Local Administrators Talk Indigent Care at LWV Event

BRADENTON – A nearly full house gathered at the Bradenton Women's Center on Monday to hear local administrators discuss the challenges of providing indigent care services in today's health care marketplace. From challenges facing providers to the cash-strapped budgets of local governments, Manatee County Administrator Ed Hunzeker along with Dr. Jennifer Bencie and Chuck Henry – administrators of the Florida Department of Health in Manatee and Sarasota Counties respectively – weighed in on what the future may hold.

Manatee County Administrator Ed Hunzeker

Bencie and Henry described each county's programs and administration, noting the major difference was that Sarasota had a community-owned hospital system that included an indigent care program, while Manatee County had hospitals owned by private interests and contracted the bulk of its indigent care services to a non-profit – Manatee County Rural Health Services, Inc.

Mr. Hunzeker reiterated the fact that the corpus created by the proceeds from the county's sale of Manatee Memorial Hospital would soon expire, and that in light of the recent failure to pass a referendum on implementing a half-cent sales tax, the county commission would have to decide how to move forward with a roughly $9 million shortfall from current spending levels.

Hunzeker noted that the options available to the board would include raising revenues through property taxes or simply doing nothing and seeing how the health care market responded. The county administrator maintained that he was not taking a position on any particular course of action.

Manatee County LWV President Lee Pflueger

Hunzeker said that one of his main concerns was, however, keeping providers in the area. He said that the failure to properly compensate providers for administering care to indigents could lead to them fleeing the market to open shop in a place that does, which would stress the entire system.

Hunzeker then asked how many people had physicians who were accepting new patients and said that losing providers while populations continued to rise would impact all citizens, which was why he viewed it as a "health care problem" and not simply a matter of “indigent care”.

Mr. Henry noted that Sarasota County's provider-per-citizen ratio was much healthier – around 1/1,300 as opposed to around 1/1,700 – but also pointed out that there is no measure of how many of those doctors accept Medicaid or otherwise treat the indigent, saying it was seen as a broad indicator of the health of a system.

Several attendees asked a variety of thoughtful questions, including retired local physician Dr. Richard Conard, who has been something of an adversary to Hunzeker on the matter.

Dr. Conard suggested that since the “overall spend” on health care related services for Manatee County was around $87 million when you included employee health care services, jail-related health care, emergency medical services and indigent care reimbursements, the county might be able to realize significant savings were a chief director of medical services in place, to evaluate the county's administration of such services and direct more efficient practices and policies.

Dr. Richard Conard

Hunzeker flatly denounced the idea, arguing that it was inappropriate to group the areas under one umbrella. The county administrator said that there is a director who oversees the county's EMS division and that its employee health care services were named the best in the Tampa Bay region, a record that he said spoke for itself in terms of its management.

Speaking afterward, Dr. Conard said he respectfully disagreed with Hunzeker.

“Currently, despite a massive public investment in health care, there is no one in the top tier of the administration with a core competency in the field,” said Conard, who's been involved with health care locally since 1967. “Without a chief medical officer on staff or a quality assurance committee to evaluate evidence-based outcomes for the $87 million we spend, there's no way to know if we're getting the best bang for our buck. I think these problems could be solved without a health care sales tax or higher property taxes, and I've suggested many ways the county might do that, though they seem to continue to fall on deaf ears.”

Monday's event was sponsored by the Manatee County League of Women Voters.

Monday's panel, from left: Chuck Henry, Dr. Jennifer Bencie and Ed Hunzeker.