDF) that emphasized a need to evaluate why the state has a 34 separate local taxing districts to run hospitals.
A narrative in the report opined that the state has so many tax-supported hospitals because many fast-growing communities in the mid-20th century found public ownership to be the quickest way to meet burgeoning health demands at the time. Now that the state has a competitive hospital market, including the presence of many for-profit hospitals, the commission recommends that local districts should be reevaluated at least every 12 years by local referendum.
Dr. Keon-Hyung Lee of the Askew School of Public Administration and Policy at Florida State University told the commission that public hospitals typically post operating costs up to 12% higher than their for-profit and not-for-profit competitors, and collect Medicaid inpatient rates up to 24% higher, after adjusting for various factors like case-severity mix and location.
Therefore, the commission recommended that hospital districts "de-couple" themselves from public hospitals and recast themselves as "indigent care districts" that could divert tax funds to less-expensive healthcare providers in nursing homes, urgent-care centers and primary-care clinics.
However, commissioners noted that selling public hospitals can also be a problematic exercise, as evidenced by the botched acquisition of publicly owned Bert Fish Medical Center in New Smyrna Beach by Adventist Health System in Winter Park.
In cases where hospital districts do sell their hospitals, the commission urged a more transparent bidding and public-disclosure process. The acquisition of Bert Fish was declared illegal after the local foundation complained that closed-door meetings with Adventist officials biased the board in favor of their bid.
Scott, who became governor in late 2010, is the former CEO of for-profit Columbia/HCA Healthcare Corp. and a former principal with the Jacksonville-based Solantic chain of urgent-care centers.
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