Manatee County on sensible path for improving health care via comprehensive program

June 8, 2014 

Participants discussed many facets of health care during a "listening session" May 29 hosted by the Manatee County Commission.SARA KENNEDY/

Manatee County's two charrettes on dealing with our prickly health care conundrum brought out divergent views and passions.

With the county trust fund that reimburses medical providers for treating indigent patients poised to expire next year, a strategy must soon be devised and implemented. Solutions have been elusive for years now.

While there was little agreement on any specific solutions during the charrettes, Deputy County Administrator Karen Windon witnessed a broad desire for collaboration, she told the Herald Editorial Board. "If we can harness the energy from those discussions, I truly believe we can eventually transform the health of this community," she stated.

One victory secured

Windon's hope comes in the wake of a concrete and positive development. The primary cost driver of indigent health care is the inappropriate use of expensive emergency rooms for primary care.

When Gov. Rick Scott signed the state budget two weeks ago, Manatee County Rural Health Services won a $300,000 grant to establish an emergency room diversion program. The program will ease the pressures and costs on hospital ERs by steering non-emergency patients into primary care settings.

The charrettes are one step in the county's development of a comprehensive health program to provide the least expensive and most effective care while also stressing healthy lifestyles and disease prevention through public education.

Of most concern is ER treatment for routine maladies. That makes the MCRHS grant a vital component of a broader strategy. People need to know where to seek appropriate care.

The money issue

As stated as the initial charrette in late May, taxpayers are major stakeholders in the discussion.

Should government -- using tax revenue -- even pay for-profit hospitals for treating the poor and destitute? Does that amount to corporate welfare?

Should private businesses -- hospitals, clinics, physicians and other health care providers -- pay for treating the indigent, working poor and other needy individuals?

Florida laws on indigent health care -- codified in statutes section 154.331 -- permits counties to establish health care districts and raise taxes to address the high cost of indigent care in emergency rooms.

Clearly, the state intended that local governments play a key role in indigent care. Unlike Manatee County, neighboring counties have established health care taxes to address the problem.

Manatee taxpayers revolted last summer and defeated a half-cent sales tax increase designed to pay for indigent care -- by a wide margin.

County commissioners cannot abandon the idea of reimbursing the medical community for the treatment of nonpaying and uninsured patients. That would be reckless and irresponsible -- and have a negative impact on the county's economic growth and quality of life.

The accountability issue

But taxpayers deserve to know their money is being spent judiciously and with accountability.

Last year for the first time, the Centers for Medicare and Medicaid released the average prices that hospitals receive for Medicare patients -- amounts the government contends reflect actual costs. But for the most part, those figures are only a tiny fraction of what hospitals charge paying customers and insurance companies, as reflected in the federal agency's comparison numbers.

So how does Manatee County reimburse hospitals and physicians? The short answer is via Medicare rates, though with hospitals the reimbursement is more complicated.

The county has agreements with the hospitals structured as grants for total service instead of individual itemized invoices.

This increases efficiencies by eliminating the need for county staff to reconcile each invoice -- with hospitals then replacing any rejected ones with others since they treat many more patients than county money covers, Brenda Rogers, the Community Service Department director, told us.

Those county dollars, though, pass through the Florida Agency for Health Care Administration, leveraging other money before reaching the hospitals here.

Manatee Memorial Hospital uses Medicare figures from verified Medicare cost reports to compile indigent care totals, a hospital spokesman reported to the Editorial Board.

In 2013, MMH received $6.9 million out of the county's indigent trust fund. But the total cost of that care came to $11 million -- in Medicare rates.

The county is currently initiating an audit, to be conducted by an outside firm.

With all the confusion surrounding payments for indigent care, we hope this provides some clarity. Accountability appears to be in place, and hospital reimbursements are set to a low national standard -- and not even fully paid.

The Medicaid illusion

The idea of waiting to gauge the impact of Medicaid expansion under the Affordable Care Act before developing a local health care plan is a nonstarter now.

Our state Legislature refuses to approve expansion, thus denying hundreds of thousands of poor Floridians Medicaid coverage.

A new study show how misguided this is. Hospitals in states that embraced Medicaid expansion are experiencing a major drop in the number of uninsured patients and the amount of charity work in the first quarter of this year, the Huffington Post reported last week. Costs are plunging.

The Colorado Hospital Association collected data from 465 hospitals in 30 states, half that expanded Medicaid and half that refused. Hospital in those non-expansion states are seeing a jump in charity care costs.

Here in Florida, politics trumps pragmatism as fervent anti-Obamacare policies rule. Meanwhile, the state's poor suffer and hospitals and counties struggle with mounting costs.

Manatee County cannot affort a wait-and-see position on Medicaid expansion -- a pipe dream right now given the politics. The county must move forward and develop a health care plan that lowers costs while improving medical outcomes.

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