The Concerned Citizens of Franklin County promote three county-wide healthcare goals: Quality, affordable health care, fiscal accountability and patient-centered decision making.
The majority of health care for county citizens is delivered outside the county at Sacred Heart, Capital Regional, Tallahassee Memorial and other providers. Overnight patient census at Weems averages one or two, and sometimes zero. Most revenue is generated from ER patients who use that facility more like a 24-hour urgent care, walk-in clinic as Weems has no functional operating room or surgeon, and most importantly, its ER doctors are not board certified emergency medicine specialists.
Fiscal accountability is a significant problem, as Weems has been deficient in running its back office, including inaccuracies with financial statements to the county board and preparation of mandated cost reporting to Medicare and Medicaid. The former chief financial officer was briefly disciplined for failure to file mandatory reports, initially costing the hospital/county over $1 million., before a portion of this money was recovered. At the April hospital board meeting, we learned that errors in other payback requests resulted in chargebacks by Medicare; a six-figure sum is to be deducted from Weems future payments.
Weems is heavily subsidized by the county-wide healthcare trust fund tax, and LIPP and DISH (low income and uncompensated care) support from the state. Sadly, local charges for health care often go unbilled or uncollected. If a new hospital is to be built without understanding actual community needs, and Weems financials don’t dramatically improve, taxpayers will again prop up the hospital with ad valorem taxes as was done to keep the ambulance service operating.
Since its inception in 2008, nearly $15 million has been collected by the one-cent local sales tax, half mandated for operations, half to capital improvements. Monies above the voter-approved 50 percent have been “loaned” to support Weems’ daily operating budget, with uncertainty as to repayment. Although the clinic in Carrabelle was constructed, it provides fewer hours of care than promised. In addition, hundreds of thousands of dollars on consultant studies were spent for various hospital construction/feasibility proposals. Now, years later, without community-responsive hospital plans, lack of construction demonstrates how marginal this project is. We see that creative accounting, not revenues, is proposed to pay the monthly mortgage note using uncertain depreciation reimbursement as the source of repayment.
It must be noted that extraordinary efforts by the CEO at Weems did result in securing nearly $1 million of DISH and LIPP subsidy money. But, since the funds were previously accounted for in the financials, the reimbursement does not drop to the bottom line.
In terms of patient-centered decisionmaking, county commissioners empower a hospital board to make day-to-day decisions, but too often, appointed members are absent when oversight of operations and funding need their full attention. At the March board meeting, February financials were not available. In April, no trend metrics were offered to board members and financial statements were glossed over. It was not explained that total liabilities had reached over $2.5 million, the highest this fiscal year. Board members who attended seemed unaware of what that important number portends.
In addition, current liabilities are at record levels. Although assets are listed on the balance sheet as $6 million, we believe these numbers are grossly overstated. After analysis, the actual liquidation value of Weems is closer to $2.5 million, taking into account that Weems’ physical plant and equipment are largely obsolete, greatly reducing their asset value to land, cash, receivables and the salvage value of the equipment, furnishings and building.
The county commissioners asked Tallahassee Memorial Hospital more than six months ago for help in finding a partner to take over Weems’ hospital management as well as the financial risks of county-owned health facilities. We applaud that effort. However, the only qualified bidder TMH identified, Community Health Care of Texas, demanded its own operational assessment before they will determine whether to present a management leasing contract. For $55,000, they promise to do (yet another) hospital assessment for the county.
For years, the Concerned Citizens has urged a truly independent study be done to determine genuine local health care needs and options. As we explained to commissioners, an independent third-party (with no financial stake in the outcome) should have been contracted for an assessment, complete with alternatives. In a final report, potential hospital leasing companies should be recommended, instead of settling for a single, self-serving report generated under the current CHC proposal. By limiting the search to a single company, then paying them to bid, a classic conflict of interest was created by county commissioners as recommended by the County Attorney.
Before it is too late, the county commissioners should ask “What constitutes an acceptable contractual arrangement with CHC - or any other company choice - on behalf of citizens, taxpayers, visitors seeking services, and one that protects our county financially?” We believe any open-ended contract which does not cap the costs to the county, and may require future support in the form of ad valorem taxes, should not even be considered.
What is the best deal for Franklin County healthcare? Public discussion is needed before single-bidder CHC crafts its own proposal, surely engineered to help their best interests and profitability. Their final contract proposal may not prove to be in the best interests of Franklin County. County commissioners should communicate a clear basis for an acceptable management/ownership relationship prior to receiving CHC’s assessment. It will be too late when the need for piecemeal crisis management by the county ensues again – as it has so often in the past.
We hope that at least one commissioner and their constituents agree with us; these concerns must be discussed now.
Allan Feifer is a board member of Concerned Citizens of Franklin County, Inc.