A panel appointed by Gov. Rick Scott could call for local voters to decide the future of public hospital districts and could recommend that district money only go toward caring for indigent patients.
Dominic Calabro, chairman of the Florida Commission on Review of Taxpayer Funded Hospital Districts, said those are two of the ideas that could be included in a report the panel is required to finish by Jan. 1.
But the report likely will not ferret out whether patients get better quality of care at government-run or private hospitals -- an issue Scott raised when he formed the commission.
The commission has received a study indicating that patient costs are higher at public hospitals than at their private counterparts. Commission member R. Paul Duncan, a health policy expert at the University of Florida, said such cost comparisons are "extremely challenging" but that trying to compare quality of different hospitals is even more difficult.
"The first one is leaping off a small cliff,'' Duncan said during a commission meeting Monday. "The second one (comparing quality of care) is leaping off a really huge cliff.''
Scott, the former chief executive of the Columbia/HCA hospital chain, appointed the commission early this year in what appeared to be a first step toward making major changes in public hospitals across the state. In an executive order, he said the commission should determine, "if appropriate to convert government-operated hospitals to different governance models (and) what the process should be for such conversion.''
The commission has been meeting since May to gather information and listen to testimony. Officials from the hospital industry are closely watching the process, and proposals to make major changes likely would touch off a lobbying fight during the 2012 legislative session.
As an indication of the interest in the issue, the commission heard a presentation Monday from David Ross, the chief financial officer of Tenet Healthcare in Florida. In part, he discussed issues involved in changing ownership of public hospitals.
The commission must submit a report to Scott and legislative leaders by Jan. 1. Already, some lawmakers have said they expect to consider public-hospital issues during the 2012 session, though it is too early to know whether they will move forward with the commission's recommendations.
Calabro, the president and chief executive of Florida TaxWatch, said the panel could call for hospital taxing districts to go before local voters in the future to decide whether they should continue operating.
Also, he said the panel could recommend only allowing funding to go to indigent care -- as opposed to other hospital costs -- and to require that money "follow the patient'' instead of going to certain hospitals.
The commission's deliberations come after a series of controversies about hospital taxing districts in places such as Volusia, Broward and Lake counties.
State Rep. Larry Metz, R-Yalaha, made a presentation to the panel Monday about a draft bill that could lead to changes in the North Lake County Hospital District. At least some of Metz's proposed changes are similar to the recommendations that could end up in the commission report.
The North Lake County district collects property taxes that go to Florida Hospital Waterman in Tavares and Leesburg Regional Medical Center, which are run by nonprofit companies. Metz described the district, which does not operate hospitals, as a "pass through" and said the nonprofits can use the money for expenses other than indigent care.
Metz's proposal, which will go before the Lake County legislative delegation Wednesday, would repeal the district and ask voters in 2012 whether they want to create the "North Lake County Indigent Healthcare District.'' The new district would include a series of changes, such as only funding indigent care, capping payments at Medicaid levels and making money available to a wider number of providers.
Metz said the proposal is not about "demonization" of the hospitals but said the current structure of the district is flawed. The district collects about $10 million a year in property taxes.
"It's time for the voters to have a say on this,'' Metz said.
But Florida Hospital Waterman and Leesburg Regional argue that the tax dollars they receive do not cover the uncompensated care they provide.
In a letter about Metz's proposal, Kenneth Mattison, president of Florida Hospital Waterman, said the hospital also is grappling with lower Medicaid and Medicare reimbursements.
"It is the mission of Florida Hospital Waterman to care for everyone in our community, regardless of their ability to pay,'' Mattison wrote in the letter, which is posted on the website of the state commission. "However, if we lose this funding in the face of decreasing Medicaid and Medicare reimbursements, it will limit everyone's local health care options at a time when our community needs local health care access now more than ever.''
