“I don’t have any question in my mind that if we went to arbitration, we’d end up with the amount the hospital has requested.” – IRMC CEO Jeff Susi

THOMAS HARDY/MARK SCHUMANN

Rejecting the Indian River Medical Center board’s call for an increase in indigent care funding that would have amounted to a substantial tax hike, the Indian River Hospital District trustees yesterday approved a tentative 2014-15 budget of $13.7 million. The proposed 2014-15 millage rate of 1.02 equates to a 5 percent increase in Hospital District funding over the current year, far short of the increase the IRMC board requested.

The IRMC had requested an increase in indigent care funding from the Hospital District from roughly $ 8.1 million to $10.2 million, which includes a $ 490,000 shortfall from the prior year. This would obviously impact Indian River County taxpayers in the form of increased property taxes, through the District’s authority to raise taxes to support the 26 percent increase.

IRMC CEO, Jeff Susi, gave a PowerPoint presentation to support the IRMS’s request for additional funding. What followed was discussion and disagreement between the IRMC’s and Hospital District’s views on costs and accounting. Hospital District trustees have expressed frustration over what they say is a lack of transparency on the part of the IRMC.

Hospital District Trustee Dr. Burton Lee, MD moved that the Trustees formally notify the IRMC that they are in default of the Indigent Care Agreement for failure to execute a reasonable, equitable and fair agreement pertaining to the renegotiation of the current Indigent Care Agreement between the District and IRMC. If within 30 days from the delivery of this notice the IRMC does not clear this default the Hospital District will proceed to arbitration.  The motion passed without opposition.

Dr. Spackman, Trustee Chairman noted that under the 1959 Special Act of the Florida Legislature (Chapter 59-1385) establishing the Indian River County Hospital District, payment of hospital expenses for indigent medical care were “at the discretion” of the Trustees. It does not stipulate how much the Hospital District needs to spend and does not specify any particular formula or standards to an amount of support. It is left to the “discretion” of the Trustees.

Just a month ago, the two sides appeared close to agreement. In a June 10 letter to the Hospital District, IRMC Treasure Jack Weisbaum wrote, “In response to your latest proposal, IRMC does not want to go to arbitration as it is a lengthy and expensive process…Therefore, we hope to reach an agreement within the total $7,047,000 reimbursement you suggest for FY 2015, even though it will put a strain on indigent care.”

More recently, the IRMC board has sounded a different tone. Last week, the IRMC’s executive committee asked the district to adopt a preliminary tax rate that would cover $9 million in indigent care funding.

Just yesterday, CEO Jeff Susi was quoted in a press report saying, “I don’t have any question in my mind that if we went to arbitration, we’d end up with the amount the hospital has requested.”

The current impasse between the Hospital District and the IRMC board brings into focus the IRMC’s real costs for providing indigent medical care. The District Trustees would like to move toward the direction of Medicaid’s method reimburses hospitals for inpatients receiving medical care by type of care, rather than pay for services based on a cost based – per diem –reimbursement. In seeking arbitration, the District Trustees, believe the “discovery” process would enable them to obtain facts and information from the Medical Center on its actual costs.

Yesterday’s meeting began with moving tributes by several Trustees to former Hospital District Trustee and Treasurer, Trevor Smith, who died suddenly last week.  Smith’s wife, Jill McPherson, who attended the meeting, thanked the Trustees for their remarks and said her husband loved being a District Trustee and felt it was a privilege.

See: Complex issues surround Indian River Medical Center Funding

See: Medical Center’s operating losses complicate negotiations for indigent care reimbursement