Anthony “Tony” Woodruff

Tony Woodfuff’s answers to 10 community questions posed by Vero Communiqué.

1. Have you ever spent any time at the health care providers funded by the Indian River County Hospital District (IRCHD) to observe how their facilities work (e.g. spent a day in the Indian River Medical Center [IRMC] emergency room) and have you ever met with any indigent members of the community to understand their life situations?  If so, generally speaking, what have you learned?

“I personally have had two occasions to be admitted to the IRMC emergency room (ER).  There are five categories that you will be put into when you arrive. One and two are very serious with little wait time. Five is the least serious and generally the wait time could be extensive and sometimes, if busy, you will be asked to return later.  Being in category two or three, I experienced great service and attention. The ER for the indigent members of our community is their primary healthcare.  They have no other choice.  They are the help for grove-growers, golf course maintenance etc.  Our golf club employs almost 80 Mexicans. They are the hard working employees who would work 24/7 if you would let them.  They also send their paycheck home to their families in Mexico.”

2. Are you concerned about the adverse impact of Sebastian River Medical Center’s    (SRMC) $64 million expansion may have on any of the health care providers supported by IRCHD? Would you be in favor any opportunities for the IRCHD to partner with SRMC to better serve the county’s underserved populations?

“No, I am not concerned and don’t think SRMC’s $ 64 million expansion will have any effect on healthcare providers supported by IRCHD, since they are a for-profit hospital.  I doubt they would have any incentive to fund healthcare providers to service the needs of the indigent population.  They are not even required to take them in their ER. On the other hand, we would certainly welcome it.” 

3. Are you familiar with the District’s Vision, Mission and Strategic Plan recently developed and approved by the Trustees? Do you support the IRCHD transitioning from a “Hospital” to a “Health” District? Additionally, if IRCHD is to become a “Health” District what other organizations, would you like to support?

“Yes, I am familiar with the IRMC’s vision, mission and strategic plan.  I was fortunate to have had as meeting with Michael Felix while he was consulting with the IRCHD Board in developing the strategic plan, as I was on the strategic planning committee at IRMC.  I do support and approve of transitioning from a “Hospital” to a “Health” District.  IRMC and IRCHD had in the past year a joint meeting to discuss the need to foster a collaborative community healthcare system.  We also discussed the role of the providers and their responsibilities; obviously to be expanded over time.”

4. In the strategic plan it says that: “By November 1, 2016, staff will recommend method for utilizing the Health Needs Assessment data in all District communications.” Is there a need for a new Health Needs Assessment to collect data from for-profit health care providers such as private practitioners and even SRMC itself, rather than only the not-for-profit organizations that were included in the current assessment?

“No, I see no need to collect data from the for-profit healthcare providers.  But maybe it would be useful in comparing metrics against the for-profits??”

5. On August 18, 2016 IRMC CFO Greg Gardner spoke before the IRCHD Trustees and projected a breakeven operation for the fiscal year ending 09/30/16. When asked why the Sebastian River Medical Center, with the same demographics, makes money and we don’t, Mr. Gardner said it was due to the “egregious” disparity in private payer rates between what IRMC, LRMC and SRMC are paid for the same services. With Blue Cross, for example, SRMC is paid twice what IRMC is paid and Lawnwood Regional Medical Center (LRMC) is paid three times as much for the same services. This speaks to different contracts between the hospitals and the private payers. SRMC is owned by Community Health Systems (CMS), who owns 200 hospitals. Mr. Gardner said if IRMC was paid the same rates by Blue Cross as SRMC, it would bring $50 million to IRMC’s bottom line. Obviously an organization like CMS has more leverage. Do you support the IRCHD taking the necessary steps to sell IRMC to organizations like CMS to gain leverage to bring more to the bottom line?

“This is a difficult question as the money begs the question. My first instinct would be certainly yes!  However, a sale of the IRMC to a for-profit organization, I believe, would mean that a lot of services we now have at IRMC that are great services but are loss leaders and subsidized by the profitable services would not exist if sold.  The new for-profit corporation would cannibalize the entire operation and only keep the cream.  Also, part of the purchase by the for-profit would have to return over $ 200 million to the IRMC Foundation.  This is more complicated than just an easy sale.”

6. Hospitals that are not part of a university, a health system or a chain of private hospitals are often called “community hospitals.” A regional hospital is a hospital that serves a larger area than a local hospital. On its website, IRMC indicates that “in late 2006, to reflect the transition from a good community hospital to a top-quality medical center, the hospital changed its name from Indian River Memorial Hospital to Indian River Medical Center. Indian River Medical Center is focused on providing quality healthcare to Indian River, St. Lucie, Martin, Okeechobee, Orange, Osceola, Polk, Brevard and Seminole counties in Florida. Counties.” So is IRMC a community hospital and what would be the difference if IRMC became part of a chain of private hospitals?

