I'm wondering about the 1/2-cent sales tax for healthcare in Escambia County.
a) The proposal is that there is an 11-member board of directors, with 5 of those members being nominated by county commissioners (1 from each district) and 6 being in the healthcare industry (1 each from Baptist Hospital, Sacred Heart Hospital and West Florida Hospital, 2 from the Escambia County Medical Society, and 1 from the Partnership for a Healthy Community). This seems to set up a controlling interest of the board amongst local healthcare workers, who may have a vested interest in this new system. Wouldn't it be easier to sell this to voters if they didn't think it was a "fix" by the local hospitals? I would suggest they re-allocate these seats to include at least 6 of the 11 being non-healthcare professionals from the community.
b) The ordinance proposes a "Watchdog Committee." What authority do they have? The ordinance is silent on this. If they're going to have any real effect, shouldn't this "watchdog" have some teeth?
c) The ordinance calls for an administrator and whatever personnel are needed to do the job of the new system. I would like to see some limits on the amount of tax revenue that can go toward administrative costs and salaries.
Subscribe to:
Post Comments (Atom)
1 comment:
Let's see if I can address you comments in turn:
a) Please don't think that the hospitals, doctors and Partnership all have a coordinated agenda. They disagree on a multitude of issues. I suspect that reimbursement rates will be an area where you wll see some widely different points of view.
The fact is, you are administering a health care program and you need to have various points of view represented, but you also have to have the expertise necessary to make sound decisions. Docs will advocate for reimbursements that are high enough to draw enough doctors into the programs. The partnership and public reps will be arguing (I feel sure) for serving the largest number of people. The hospitals' incentive will be to make sure that there are enough services available to keep people out of the emergency rooms. I think the best way to look at it is to see the public's reps as the "tie breakers" and thus informed decision makers.
b) The watchdog committee will serve as a check on the actual results of the program. Is the money being spent as it should be? Is the program getting results? The watchdog is the public's eyes and ears. They will report back to the Commissioners and alert the public to any malfunctions within the program. The intent is to have this group operate the same way the school board's watchdog committee does. What "teeth" do you recommend? The Commission can give this group whatever authority it wants them to have. But, they shouldn't be just a second board of directors. We left that open for their discretion. By the way, the County, not AccessEscambia, had final say on the ordinance language. We got the final copy at the same time it went to the Supervisor.
c) You could certainly put a number on there, but where would that number come from. The MGT business plan actually recommends about 10 employees (don't carve that into stone because I don't have the report in front of me), but we resisted doing that because the amount necessary to start the program up may be different than the ultimate number.
During the start-up phase, I expect you'll have more of an emphasis on the enrollment effort -- getting the word out through churches and civic organizations and news media. And, actually signing up participants. (So we can avoid Alachua's problem). As the program matures, you'll need more folks to pay bills and do case management.
The choice of this model was based on devoting as much money as possible to providing care. Other models (Hillsborough County) put an emphasis on creating and maintaining the whole system. Tampa General is funded by Hillsborough County. Lots of money from that program goes into hiring doctors, maintaining the facility, etc.
We felt like the best choice was just to get people to a doctor and get them prescription drugs. That way, we aren't spending money on bricks and mortar and very little on personnel.
Post a Comment