Eugene Feinour’s 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?
“As Chairman of the IRCHD Board of Trustees, I have met with the head of each of our recipient organizations. I have toured their facilities and met with several patients. I have learned that they are, for the most part, fulfilling the needs of the community.”
- 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?
“At this point, I am unable to determine what the impact of the $ 64 million expansion may have on the healthcare providers supported by IRCHD. Over the past several years, the IRCHD has reached out to SRMC and they have chosen not to submit an application to receive reimbursement for services provided to indigent patients. As a member of a large for-profit hospital, it is possible that SRMC would be unwilling to provide IRCHD with all the required information, including detailed financial data.
- 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, as Chairman of the Board of IRCHD, I was integrally involved with the creation of all documents and I fully support them. Further, implementation of numerous objectives is underway. The IRCHD has already been transitioning from a “Hospital” District to a “Health” District. In the very near future we expect to receive funding requests from a number of community organizations. We have set aside money in the 2016/2017 fiscal year budget to provide funding if the request passes a rigorous vetting process.”
- 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?
“This year the IRCHD completed an inclusive Health Needs Assessment and its leadership the prioritization of its results with an implementation schedule. This was an excellent effort and I do not believe the IRCHD needs to consider another assessment at this time. During this process, the assessment team asked SRMC to become a member of the steering committee and they chose not to participate until the last meeting.”
- 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 statement is accurate; however, the payor rate difference would only apply to approximately $ 50 million of IRMC revenue. The bottom line impact would only be a small percentage of that amount, but would result in a positive impact to IRMC earnings.
The IRCHD is not currently discussing the potential sale of IRMC. If the option was necessary due to unforeseen circumstances, a number of requirements would have to take place. First, such an issue would have to be put to a referendum voted on by the residents of Indian River County. If approved by the voters, then action could be taken.”
- 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?
“I believe that IRMC is still a not-for-profit community hospital, which is partially supported by the tax payer. As a result of its many strengths, (e.g. Cancer, Heart and Stroke Centers) it draws patients from surrounding communities. It also receives tremendous philanthropic support from the community. If IRMC did become part of a chain of for-profit hospitals, it would not be able to provide the broad range of services it delivers today.”
- 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 do not agree with this statement. For example, when a direct IRCHD or public records request is provided to IRMC, IRCHD has always received an appropriate answer. A process also exists to permit Trustees to directly meet with IRMC personnel to obtain and clarify information. Further, IRCHD Trustees sit on committees of IRMC BOD including strategic planning, nominating, finance, governance and patient care.”
- 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?
“Under the current legislation, the IRCHD is charged with the oversight of IRMC and distribution of tax revenues to healthcare providers, which covers the cost of caring for indigent patients. It is not the IRCHD responsibility to run hospital operations.”
- 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?
“Absolutely, I have numerous contacts with IRMC administration, members of the IRMC BOD and its Chairman. I also have contacts with several with our funding organizations. I think it is essential to ensure that Indian River County is receiving the best possible healthcare. It also helps shape our future and how we will support other worthy healthcare organizations.”
- “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.”
“It appears the Affordable Care Act has provided a portion of the indigent population of Indian River County with healthcare insurance. This is measurable by the fact the IRMC and other providers are requesting less funding from the IRCHD. Unfortunately, many recipients of ACA are unable or unwilling to pay for premiums of their insurance or cover deductibles or copays for the provided services. If payment is not received by the providers, they are no longer able to request reimbursement from the IRCHD. As a result, the providers will most likely be forced to take a loss on those services. I do not have first-hand knowledge about the private practice community, but I feel that their operations would show similar results for the above mentioned reasons.”