“IRMC already has operational benefits with partnering with other hospitals in the area.  Purchase and services agreements represent cost savings.”

7. There has been a lot of community discussion that IRMC is not transparent to the IRCHD with its financial data surrounding personnel issues, other subjects including financial details on IRMC’s Heart and Cancer Center, affiliations with Duke University’s programs and why, for cancer, IRMC chose Duke rather than the Moffitt Cancer Center; as well as, whether or not the private practices acquired by IRMC are making or losing money. In accordance with the IRCHD lease with IRMC, Section 9.f.i. b, “with reasonable promptness such other financial data requested by Lessor (IRCHD) as may be demonstrated to be necessary to protect the interests of the Lessor” shall be furnished to IRCHD.  Additionally, two IRCHD trustees sit on the IRMC Finance Committee.  With this background, why can’t these transparency issues be resolved as a duty to the Indian River County taxpayers who support the IRMC?

“I think you have answered your own question.  Please remember that IRMC is required by virtue of its lease with the IRCHD (Sunshine Law) to have our Board meetings open to the public. IRMC is also required to present its financials to IRCHD on a quarterly basis.  Unfortunately, the reporter from 32963 attends out meetings and then proceeds to take things out of context and report erroneous facts.  Two IRCHD trustees sit on the IRMC finance committee, as I did.  In my view, that is the definition of transparency.  IRMC is run well and among the best hospitals in Florida by U.S. News and World Report for 2016-2017; recognized for excellence in hip and knee replacement, COPD and heart failure.  This is a remarkable accomplishment for which IRC taxpayers should be proud.  

8. Do you feel that the IRCHD is over-reaching its duties by trying to run the IRMC rather than just fund it? Do you feel the IRCHD is trying to run it?  If not, should they pay more attention to doing so?

“I feel that over the past couple of years, there has been a concerted effort and commitment by both IRCHD and the IRMC boards to build a healthy collaborative relationship in order to promote the best community healthcare by all the providers.  It has also helped that we have had our new IRCHD Trustees over the past three years who have been supportive of the IRMC and its Board of Directors (BOD).  I have served on the IRMC BOD while I have been Board chairman of the IRMC Foundation.  The IRMC BOD, under the leadership of Dr. Wayne Hockmeyer are the most qualified and dedicated people of any BOD on which I have ever served.  We are extremely fortunate to have fine healthcare resources and many excellent physicians available to us in Indian River County. It is non-productive to continuously be the voice of negativity.  Hopefully, this will change after the election.”

9. Have you had any communications of any type with IRMC administration, any members of the IRMC Board of Directors, or any of the IRCHD funded organizations related to running for or serving on the IRCHD?  Do you have any personal relationship with any member of IRMC administration, members of the IRMC board of directors, or members in the same capacity of any IRCHD funded organizations? If yes to either, what was the content of those conversations about the IRCHD or nature of the personal relationship and how do you plan to avoid any perceived or real conflicts of interest?

“As I stated in answering question eight, I have served on the BOD of IRMC for a three-year term.  My relationship with IRMC administration and BOD members is purely professional.  I do not perceive any conflict of interest.  If anything, having the knowledge and understanding of the inner workings of IRMC and having served on three committees, Patient Care, Finance and Investments and Strategic Planning I will be a great asset to the IRCHD as a Trustee.

10. “Please share your thoughts on how the Affordable Care Act (Obamacare) has affected our indigent population, IRMC, the health care providers IRCHD supports and the private practitioner community.”

“The Affordable Care Act has been favorable for IRMC.

* Over the past 1.5 years, IRMC has seen fewer truly uninsured/self-pay patients because more people now have coverage through the Affordable Care Act.

* More covered patients has reduced the medical center’s bad debt as IRMC is receiving some payment for care that previously would have gone unpaid. Even so, our bad debt last year was $10.8 million.

* Receiving a portion of the payment due puts IRMC ahead, even if the ACV patients don’t pay their out-of-pocket portions.

 * Many of the newly insured patients likely would have qualified for Hospital District reimbursement so it is also favorable for the District and lessens the burden for the taxpayers.

 * Having more patients insured by ACA is probably positive for other providers, including private physicians for same reason. Getting 50% of the dollar reimbursement is better than no payment at all.”