Robert Savage

Robert Savage’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?

“Having served as CEO in two separate not-for-profit hospital systems, I have worked with indigent patients and families for decades. Both systems offered extensive clinics for primary medicine and specialty services. Costs to patients were on a sliding scale and were free to indigent patients/families.

Working with indigent patients and families taught me that access to care is imperative since physicians commonly diagnose conditions early enough to save lives and costs to the system. I also learned that ALL patients and families want (and need) respectful, responsive care- regardless of ability to pay.”

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?

“SRMC’s expansion is a reasonable strategy. Any hospital needs a full set of services for the community it serves as well for its own financial reliability. It should be noted that the higher level of reimbursement SRMC receives could actually increase the cost of healthcare in Indian River County if volume moves from IRMC to SRMC as a result of the expansion.

 Higher health care costs can impact the cost of health insurance to individuals and companies providing health insurance to employees. The cost increase may very well be minimal, if spread over a large number of health insurance policy holders.”

I am wholeheartedly in favor of the hospitals working together to support the county’s underserved population.

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?

“I have read and agree with the Vision, Mission, and Strategic Plan. Since the Mission indicates the “District is to foster a collaborative community health care system with the objective of improving the health of our community,” it seems the transition to a Health District is wholly in line with the stated intent.

Nationally, health care is emphasizing wellness, healthy lifestyles, education, treatment in less expensive outpatient sites, better measurements of outcomes, and more coordination of services in the community. The term “Health District” better describes this spectrum of options and services.

 Finally, I believe other health services should be considered for support. For example, recently the Healthy Start Coalition became a supported organization. Clearly, all families want a normal delivery without complications at birth, because complications can lead to an expensive delivery and potentially, a child with special medical, social, and educational needs for decades.”

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?

“I believe that as developed, the Strategic Plan identifies and prioritizes issues which will require significant resources, time, and talent to implement. I would be concerned that another assessment would add to the volume of work to be done and either require more resources or would slow progress. I would not recommend another assessment at this time.”

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?

“As previously stated in my answer to #2, an increase in reimbursement of $50 million would likely result in an increase in health insurance costs/rates for individuals or companies who purchase insurance for their employees. Currently, I would not support selling IRMC to a for profit company.”

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?

“The American Hospital Association (AHA) defines a community hospital as a non-federal, short-term general or specialty hospital. An important part of the designation relates to the role the hospital plays in a town/county’s economy and the hospital’s role to increase access to care.

Yes, IRMC is a community hospital. If the hospital becomes part of a chain of private hospitals, some direction would come from a corporate office rather than a community board, which could adversely impact the existing mission of IRMC.”

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?

“IRMC is a not for profit community hospital governed by a Community Board of Trustees who are responsible to provide oversight and direction of the hospital’s activities. The Board hires and evaluates the performance of the CEO. The Board should ask for community input, but the community should not expect IRCHD to guide decisions on personnel actions or the best alternative for major affiliations or the development of new services.

 At this juncture, I am unsure how to respond to the issues of financial data and actions about senior personnel, especially considering two District Trustees sit on the Hospital Finance Committee, which reports to the Hospital Board.

 Also, it must be noted that IRMC Board Meetings are (mostly) open to the public. Citizens and taxpayers may attend the Board Meetings and offer suggestions and guidelines.”

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?

“Yes, the role of the District is to fund indigent care. The hospital is obligated to share reasonable data, but the Board runs the hospital.  IRCHD does not and should not expect to do so in the future. IRCHD roles are defined in the Hospital Bylaws, the Master Lease, and the Indigent Care Agreement.

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?

“I have two links to other IRHD-funded organizations. My wife, Mary Linn Hamilton, is the President of the Visiting Nurse Association (VNA) of the Treasure Coast. The VNA is a fund recipient, from the District.

Also, I am the Vice Chair of the Healthy Start Coalition, which is a recent addition to the list of funded agencies. I will resign from Healthy Start if elected. However, I do intend to remain married to my wife.

Finally, I do not have any relationships with IRMC administration or Board Members. For the record, I requested a hospital tour from Jeff Susi a few weeks ago. The same was granted.

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 ACA has provided levels of coverage to the indigent and underinsured population. This original concept was realized, along with the anticipation that providers would receive some reimbursement which had not been previously available.  What was not anticipated is the significant number of patients/families and the severity of the medical issues they presented.  As a result, the insurance companies participating in the exchanges lost considerable monies due to preexisting and ongoing health issues in the newly-covered population. Currently, many insurers are no longer participating in the exchanges.

 Additionally, newly-covered patients and families have experienced significant costs due to deductibles and co-insurance, which further impacts their finances.

All providers have seen some increases in reimbursement, but they have also seen their un-collectibles rise.”