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No deal yet on funding indigent care


The Indian River Medical Center has offered a major concession to the Hospital District in the ongoing dispute over indigent care funding, but the two sides still remain far apart over other terms.

In an exchange of letters, hospital management had agreed to cap the district’s contribution to indigent care at just over $7 million in county taxpayer funds in fiscal year 2014/2015, which begins Oct. 1. However, the District had also sought to lower the caps in the next two years of a three-year agreement, proposing $6.7 million in the second year and $6.3 million in the third year.

The hospital had rejected those lower caps in the last two years of the agreement, and wanted a one-year pact leaving reimbursement levels for years two and three open for another renegotiation.

That part of the hospital’s last counter-proposal didn’t sit well with the trustees, as became evident at a special Monday chairman’s meeting of the district.

In view of the acrimonious negotiations to date, District Treasurer Trevor Smith said, “Frankly, I don’t relish the idea of having to go through this again next year.”

Trustee Dr. Michael Weiss even suggested hardening the district’s negotiating position, taking the district’s last offer off the table, and going back to the district’s first proposal of $5 million, based on the Florida Medicaid reimbursement rate, saying he did not want to “reward the hospital for non-exemplary management.”

However, District Chairman Tom Spackman said he wanted to let the district’s final offer stand, putting the ball back in the court of the hospital management.

Hospital CEO Jeff Susi, who attended the meeting, did not have any immediate reaction, saying afterwards he and Hospital Treasurer Jack Weisbaum, who had conducted the previous negotiations, now needed to look again at the district’s refusal to consider the hospital’s counter-offer of a one-year deal.

The district would like to approve a preliminary budget by July 10 to know what its expenses will be. It has said it will submit the funding dispute to arbitration, as per the terms of the present contract that expires Sept. 30, unless the hospital accepts the district’s “last and best final offer.”

Smith said that the hospital’s budget overruns in indigent care over the last two years, when the present contract had no caps but provided for reimbursement on a cost basis, have forced the district to significantly run down its reserves, and “this year we must at last break even.”

He said even funding the hospital for indigent care at $7 million in the first year, as both sides have now agreed, will require a 5% increase in the amount the hospital district seeks in real estate taxes across the county.

The hospital gets the lion’s share of the district’s $12 million budget for funding indigent care.

According to Smith’s preliminary budget for fiscal 2014-2015 presented at Monday’s chairman’s meeting, other principal recipients of funding that provide important primary care and can keep people out of expensive hospital treatment, are:

- The County Health Department for $2.3 million, including just over $300,000 for We Care.

- The Mental Health Association for $425,000

- The UF Center for Psychiatry & Addiction for $260,000

- The Visiting Nurse Association for $700,000, and

n Treasure Coast Community Health, which would have funding restored after a one-year hiatus, for $575,000.