THIS IS AN ARTICLE ABOUT HOW VERO COMMUNIQUE’S PUBLISHER, THOMAS HARDY, MADE REPEATED ATTEMPTS TO FOLLOW-UP ON A PERSONAL INVITATION BY INDIAN RIVER MEDICAL CENTER (IRMC) CEO JEFF SUSI TO SIT DOWN AND DISCUSS ISSUES RELATED TO IRMC REIMBURSEMENT RATES FROM PRIVATE INSURANCE COMPANIES (E.G.FLORIDA BLUE AND AETNA / NOT MEDICARE OR MEDICAID).
[Publisher’s Note: This article was originally published on January 13, 2017. On January 14, 2017 we received the following email from Mr. Susi:
I apologize for not responding to this email. I completely missed it.
I will get with Lewis on Monday and set up time for us to meet. We will share all public information that we are allowed to share, but will not be able to share confidential information that is protected contractually or statutorily.
Will look forward to seeing you.
On August 18, 2016 at the Indian River County Hospital Hospital District (IRCHD) Chairman’s meeting, IRMC CFO Greg Gardner was asked by IRCHD Trustee Dr. Val Zudans, during Mr. Gardner’s presentation of IRMC financials, “Why doesn’t IRMC make money?”
Mr. Gardner answered by saying “there is an egregious disparity in managed care payments ” (private insurers).
He indicated that Sebastian Medical Center is paid twice as much as IRMC for hypertension check-ups and other services and if IRMC was paid twice the rate for its $ 50 million in revenue from private/managed care providers it would bring $ 50 million to the bottom line.
Please refer to related article:
At the conclusion of that meeting, Mr. Hardy was approached by Mr. Susi extending an invitation to discuss the issue of IRMC private payor reimbursement rates.
Subsequently, Mr. Hardy emailed Mr. Susi to acknowledge and accept his invitation.
With no response, Mr. Hardy emailed Mr. Lewis Clark, IRMC Vice President, Marketing/Corporate Communications asking if he would facilitate a meeting. Mr. Clark replied that he would try to do so.
And then, with no response from Mr. Clark, Mr. Hardy, as publisher of Vero Communiqué, sent Mr. Clark a public records records request dated January 3, 2017 indicating that:
“Pursuant to Article I, Section 24 of the Florida Constitution, and Chapter 119, F.S, I am requesting an opportunity to inspect or obtain copies of all correspondence between the Indian River Memorial Hospital (IRMC) and all private insurance payers (e.g. Blue Cross) for the past five years having to do with renegotiation of reimbursement rates for medical services provided by IMRC.
If there are any fees for searching or copying these records, please inform me before fulfilling my request.
In fact, I request a waiver of all fees for this request since the disclosure of the information I seek is not primarily in my commercial interest, and is likely to contribute significantly to public understanding of the operations or activities of IRMC operations; making the disclosure a matter of public interest. (Emphasis added).
Should you deny my request, or any part of the request, please state in writing the basis for the denial, including the exact statutory citation authorizing the denial as required by s. 119.07(1)(d), F.S.”
As recently as January 11, 2017, Mr. Hardy emailed Mr. Clark to “Please advise if I will be receiving any response from Indian River Medical Center to my Public Records Request of January 5, 2017.”
In researching if IRMC has an obligation to respond to a Public Records Request we found this opinion by Florida Attorney General Pam Bondi:
Florida Attorney General Pam Bondi
“In Attorney General Opinion 91-99, this office reviewed the relationship between the Indian River County Hospital District and the Indian River Memorial Hospital, Inc., under a lease providing that the corporation would comply with the Sunshine and Public Records Laws when engaged in the operation and management of the hospital. Based upon the lease and using the Schwab criteria, this office concluded that the private corporation was subject to section 286.011, Florida Statutes, when engaged in the operation and management of the public hospital; however, it was not, by virtue of the lease, subject to the Sunshine or Public Records Laws when conducting business as a private organization unrelated to the lease agreement and when not acting on behalf of, or at the direction of, the hospital district.”
We interpret this to mean the setting of reimbursement levels with insurance companies is “the operation and management of the hospital.” An example of an activity that would NOT be operating and managing the hospital would be the purchase and operation of medical practices, such as Vero Radiology.
However, one could argue that it would include the purchase and management of Vero Radiology, physician practices, walk-in clinics, etc. Those are all related to the running of the hospital business. The exception might only apply IF the corporation got in to another line of business.
We will continue to pursue this and other questions as to the financial performance of the Scully-Welsh Cancer Center relative to its initial pro forma when approved by the IRCHD, how many oncologists the Center has relative to patients and the nature of IRMC contracts with the Duke Cancer Center.
Incidentally, when Mr. Greg Gardner spoke before the IRCHD trustees on August 18, 2016 he projected a “breakeven operation” for the fiscal year ending 9/30/16, while in fact, in an unaudited Consolidated Financial Statement provided by IRMC, obtained from the IRCHD, on $ 248,285,000 in revenue, IRMC lost $ 1.24 million in fiscal 2016 vs. a budgeted profit of $ 2.08 million. That is a $ 3 million swing and remarkable on $248 million in revenues.
This, and other denials for financial data represents a lack of transparency and leads one to believe we are dealing with an enormous problem of IRMC’s viability, under the leadership of Mr. Susi.
IRMC CEO Jeff Sussi “Survives ‘no confidence push.'”
Vero News.com – 2/20/2014