Health care providers seek share of new revenue stream

Sept. 13--With hats in hand, Marion County health care operators are preparing to seek their share of millions of dollars earmarked for local spending.

The money will come from the interest off about $200 million the Marion County Hospital District received from Community Hospital Systems in exchange for allowing that private company to lease Munroe Regional Medical Center. The money is sitting in interest-bearing accounts and investment vehicles.

With dozens of nonprofits looking for new revenue streams as state and federal funding spigots tighten, the hospital district money could be a godsend: the largest revenue stream of its kind in the county.

While the first checks won't be written for at least another year -- and while the hospital district trustees aren't even close to deciding who should get how much -- the Star-Banner asked some local health care leaders how they think the money should be spent.

Among the first in line with suggestions is Heart of Florida Health Center CEO Kerrie Jones Clark.

"First, continue to fund primary care for the uninsured," Clark said.

About half of Heart of Florida's 15,000 patients are uninsured. The other half mostly has Medicaid.

To fill the gap, the health center depends on local grants and corresponding federal drawdowns. For example, Heart of Florida gets $400,000 a year from Munroe Regional Medical Center and a corresponding $1.1 million from the Centers for Medicare & Medicaid Services.

But CMS warned this year that its contribution will end next year. For Heart of Florida, which has a $9 million annual budget, that's a significant loss.

That is where the hospital district could step in, Clark said. A $1 million grant from the district would pay for about 10,000 health center visits and make up the CMS loss.

The alternative: Patients heading to already crowded emergency rooms.

Another community need the hospital district money could address: adult dental care.

Heart of Florida now only offers pediatric dental care, serving 2,700 young patients. If the hospital district were to come across with $700,000 annually, that would be enough to pay for two dentists, support staff and infrastructure.

The bottom line: dental service to 5,000 adult patients.

The alternative is what's happening now, said Dr. David Willis, Heart of Florida medical director.

"(Hospital emergency rooms) get the same patients over and over again with the same affected tooth," he said.

A third neglected area needing hospital district help is mental health treatment.

Willis estimated that about a quarter of Heart of Florida patients have some sort of mental health problems that are not getting addressed. But Heart of Florida has only one clinical social worker on staff.

With an additional $300,000 annually from the hospital district, Heart of Florida could add an additional three social workers, along with support staff, and give its patients the kind of help they need, Clark said.

If not, those with mental health problems will cost taxpayers in other ways -- namely, tax dollars when the clients find themselves in jail or emergency rooms.

The Centers

Tim Cowart, CEO of The Centers, a nonprofit mental health provider in Marion and Citrus counties, said there is no shortage of mental health programs that need the hospital district's help. The agency has 17,000 clients.

One of the best ways to spend that money is helping to integrate mental and primary health care, Cowart said.

He noted that about 70 percent of people with behavioral issues also have at least one chronic physical problem -- and 45 percent have at least two such problems.

"Because of the great overlap of mental and physical health, I'm trying to move more toward ... an integrated care model," Cowart said. "Right now there's no coordination of services."

The coordination of services would include unified treatment records and better coordination between doctors and mental health professionals, he said.

How to achieve this? One option is to partner with Heart of Florida inside an existing Centers' facility on Southwest Martin Luther King Jr. Avenue in Ocala.

The problem: That facility is too small and outdated. But $2 million from the hospital district would cover enhancement of the current facility or construction of a new one.

Meanwhile, The Centers has lost $1 million in state funding each year for the past two years. As a result, The Centers is struggling to keep up with the demand for services.

The agency can't even dedicate a therapist full time to work with its indigent, outpatient mental health patients. Likewise, it has just one full-time therapist for its substance abuse program for the indigent.

"We could use three more (full-time therapists) on both sides," he said.

The annual cost would be $350,000-$400,000.

There is no shortage of patients who could benefit, he said. The Centers treats 91 indigent mental health clients and has 169 on a waiting list. Cowart estimates that as many as 300 Marion County residents per year could be helped.

Similarly, there are 17 indigent substance abuse clients. The Centers keeps no waiting list. He estimates that about 250 residents could benefit from a fully funded substance abuse program.

Cowart also would like help starting a new program in which recovered substance abuse clients and mental health patients would mentor those currently getting treatment.

