PUBLIC HOSPITALS EXAMINED. NOW WHAT?

By JIM SAUNDERS
THE NEWS SERVICE OF FLORIDA

THE CAPITAL, TALLAHASSEE, January 3, 2012.......After months of work, a panel appointed by Gov. Rick Scott released a report Tuesday that calls for major changes in the state's taxpayer-funded hospital districts.

But it remains unclear what --- if anything --- lawmakers will do with the recommendations when the annual legislative session starts next Tuesday.

So far, lawmakers have filed few bills that are similar to the recommendations. Those bills deal with requiring more oversight of the sales or leases of public hospitals, a touchy political issue that also was debated during the 2011 session.

But the Scott-appointed Commission on Review of Taxpayer Funded Hospital Districts wants more far-reaching changes, such as holding periodic local referendums about whether some districts should have the power to continue levying property taxes.

Separate from the commission recommendations, lawmakers also will grapple during the session with a highly controversial Scott budget proposal to revamp --- and cut --- Medicaid funding for hospitals. That proposal includes large cuts for public hospitals and likely will spur a debate that could divert attention away from the commission recommendations.

During an interview last month, Scott said he still needed to see the commission report. But he said that if "there is a recommendation that we all think makes sense, that we ought to get it done quickly.''

"Let's make sure the money is spent in the manner that gets us the biggest return for the people who we want to take care of,'' Scott also said during the interview. "We clearly want to make sure people have a safety net, but we don't want to waste money.''

Scott, the former chief executive of the Columbia/HCA hospital chain, issued an executive order in March that created the commission. In that executive order, he called on the commission to "make recommendations on the role of hospital districts, whether it is in the public's best interest to have government entities operating hospitals and what is the most effective model for enhancing health-care access for the poor.''

The commission, chaired by Florida TaxWatch President Dominic Calabro, issued a report that largely carries out the executive order.

For example, a key recommendation calls for moving from hospital taxing districts to "indigent health care districts.'' The basic concept is that tax dollars should not be linked to district-owned hospitals but should flow wherever low-income patients get care --- whether they go to public or private hospitals or other types of providers.

Another recommendation would require that districts go through what is known as a "sunset review" of their taxing power every eight to 12 years. Referendums would be held about whether voters want to again approve the taxing authority.

The commission, however, could not reach a conclusion about whether the quality of care was better or worse in different types of hospitals. It pointed to vast differences in Florida's hospital industry.

"A key problem in attempting to conduct a comparative analysis of hospitals is that they are very diverse and their business models are complex,'' the report said. "For example, one third of the state's publicly owned hospitals are small rural facilities. It is extremely difficult to compare rural hospitals to larger hospitals because rural hospitals often have too few patients to produce comparable data. It is also difficult to compare larger hospitals because they offer a different array of services.''

That diversity also could make it more politically difficult to make changes, as hospital districts are dotted from rural North Florida to urban South Florida and are in communities represented by a wide range of lawmakers. Also, the Safety Net Hospital Alliance of Florida, which includes public hospitals, closely watched the commission deliberations and was critical of parts of the report as it was being drafted.

The Legislature's top health-budget writers, Rep. Matt Hudson, R-Naples, and Sen. Joe Negron, R-Stuart, served on the commission. Neither could be reached Tuesday, but Hudson gave a blunt assessment during a recent meeting about how lawmakers would view the recommendations.

"All of this is going to be decided by the Legislature,'' Hudson said as he argued for an issue that was supported by Lee Memorial Health System in Fort Myers. "And you know what? The wordsmithing will be done by us.''