TAMPA — Is H. Lee Moffitt Cancer Center, with its 16 affiliates, tax-exempt status and public research funding, trying to muscle out competitors in the lucrative cancer market?
Or is Florida's most prestigious cancer institution sharing its expertise as it seeks to treat, prevent and cure some of our most feared diseases?
That's the heart of a controversy that has erupted since Florida Gov. Rick Scott wrote a letter to Moffitt and two other Florida cancer centers warning that they risk losing state research dollars if they do anything to expand their brands to other institutions.
"To maintain a robust and competitive environment in this area, I believe a fair and balanced playing field for all organizations is essential,'' he wrote in the May 10 letter.
On Tuesday, Moffitt's CEO said playing field already is level.
"We see ourselves as a resource and work shoulder-to-shoulder with our physicians in the community,'' said Dr. Alan List, "not as competition.''
In his letter, Scott referred to $5 million Moffitt received last year from the state for biomedical research.
Although a small part of its $800 million in revenues last year, List called the sum "critical in this period of dwindling funding,'' adding, "we would like to see, rather than it disappear, whether it could grow even more.''
The letter also mentioned Scott's interest in developing a "comprehensive cancer policy,'' and List said he looks forward to participating in that.
Florida ranks second in the nation in cancer incidence and mortality, List said, yet research funding lags behind states such as North Carolina and Texas.
Scott stipulated that if Moffitt is to keep getting research dollars, it must not franchise its name or receive royalties for such branding.
Moffitt, the only Florida institution designated as a Comprehensive Cancer Center by the National Cancer Institute, is affiliated with 14 Florida hospitals and two more out of state. But these aren't franchises in the for-profit sense, List said.
"One of our mandates (from NCI) is to be a resource for the entire state,'' he explained. "We charge a fee for services but we don't make profits and don't franchise.''
Moffitt, which opened its doors in 1986, draws more than a third of its patients from outside the Tampa Bay area, according to its annual report.
Dr. Linda Weiss, who runs the NCI Cancer Centers program, said that the collaborations that Moffitt has with other providers "are viewed as positives."
"They can do a couple of things. They help to extend the benefits of cancer research into the community, and they can make clinical trials available to people who wouldn't be able to come into the center itself."
Jay Wolfson, associate vice president for health law, policy and safety at USF Health, said the governor's letter displays his "for-profit bias.''
Scott is the former president and CEO of the Columbia/HCA hospital chain. Earlier this year, he proposed cutting $2 billion in Medicaid funding to hospitals. Nonprofit safety-net hospitals would have lost money, while a few for-profit hospitals, including some owned by HCA, would have gained. The effort failed.
Last year, despite legal challenges from Tampa Bay-area nonprofit hospitals, the state allowed HCA to open new trauma centers in Pasco and Manatee counties.
Wolfson said the governor long has been concerned that not-for-profit hospitals, "especially if they receive direct or indirect public money,'' have an unfair advantage over for-profit competitors.
Wolfson studied the issue in the early 1990s and found that many nonprofit hospitals enjoyed tax benefits that outweighed charity care and other community service they provided. He has not evaluated Moffitt on that score, however.
Scott's letter didn't explain what he meant by "franchising'' or using a brand for a fee, as opposed to collaborations common at academic and research institutions.
"That's what we need to talk to him about so we can understand what that means,'' List said.
Bethesda Comprehensive Center in Palm Beach County, for instance, has the Moffitt name on the front of its building.
Doctors there regularly consult with Moffitt about care, particularly involving rare cancers, Bethesda spokeswoman Lisa Kronhaus said. Bethesda doctors also receive ongoing professional training.
Moffitt is "really educating our physicians on what research is out there and discussing the latest treatment protocols,'' Kronhaus said.
Bethesda does pay Moffitt a fee, Kronhaus said, but she could not provide details on Tuesday. List said such fees are only to cover expenses.
Closer to home, Morton Plant Mease hospitals in Pinellas County are collaborating with Moffitt on its Total Cancer Care project, collecting genetic tissue from individual tumors so patients can get quick access to drugs coming on line that target those specific cancers.
The St. Joseph's hospitals in Tampa are also "tapping the expertise and resources of (Moffitt's) academic researchers to assist in the treatment of rare and complicated cancers,'' according to its website. St. Joseph's and Morton Plant Mease are part of the not-for-profit BayCare Health System. They don't pay a fee for the Moffitt affiliation, said spokeswoman Lisa Patterson.
But Scott is right to be concerned about Moffitt using public funds while extending its brand, said Tim Boozan, vice president of marketing for Florida Cancer Specialists and Research Institute, a for-profit company with 60 clinics throughout the state.
Moffitt "is a great organization that does wonderful work,'' Boozan said, adding that his company refers many of its complicated cases to Moffitt. Still, he said, public funds allow Moffitt to build on its cachet.
"Patients are the backbone of any practice,'' Boozan said. "Anything that gives you the ability to increase your patient levels that you don't generate yourself could be considered an unfair advantage.''
Boozan said his company can't compete with Moffitt's name recognition.
"We serve thousands of more patients than Moffitt, but have you ever heard of us?''