The program would operate similar to Alcoholics Anonymous sponsorships, but be more structured and organized.

He would like two peer sponsorship employees, at a cost of about $80,000.

Children's Alliance

Dr. Michael Jordan, executive director of the Marion County Children's Alliance, said the best way to spend the hospital district's money is to invest it in the health of young people in hopes that they don't ever wind up as patients at Heart of Florida or The Centers.

In fact, "I think the alliance is in a unique position to provide primary prevention to our community," Jordan said.

The agency coordinates an array of services involving children, addressing issues such as domestic abuse, teen substance abuse and nutrition.

"Many of these diseases have their origins in childhood," Jordan said, citing nutrition and children's lifestyles.

There is no shortage of children who could benefit. Nearly 47 percent of Marion County students are either overweight or obese, according to the Florida Department of Health in Marion County.

Nearly 30 percent of Marion County middle school students admit to having used alcohol, and 9 percent admit marijuana use.

The goal is to persuade children to make healthy lifestyle choices early -- namely, exercise and good nutrition.

For those who say these habits are best learned at home and school, Jordan said that strategy isn't working.

The hospital district should fund programs for individuals to "interact with kids, schools, youth groups, churches and with parents and present alternatives" to improve the long-term health of the community, Jordan said.

"This is a way to reach people who don't regularly go to doctors," he said.

Once they go to Heart of Florida with hypertension, diabetes or heart disease, the lifestyles that brought on those problems are well established, Jordan said.

The community needs about six such social workers tasked to instruct children and families, he said. The cost would be about $80,000 annually per employee, including support facilities and staff.

The hospitals

Randy McVay, chief executive officer of Ocala Health, the parent company of Ocala Regional Medical Center and West Marion Community Hospital, also has advice.

He said his hospitals are seeing a growing number of patients who no longer need inpatient medical care but are not ready to go home, have no home, or have no insurance to pay for a stay at a third-party facility.

"That continues to be a struggle for us," McVay said. "We take care of them as best we can ... but they need to go somewhere for a period of time."

On any given day, his two hospitals house 10-15 patients who no longer need acute hospital care but have no other place to go. Not only does this cost the hospital, but it also ties up beds needed by those who are more ill.

One solution: Contract with existing third-party facilities to take on those patients.

McVay said that's a cost the hospital district could pick up, in whole or in part.

How much would that cost? McVay said he isn't certain; it would depend on the patient's circumstances.

Salvation Army Maj. George Patterson knows the cost of patients with nowhere to go. Earlier this year Patterson told the Star-Banner that his agency's emergency shelter was experiencing a troubling increase in patients recently discharged from area health care facilities who still needed medical care.

One or two such discharged patients per week knock on the door -- often unannounced, he said.

Munroe Regional Medical Center officials did not grant the Star-Banner an interview on this topic. Instead, they referred a reporter to the results of a 2012 community health study.

Department of Health

Cheryl Brown, interim health officer for the Florida Department of Health in Marion County, said there are plenty of services her agency would expand if it got additional money.

The DOH already serves many of the county's poor and has partnerships with other agencies that do the same. For example, the DOH already has contracts with medical laboratories to screen patients for various illnesses.

Additional money could fund an enhanced Pap smear program. The program could be better advertised, she said.

The cost? Brown said that depends.

"The problem is also that once you find the cancer, you have to find someone to treat it," Brown said.

The DOH already has relationships with local health care providers, Brown said. Using those relationships, the DOH could create programs with local doctors to treat women at set prices who need help based on their screening results.

DOH's annual budget is $12 million. About 10 percent goes toward education. Brown estimates that for every one person getting DOH help, there is at least one who is eligible but is not getting the help they need.

Scot Quintel, president and CEO of United Way of Marion County, said the hospital district's position reminds him of the time he headed a United Way branch in Indiana that unexpectedly received a $10,000 donation.

A couple of board members suggested how to spend the money, he said. That same year, another unexpected gift of nearly $700,000 arrived. All 18 board members dove in with suggestions, he recalled.

Something of the same is bound to happen as millions of dollars are paid in interest annually to the hospital district, Quintel said.

"There is going to be a multitude of opinions and (the district members) will be pulled in a multitude of directions," Quintel said. "It's going to be a tough position to be in."

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Contact Fred Hiers at 867-4157 or [email protected].

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