Paul-Hus may be right. But it's not clear that the district's current political concerns are worse than the solution, which appears to eliminate politics chiefly by eliminating oversight of the district by the public. More from Paul-Hus after the jump.
Paul-Hus responded to one of three questions I posed yesterday -- specifically the one in which I asked whether the district's nonprofit move was driven by commissioners' desire to remain in influential positions at the district long after they left the board.
To be clear, the proposed arrangement would not eliminate the tax district, which would continue to be governed by a board appointed by the Florida governor. The chief function of that board, then, would be to set the millage rate through which the county taxes homeowners, a tax that pays for the care of indigent patients in the county.
"What the proposal does do is take the politics out of the management of the health-care business, which is something the district has been criticized of for years," says Paul-Hus. "The reason Broward Health is exploring this change in management structure is because transitioning to a community not-for-profit corporation puts Broward Health in a stronger and more flexible position to compete in the face of impending changes in our operating environment brought about by federal health-care reform."
But Paul-Hus -- as well as board chair Rhonda Calhoun and district CEO Frank Nask -- have so far not offered specific examples for how a not-for-profit is more "flexible" and competitive in the new health-care age.
For instance, the public hospital district's charter allows for privacy in cases in which a public discussion of district business could be exploited by competing health-care providers.
For another, Nask and the commissioners seem to take for granted that they'll be able to execute this transaction while maintaining their sovereign immunity, an invaluable resource in keeping down the costs of providing care. Since that immunity flows from the district's status as a political subdivision of the state, there's no guarantee that that privilege can be extended to a nonprofit corporation that takes over managing the district.
Thus far, Paul-Hus is the only one of the seven commissioners to respond to my questions. I thank him for that. Here is the full, unedited version of his remarks to the Juice:
I would first like to clarify that the current proposal does not change in any way the appointment process for commissioners to the North Broward Hospital District Board. Furthermore, the North Broward Hospital District will continue to exist and its Board, whoever may be on it, will retain the power to set the millage rate to fund the care of indigent patients in the district. What the proposal does do is take the politics out of the management of the healthcare business which is something the system has been criticized of for years.
The reason Broward Health is exploring this change in management structure is because transitioning to a community not-for-profit corporation puts Broward Health in a stronger and more flexible position to compete in the face of impending changes in our operating environment brought about by federal health-care reform. As we increase our capabilities of competing for the business of paying patients, we will be in a better position to meet the financial burden of delivering care to indigent patients over and above what tax revenues currently support and potentially even reduce the tax revenue burden on the NBHD.
The proposed change does not alter the basic mission of Broward Health as a safety-net hospital system. The public can rest assured that this type of transition has worked in many other similar circumstances to the benefit of the communities in which those hospitals operate. Since the statue was first passed in 1982 the law has been amended six times to safeguard the public interest. In that time span, there have been 23 conversions of public hospital systems in Florida alone. The experience of other hospital systems that converted to this model, in Florida and other states, shows that they were able to continue meeting the needs of the indigent patients in their communities while expanding services to other paying patients. A Kaiser Family foundation study conducted in the late 1990s concludes as much.