Another warning bell is sounding over the impending demise of Manatee County's health care trust fund. Should county commissioners elect to halt payments to hospitals for indigent care, this repercussion would be a severe loss as the county can ill afford to lose the volunteer services of dozens of specialty physicians and surgeons.
But that prospect arose when We Care Manatee, the organization behind the specialty care for poor and uninsured patients, warned of closing if hospitals lose financial support from the county.
We Care served some 1,000 patients who had nowhere else to turn last year. The organization has been valiantly serving these patients since 1999 with physicians donating their time. That bears repeating: Doctors are working for free, out of compassion.
With 86 physicians, eight nurses and eight partner medical businesses -- imaging and surgery centers, home health agencies and others -- We Care Manatee relies on partnerships with the three hospitals holding contracts with the county to provide indigent care.
Those contracts expire on Sept. 30. The remaining money in the trust fund for fiscal year 2015, a shade under $7 million, would barely cover the current hospital contracts, at $6.7 million -- and that would leave other providers, such as Manatee Glens and Manatee County Rural Health Services, with meager if any funding.
With the trust fund nearing insolvency, this latest dire warning coming from We Care Manatee should lend even more urgency to the county commission's consideration of a strategy to deal with indigent care.
One of We Care's founders, Dr. Thomas Morrish, an ear, nose and throat specialist, explained the situation succinctly to Herald reporter Sara Kennedy last week:
"The problem is: As a specialty physician, if they need surgery, they need a facility to get it done. And right now, Manatee Memorial Hospital is that facility.
"If the county does not renew the contract with the hospital, the facilities will go away. So this organization doing very good work over the last 15 years will probably be gutted or made extinct.
"It's really unfortunate."
Tragic better describes this potential outcome.
The vast majority of We Care patients -- as many as 90 percent -- require county assistance for lab work, imaging, biopsies, pathology or surgery, among other procedures and tests.
Without any hospitals in which to operate, We Care would be forced to turn away patients. Comprehensive care would suffer.
The organization only receives $74,000 from the county, in grants from the Community Services Department, not the trust fund. Its operating budget is covered by private donors, fundraising and other sources.
Again, though, the physicians donate their time and skills. Manatee Memorial Hospital volunteers the space. But without any county funding at all, "I don't see how we can provide that venue for these patients," Manatee Memorial CEO Kevin DiLallo told the Herald.
The county must throw We Care Manatee a lifeline.
Another negative impact
The nonprofit Manatee Glens mental health care provider now serves Baker Act and Marchman Act commitments, some involuntary, and offers detox care with trust fund dollars. The trust fund has been providing a combined $645,000 annually to Manatee Glens to treat Marchman (substance abuse) and Baker (other mental illnesses) patients. What will happen to those patients -- and society -- if county financial support evaporates?
Busting the myths
A rescue by the Affordable Care Act is as unlikely as divine intervention -- unless Florida Republicans in Tallahassee suddenly reverse their political abhorrence of Obamacare and expand the federal Medicaid program for the poor. That, too, is highly unlikely.
Yet many in this community embrace ACA as the answer, despite the fact Florida remains unwilling to expand Medicaid.
We're compelled to once again refute another misguided notion. Nobody's getting rich off Manatee's health care trust fund. Hospitals and doctors are reimbursed at low federal Medicare rates for indigent care.
Manatee Memorial Hospital (which also operates Lakewood Ranch Medical Center) still absorbs a loss since trust fund money does not cover all the Medicare rate charges the two hospitals rack up annually.
We're baffled that a large number of Manatee residents think the hospitals and physicians should cover the costs and donate their time to serve indigent patients. That's unrealistic and unsustainable.
Hillsborough County sustains an award-winning comprehensive managed care plan for indigent residents with a half-cent sales tax. County-owned Sarasota Memorial Hospital provides indigent care and other services thanks to taxpayer support via ad valorem property taxes, currently 1.08 mills for the medical center.
Manatee County voters rejected an all-too-hastily called half-cent sales tax ballot issue last summer, so that option is out.
Now, commissioners must contend with a vexing dilemma. Those discussions are under way as the county crafts next year's budget.
We eagerly await developments as the state-mandated deadline looms. Two public hearings will be held in September before commissioners approve the budget for the fiscal year beginning Oct. 1.