For more than a year, Manatee County has faced a crisis in paying for indigent care as dedicated funds were depleted. So it was with much anticipation that county commissioners gathered Thursday to hear a long-awaited report on developing a health care model to provide services to the uninsured citizens of Manatee County.
But the report, titled “Manatee County Health Care Plan for Low-Income Uninsured Adults,” contains no new revenue model and cuts indigent funding to the county’s hospitals, leaving commissioners and health care providers exasperated.
What the $125,000 report does outline clearly are shortcomings in Manatee’s health care system:
▪ With only one doctor for every 2,400 residents, Manatee County immediately needs more primary care doctors.
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▪ The county needs to hire five health care managers who will work together to track uninsured adults with major health issues so those residents do not end up in local emergency rooms.
▪ The county needs more mental health and substance abuse services for uninsured residents as well as improved access to dental care, jail health services, safe and affordable housing and a health navigation system that is easy for residents to use.
▪ The county needs programs that offer better tracking of data on the uninsured and a way to see if services being paid for are achieving desired outcomes.
For all these initiatives, the report states, Manatee needs to spend $945,000 more annually from general revenue on health care.
These points were part of that report, which was presented Thursday to Manatee County commissioners in a 2 1/2-hour work session.
The report was prepared by consultant Health Management Associates, also known as HMA, which won the $125,000 contract from the county to develop the health care model.
The report proposes Manatee spend $23.1 million in 2016-17 on health care, up from $22.7 million this fiscal year.
But the report doesn’t tout a really creative new revenue stream for future indigent care.
One controversial part of the report is that Manatee Memorial Hospital, which serves as the main safety net for Manatee’s indigent population, would receive $125,000 less in 2016-17 than this year.
Manatee Memorial and Lakewood Ranch are receiving $3.5 million this year for indigent care and would get $3.4 million under the plan proposed by HMA.
Reaction from the commissioners was mixed. There were no cheers. But there were no outright boos, either.
Commissioner Vanessa Baugh said she was disappointed that the report doesn’t offer exact and specific measures to bring down the total of indigent users of local hospitals.
“I wanted to hear how we could keep people out of the ER,” Baugh said.
Baugh also was not pleased with the $23.1 million bottom line and the thought of telling taxpayers in a financially strapped county that she was endorsing spending even more money than last year.
Baugh said the situation “makes me choke. Knowing that we are not necessarily in good shape it’s like, ‘OK here we are. Nothing has changed in that regard.’”
Commissioner Betsy Benac also noted that many of her constituents tell her that county government should have no role in health care, something that she does not agree with, but respects. She was chagrined that the report didn’t offer a suggestion for a new revenue stream, which she noted is something the county really needs.
Commissioner Carol Whitmore, however, said that while the report had nothing radically new, perhaps commissioners needed to finally heed some of its advice, like spending for care management, focusing on dental and mental health and creating an infrastructure to track people and outcomes.
“He hit everything on spot,” Whitmore said of Maurice Lemon of Health Management Associates, who delivered the report.
Lemon drew an audience of about 50, including many who felt strongly enough about the report to speak to commissioners during public comments.
Of the speakers, who included Michael Meehan, Linda Christman, Dominique Kohlenberger, Kim Denmark, Kevin DiLallo, Victoria Kasdan, Sandy Marshall, Philip Brown, Ray Fusco and Melissa Larkin-Skinner, none seemed as passionate as DiLallo, chief executive officer of Manatee Memorial Hospital.
“Manatee Memorial has honored its commitment to the county,” DiLallo said. “We have served the indigent population of this county very well, I hope you would agree with me. We have put our best foot forward to solve this problem. I think you can tell by talking to people in this community that we try to do our best in taking care of every patient that comes into this hospital.
“Commissioner Baugh said she chokes,” DiLallo said. “What makes me choke is the increased deficit that I am running from taking care of indigent patients. The continued uninsured shortfall is creating such a strain on us that I want to throw back in the equation the funding issue. I think it is the key issue here. Without the funding, I don’t see how this all happens.”