Hospitals in the Tampa Bay region that long have vied for patients now may band together to take on a bigger competitor: the managed care industry.
At stake: the multibillion-dollar business of caring for Florida's poorest residents.
Tampa General Hospital, All Children's Hospital and BayCare Health System — which includes the St. Joseph's hospitals, Morton Plant and St. Anthony's — are discussing forming a network to coordinate care for low-income children, pregnant women and poor adults.
The concept would allow the not-for-profit hospitals to compete directly with for-profit managed care plans. The driver? Gov. Rick Scott and the Republican-controlled Legislature plan sweeping changes to the Medicaid program, which at $20 billion annually represents one of the state's biggest expenses.
Lawmakers think the state could save money by putting nearly all Medicaid patients into managed care plans run by insurance companies or health care providers. Currently, Medicaid recipients don't have to join a health maintenance organization, and can deal directly with doctors and other practitioners.
Local hospitals contend that they would do a better job at coordinating care.
"It's in the spirit of the needs of children and pregnant moms and adult citizens that are in the Medicaid program that we're looking to find a way that we can make every dollar of the Medicaid program count," said BayCare chief executive Steve Mason.
It's better to send tax dollars to not-for-profit local institutions that already are caring for residents than to national companies seeking profits for their stockholders, he said. And local hospitals are going to continue to care for the community's poor even if the for-profit companies decide to pull out.
Exactly what will change for the 430,000 Medicaid patients in the Tampa Bay area and 2.9 million around Florida? It's too soon to tell. The Legislature won't conclude its session until next month. And Medicaid is funded by both the state and federal government, so Washington would weigh in.
But because the hospitals have so much at stake, their leaders have started planning. Seventy percent of patients at All Children's are covered by Medicaid, as are half the moms who give birth at St. Joseph's Women's Hospital. At Tampa General, nearly 75 percent of deliveries and one in five patients overall are covered by Medicaid.
"We feel we're better together," All Children CEO Gary Carnes said. "And it would be more cost-effective to be together than if we all are doing different plans."
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Facing a $4 billion budget deficit, state lawmakers have targeted cuts to Medicaid, which accounts for more than one-fourth of the state's total budget.
Earlier this month, the Florida House approved a proposal that would shift most of the state's Medicaid patients into managed-care plans over the next five years. A bill analysis stated cost savings were not a sure thing, but enthusiasm among the probusiness governor and legislators has put this plan on the fast track. Similar legislation is advancing in the Senate.
More than half of the state's Medicaid patients voluntarily belong to a for-profit HMO, or are in a pilot program testing managed care by health care providers in five Florida counties along the east coast.
Nobody can say for certain whether either kind of managed care is saving any money over traditional Medicaid. And a Georgetown University study of the pilot program found that if money was saved, it could be because some patients didn't get the care they needed.
Local hospital officials say that if they banded together to form what is known as a provider service network, they could not guarantee cost savings for the state. But they do hope they can deliver better preventive care, said Tampa General CEO Ron Hytoff.
Currently, many Medicaid patients, like the uninsured, wait until they are sick enough to go to an emergency room. By then, their problems are usually more expensive to treat.
And many say they can't find private doctors who will accept Medicaid's reimbursements, which are lower than Medicare, the government plan for seniors, or private insurance.
Local hospital leaders say that if care were better managed, people would receive more preventive care, avoid the ER, and enjoy better health.
But again, no one knows for certain.
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Jay Wolfson, a health policy expert at the University of South Florida, noted that lawmakers have focused largely on saving money.
"There's not a whole lot in the legislative language that looks at quality, safety, outcomes or access," he said. "It could be bad for care."
He commended the hospitals for talking about better care, not just cheaper care.
"It's really cool that you've got these hospitals coming together to talk about caring for this at-risk population," he said.
Hospital executives are talking about forming a corporation to receive state funding for 20,000 to 50,000 Medicaid patients. The corporation would contract with local physicians and hospitals to serve patients, said Steve Short, chief financial officer for Tampa General.
Sarasota Memorial Hospital has also joined the discussion, and leaders say they are open to including other not-for-profit hospitals, such as Bayfront Medical Center.
"It's not an exclusive club," Short said.
A consortium of local hospitals forming their own network is believed to be a new concept, Short said, one that developed in recent months from discussions among hospital CEOs.
Regardless of who gets the business, experts say the push for privatization should inspire new players to enter the market as they vie for Medicaid beneficiaries.
"It's going to be quite competitive," Wolfson said.
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330. Letitia Stein can be reached at email@example.com or (813) 226-3322.