Florida Legislature Special Session Over, Spotlight On Hospitals Continues
A panel formed by Gov. Rick Scott to examine the finances of hospitals and other parts of the health-care industry held its first meeting Wednesday since the end of two legislative sessions dominated by those issues, as Scott signaled he would continue pushing for changes.
The governor's Commission on Healthcare and Hospital Funding met in Jacksonville to hear from local hospitals — and particularly UF Health Jacksonville — and to consider data on executive compensation and the quality of care around the state.
In a statement issued after the meeting, Scott made it clear that, despite the end of the special session last month that focused on resolving health-care funding, he wanted the panel to come up with future modifications.
"As we prepare for the next legislative session, it is imperative that the Commission continues to look at taxpayer funded hospitals to ensure there is a measurable return on investment on any money these institutions receive in the future," Scott said. "This review will help guide our decisions when determining how to best move forward so all Floridians can know exactly how their tax dollars are being spent and the outcomes being received at each hospital."
The Jacksonville meeting came about a month and a half after Scott wrote a letter to Russell Armistead, chief executive officer of UF Health Jacksonville, asking why the institution "appears to be more reliant on supplemental payments through the LIP program than any other hospital in Florida."
The Low Income Pool, or LIP, is largely used to cover the expenses of uninsured, low-income Floridians who show up at hospitals needing treatment. A conflict between the federal government and the state over extending the program derailed the 2015 legislative session and forced lawmakers to return to Tallahassee in June to approve a state budget.
The federal government eventually extended the program but cut its funding from about $2.2 billion to about $1 billion. A mix of state and other federal funds was used to fill in the hole.
In his remarks to the commission, Armistead defended his hospital, saying that the state's return on investment from the facility "may be the best in Florida." He said UF Health Jacksonville treats a disproportionate number of residents with Medicaid or no health insurance, is the sixth largest employer in Jacksonville and keeps many of its medical residents in the area when their education is complete.
"We do all this, as we'll explain, despite the markedly declining levels in the LIP funding over the last several years," Armistead said.
Armistead's facility, formerly known as Shands Jacksonville Medical Center, also won praise from some of the members of the panel.
Gainesville surgeon and commission member Jason Rosenberg says it’s all about quality and affordability.
“What we’re trying to look at is the hospitals that do that very well, or that do various things very well, how they do that and can we share those best practices around the state?” Rosenberg said. “Can we learn lessons that we can suggest to the rest of the healthcare system in the state of Florida?”
Armistead questioned plans by some lawmakers to change the "certificate of need" program, which regulates such issues as the construction and replacement of hospitals. Supporters of the CON program say it is needed to prevent the proliferation of small, private facilities that could pick off the most lucrative patients and leave the least attractive ones for public hospitals.
"If you want business to work and do away with CON, do away with all that stuff, it's great. Just tell hospitals you don't have to take care of people who don't have money," said Armistead, who added that it wasn't his preferred solution. "Then, I could turn Shands Jacksonville around probably (in) three weeks."
Armistead made the case for more money by comparing his hospital with one in South Florida.
“Jackson Memorial in Miami is about twice the size we are. They receive $360 million from local support compared to the $26 million we receive from Jacksonville,” Armistead said. “So, actually, we may be the miracle on 8th Street.”
Meanwhile, some members of the panel continued to express frustration with the inability to get hospitals to open up their books.
But doing so could require a change in law, according to an official with the Agency of Health Care Administration at the meeting.
Sam Seevers, a former Destin mayor who serves on the commission, pointed out that the members of the panel — who are volunteers appointed by Scott — have to disclose their own finances as part of their obligations under the state's open-government laws.
"That should be part of what (hospitals) do as well if they're receiving monies," she said.