Dr. Michael J. Weiss
Dr. Weiss’ answers to 10 community questions posed by Vero Communiqué.
- 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?
“Yes I have met with patients that are the beneficiaries of the indigent care program. I have spent time on the VNA medical van and have interviewed the patients that were being treated. They were extremely grateful for the high quality of care that they were receiving from the VNA. They had no insurance nor any other means of paying for their healthcare. One patient in particular stuck out. She was a middle aged lady whose husband had lost his job and had no prospects of finding a similar job with the same salary and benefits. She had also lost her job and their house was in foreclosure. She blessed the IRCHD and the VNA for providing her and her family with free healthcare.
I spoke with other people who were in very difficult circumstances and would not have been able to receive health care without the IRCHD’s indigent care program. It was gratifying to see our tax dollars being used in such a good cause.
The Indigent program helps make the unthinkable desperation of its clients a bit more bearable by knowing that they still have access to quality healthcare thanks to the taxpayers. Hearing these stories convinces me that the IRCHD is serving the under cared for population of our county.”
- 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?
“Yes. The expansion of the SRMC is largely due to the failure of IRMC to adhere to its mission as a community Hospital. The IRMC has lost the confidence of the residents of Indian River County. IRMC is licensed as a 335 bed hospital and it functions as a 191 bed hospital. The new gynecology practice should have an enormous effect on the Partners program. I predict it will attract a large percent of the gynecology portion of the Partners Program.”
- 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?
“The IRCHD was established by the Special Act to ensure that quality health care was available to all of the residents of Indian River county. Under the terms of the special act the IRCHD is really a ‘healthcare district.’ It is about time that it took its responsibility to this goal seriously. In the past the Hospital District has concentrated on the IRMC, in part due to the fact that IRCHD owns IRMC and leases it to the IRMC to operate the IRMC.”
- 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?
“The Health Needs Assessment is a highly flawed document, it did not include the SRMC and input from other healthcare providers. At this time, the IRCHD, as per a recent meeting, did not deem the Veterans Council adequate to qualify indigent veterans for the Indigent Care Program. This is a disgrace. I, as past Vice President of the Veterans Council, have been an advocate for the veterans of our community. IRCHD Executive Director, Ann Marie Suriano and I have been in contact with the VA. We have tried to arrange for the VA to allow our local veterans to be treated at our local facilities. Unfortunately, the VA has been unresponsive.”
- 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?
“The fact that other local hospitals have a higher reimbursement rate than IRMC is a direct result of poor management. The IRMC negotiators out and out failed to do their job. The IRCHD cannot sell IRMC. This decision would have to be made by the residents of Indian River County. IRMC should engage in better negotiation strategies, if it had a competent and aggressive administration. The CFO should stop whining and move to solve the problem of a lack of leadership.”
- 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?
“By law, the Special Act, IRMC is a community hospital. The fact that the IRMC management have delusions of grandeur does not alter this fact. The hospital, IRMC, is and must be a community hospital.”
- 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?
“This is a good question. Because of the lack of transparency as required by the lease between IRCHD and IRMC, the IRCHD has no idea of the content of the Duke contract. Duke is ranked number 40 in the nation as a cancer center Moffit is ranked number six. Moffit is two hours away Duke is eight hours away. We need to see the Duke Contract to understand, if possible, why IRMC went with Duke. What is IRMC hiding?”
- 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?
“The District is not over reaching. We should and hopefully a new IRCHD BOD will demand that the IRMC live up to the terms of the lease agreement between the IRCHD and the IRMC.”
- 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?
“No and no.”
- “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 answer to this question is simple. The Affordable Care Act has been an unmitigated. The program has higher costs combined with large deductibles. This is really a catastrophic illness policy. The hospital ER sees patients who think they are insured only to find out that they may have a $10,000 deductible. The patient cannot pay and the hospital is stuck for the $10,000. This is a lose, lose situation. The number of indigent patient has decreased, but the cost of the care is shifted to the providers., This system must end and a new and meaningful program should replace it.”
“This has to do with the Scully-Welsh Cancer Center. An acquaintance of mine advised me that her husband had been diagnosed with cancer. Her health insurance policy said that Scully-Welsh was in her network; but when she went to visit the doctor he said he couldn’t provide care because he wasn’t in the network. He said he would help pro-bono. IRMC would not allow it. Asked why she wasn’t covered IRMC told her ‘she had cheap coverage.’ It took her several months to sort things out delaying treatment for her husband. Remember, I was the only IRDHD Trustee who voted not to approve the new Scully-Welsh Cancer Center. The new Cancer Center, as part of our community hospital, must serve all of the residence of this county regardless of their ability to pay.”