Manatee commissioners give tentative OK to new indigent health care plan

MANATEE -- A staff recommendation on how to spend $7.5 million on indigent health care got a preliminary nod of approval Tuesday during a Manatee County Commission workshop.

Community service director Brenda Rogers said the transition plan for indigent health care is designed to offer more transparency and accountability. The plan also includes sharing patient medical records with health providers to avoid duplication of services.

"We will provide commissioners a breakdown in about a month on how we recommend to spend those dollars," Rogers said.

About 40 people attended the workshop on the fourth floor of the administration building.

The county indigent health care fund is nearly depleted and commissioners have been pushing for a plan for the remaining funds.

The county only pays for indigent health care for those making 200 percent below the poverty rate who do not qualify for any other health insurance, including Medicare and Medicaid.

"We are the provider of last resort," Rogers said.

Commissioners also showed support for a second plan they hope would be funded by Centers for Medicare & Medicaid Services rather than from county funds.

The plan, conceived by residents concerned over indigent health care spending and presented by United Way President Philip Brown, would be a three-year pilot project. The group wants to create a community-run organization to track accountability for an estimated 15,000 uninsured residents and would be funded federally, Brown said.

Commissioners said they liked this program and encouraged the group to apply for a grant.

Accountability and transparency are strong themes in the staff plan because the public has asked for it with regard to indigent care, Rogers said.

Under the plans, eligibility lasts just six months before patients are asked to requalify. The county would pay providers the Medicare rate.

A pilot case management program would be created for patients who frequently use the system.

The plan also calls for a request for proposal from health care services consultants who would provide expertise to a separate advisory board to look at health care data and make recommendations to the board.

"We have listened to a number of individual and groups who came forward with ideas and suggestions and we looked at the things they all had in common and then pulled those together," Rogers said.

The staff also looked at what other counties are doing.

"We really want to use the expertise we have in our community partners to make this plan work," Rogers said. "We want to take the best practices that would fit in our budget constraints and strengthen the transparency to the accountability."

Rogers said the county has to protect individual patient information and is looking for ways to share such information as how many patients are being served and at what cost.

The county would use medical records to provide "dashboard" reports to the public about how much money is being spent on indigent care and how many patients are being treated, Rogers said.

"I think we have made incredible progress," said Commission Chairwoman Betsy Benac. "The devils are in the details."

Not everyone was on board with sharing medical records, especially given privacy concerns -- something that could end up being a hurdle to receiving federal funds.

"I have a real concern about protecting patient information," said Blake Medical Center Chief Executive Officer Dan Friedrich. "I hope there is consideration for alternative ways to share information."

Blake, the area's newest trauma center, treats emergency room patients, including indigents. Blake spends between $9 million and $10 million annually to keep doctors on call for the emergency room and surgery suite. Last year the hospital received $916 from the county, Friedrich said.

"We have people we pay $2,500 a night to keep them on call," Friedrich said. "These are unreimbursed expenses."

He said the hospital is required to keep doctors on call for its trauma center and new burn unit.

Manatee Memorial Hospital CEO Kevin DiLallo said his hospital spends between $7 million and $7.5 million annually on unreimbursed indigent care.

"Last year from the county we got $4.5 million," DiLallo said. "So that doesn't really cover the costs."

Commissioner Charles Smith said he was surprised by the amount of money hospitals spend on indigent health care.

"Our money is only covering a portion of uncompensated care," County Administrator Ed Hunzeker said.

Commissioner Vanessa Baugh said she was hoping for better news but is encouraged by the proposal.

"I think we now need another meeting for a hard plan," said Commissioner Robin DiSabitino.

Richard Dymond, Herald reporter, can be reached at 941-745-7072 or contact him via Twitter @RichardDymond.

This story was originally published August 5, 2015 at 12:00 AM with the headline "Manatee commissioners give tentative OK to new indigent health care plan."