Voters should be allowed to decide every so often whether hospital taxing districts should be able to continue levying taxes, and hospitals in those taxing districts should be separate entities, not owned by the district, a panel appointed by Gov. Rick Scott is set to recommend.
The Commission on Review of Taxpayer Funded Hospital Districts, in completing its report Thursday, stopped short of a more radical recommendation to completely privatize public hospitals.
“There’s a role for public hospitals, there’s a role for nonprofits, we’re not calling for the abolition of any of those things,” said Dominic Calabro, the chairman of the commission, which held the last of 14 meetings that started in May. “I think it does make it clear there’s a role for public hospitals.”
The final report will be sent to the governor by today and likely a final version will be available publicly on Tuesday.
Scott appointed the panel in part to determine if government-operated hospitals were operated better or worse than private hospitals, whether the quality of care at the different types of facilities was notably different, and whether private hospitals can operate cheaper than public ones while getting at least the same results.
On that, the panel wasn’t able to say much, definitively.
“Using the available outcome data, the Commission could not establish that there is a pattern of higher or lower quality in Florida hospitals based on ownership,” the panel says in its final draft report, which the commission on Thursday unanimously signed off on.
The commission recommends that the Agency for Health Care Administration should continue to publish data on quality in an effort to get closer to an answer to that question.
On costs, the commission earlier this year heavily debated a study it received that indicated that costs were higher at public hospitals.
The commission also notes in its report that the way hospitals are paid to treat poor patients is in flux. Medicaid in Florida is shifting into a managed care model, and the Legislature also is looking into another change that sets payments for care based on grouping patients by diagnosis, or paying for a patient based on what it should roughly cost to treat their ailment rather than billing by specific costs. The panel is recommending that the state continue to look at changing the way Medicaid pays hospitals.
The study showing the cost difference was heavily criticized by public hospitals, but its findings were included, though with some input from the hospitals, in the draft report.
The commission also was charged by Scott with determining the most “cost-effective” way to provide hospital care to the broadest possible population, including the poor.
The group recommends changing the hospital districts into “indigent care districts” to focus more on having tax dollars follow indigent patients no matter where they get care, rather than focusing on paying certain hospitals to treat them.
“The goal is to move from ‘how can we help the hospitals?’ to ‘how can we help the patients?’” Calabro said. “When you use property taxes to support hospitals, and not indigent patients, you get unintended consequences.”
Like spending those tax dollars on other items besides the core mission of treating those poor patients, Calabro said. Public hospitals have said throughout the process that they do more than that.
Calabro acknowledged that in some areas in the past, there wouldn’t have been hospitals if not for public hospital districts. He argued that’s not the case anymore, however.
Operators of public hospitals have chafed at the attempt to compare them in an apples-to-apples way to privately run hospitals, when they have different missions and provide certain services that for-profit hospitals don’t do. Some of those high cost services never would be undertaken by for-profit hospitals, they argue.
The Safety Net Hospital Alliance of Florida has closely watched the commission, and its officials have warned against broad-brushing of public hospitals to satisfy an ideologically driven desire to reduce taxes and spending.
The alliance, which represents public and teaching hospitals, praised the commission Thursday for a draft report that ultimately acknowledges that public hospitals are important.
“The Commission found during its review that public hospitals play a critical role in the delivery of health care to Florida communities,” the Safety Net Hospital Alliance’s Jim Zingale said in a statement. “According to the Commission, these hospitals provide quality care; offer innovative services; conduct themselves with transparency, operate ethically; and are accountable to taxpayers. These results are particularly noteworthy given the level of costly specialty services that public hospitals provide when compared to for-profit hospitals.
“SNHAF applauds the multiple attempts by some Commissioners to reject ideologically driven, rather than fact-based conclusions, in the final report,” Zingale said.
Critics have said the governor created the panel to reinforce what he already believes. Scott, a former private health care executive, has questioned numerous times whether hospital districts are a good thing, and a Scott spokesman confirmed in a story this week in the Palm Beach Post that Scott already believes private hospitals are better than public ones before receiving the commission’s report.
“The governor believes that private hospitals are more efficient and provide just as much indigent care as public hospitals, and they pay taxes rather than spend taxpayer dollars,” Scott spokesman Brian Burgess told the Post.
If the panel’s recommendations are taken, voters could get a say on whether hospital taxing districts should continue.
“Re-approval of the districts’ taxing authority should be voted on by local referendum in a general election,” the panel says, adding that it should go before voters every eight to 12 years.
The panel also says that such sunset reviews need to consider what the impact would be on the ability to finance projects through the bond market if potential bond buyers are aware that a district could be abolished — leaving no tax collections to repay bondholders.
Ultimately, whatever changes are made will come from the Legislature, which has a busy session coming up, leading Scott to suggest recently that it may be that nothing happens on the issue until 2013.
Calabro agreed that it would take a while.
“Hopefully by 2013 they will consider much of what we’ve recommended,” he said.