PRESENT: Sarasota City Commission - Mayor Suzanne Atwell, Vice Mayor Terry Turner, Commissioners Paul Caragiulo, Willie Shaw, and Shannon Snyder, Interim City Manager Terry Lewis, City Auditor and Clerk Pamela Nadalini, and Deputy City Attorney Michael Connolly Sarasota County Public Hospital - Chairman Richard Merritt, presiding, Vice Chair Teresa Carafelli, Members Gregory Carter, Richard Donegan, Darryl Henry, Marguerite Malone, Robert Strasser, and Thomas Towler, and Gwen MacKenzie, President and Chief Executive Officer ABSENT: Sarasota County Public Hospital - Member Thomas Kelly, M.D. INVOCATION: City Auditor and Clerk Nadalini PLEDGE OF ALLEGIANCE: Chairman Merritt 1. INTRODUCTIONS (AGENDA ITEM I) The members of the Board of Directors of Sarasota County Public Hospital (Sarasota Memorial Hospital - SMH) and the Sarasota City Commission introduced themselves. 2. DISCUSSION RE: POSITIVE ECONOMIC AND JOB IMPACT OF THE HOSPITAL ON THE CITY (AGENDA ITEM II) Ms. MacKenzie gave a computer-generated presentation concerning the positive economic and jobs impact of SMH on the City including: $277 million in total payroll $509 in total operating expenses supporting local businesses $250 million in building and infrastructure upgrades 500 plus construction-related jobs $755,610 investment in workforce development and education Ms. MacKenzie stated that the following is the estimated number of staff or physicians in the City: 561 employees who live in the City 153 SMH physicians or allied health professionals who live in the City 571 SMH physicians or allied health professionals who work in the City Ms. MacKenzie continued that SMH is a major economic driver in the City; that SMH focuses on local jobs; that the demand for health-care services continues. 3. DISCUSSION RE: NEGATIVE OUTCOMES AS A RESULT OF POSSIBLE ACTIONS ON THE FLORIDA LEGISLATURE (AGENDA ITEM III) Ms. MacKenzie gave a computer-generated presentation concerning the negative outcomes which could develop as a result of possible actions of the State Legislature; and stated that hospitals in Florida have faced more than $966 million in cuts since 2005, including $500 million last year; that Medicaid has been cut despite increases in enrollment; that Medicaid only reimburses approximately 50 percent of the cost of services; that services provided by SMH could be eliminated due to action of the State Legislature; that the majority of Medicaid Program funding is provided by the Federal government; however, only 15.5 percent of the funding of the Medicaid Program is provided by the State; that programs for the area's most vulnerable including pregnant women, children, the disabled, and the elderly could be cut if Medicaid is cut; that SMH provides approximately 90 percent of Medicaid care in the area; that cuts will hurt the quality of care for all patients, not just the poor or uninsured; that the result of cuts in Medicaid would be a cost shifting to private Book 61 Page 34270 02/27/12 2:00 P.M. insurance sO insurance rates would increase; that 72 percent of voters oppose plans to reduce the number of days that Medicaid patients can be hospitalized annually. Ms. MacKenzie continued that the Governor's Tax Commission to Review Hospital Districts met throughout 2011 (Tax Commission) and determined public hospitals offer quality care ethically and efficiently; that public hospitals have no unfair competitive advantage over private hospitals; that the Tax Commission made no finding a public hospital has outlived its usefulness; that the Sarasota Hospital District has elected, unpaid Board of Directors; that the enabling legislation has been updated 30 times to respond to changing community needs; that only slightly more than 6 percent of operating expenses are funded through taxes; that some members of the Tax Commission advocated the funding should follow the patient but did not consider if the required services are not provided; that SMH is the only area hospital to offer specialty service in the area of obstetrics, pediatrics care, neonatal intensive care, psychiatric care; that the Tax Commission had several troubling recommendations including requiring taxing districts to get reauthorized every eight to twelve years, which would make borrowing money for capital improvements very difficult; that another troubling recommendation is every hospital should be able to access taxing district funds; that in 1980, Manatee Memorial Hospital was sold for approximately $45 million; that the thought was an indigent care fund existed which would last forever; however, by 2014 the fund runs out of money. Ms. MacKenzie further stated that a bill from the last legislative session mandated a review of whether to sell or lease every public hospital in the State to include a fair market evaluation and a cost-effectiveness study; if any hospital sold or leased; that the sale or lease of SMH would require a voter referendum; that SMH is not considering lease or sale; that an excellent website describing the impact of cuts in health care in Florida is ww.neatheatharecom: that the City Commission is requested to express an opinion, particularly concerning potential cuts in Medicaid. In response to a request from Member Henry to explain the difference between charge and cost, Mr. William Woeltgen, SMH Chief Financial Officer, came before the body and stated that charges are the price set for services and appear on the hospital bill; that cost is the actual cost to provide the services; that a variety of adjustments bring the charges down to very little over the cost. In response to a question from Mayor Atwell concerning the impact of Medicaid on community mental health care, Ms. MacKenzie stated that the area's mental health coalition works together to assure patients receive necessary care; that SMH was requested to provide necessary adolescent services in mental health care. Member Malone stated that the City's support is appreciated; that SMH is one of the most cost-effective hospitals in Florida; that SMH has national recognition for the quality of care; that one of the for-profit chains has 23 lobbyists in Tallahassee; that the support of the entire community is necessary. Commissioner Shaw stated that the level of service provided by SMH is appreciated. Commissioner Snyder stated that the economic impact of SMH is recognized; that many people relocate to Sarasota due to the quality of medical care; that Staff of the Office of the City Auditor and Clerk may be able to provide collaborative efforts with multi-media. A motion was made by Commissioner Caragiulo, seconded by Commissioner Snyder, and carried by a 5-0 motion to send a letter signed by the Mayor or a resolution adopted by the Commission to the City's Legislative Delegation opposing any cuts to the Medicaid program. Vice Mayor Turner asked if the CEO of SMH will provide guidance, Ms. MacKenzie stated yes. 4. ADJOURN (AGENDA ITEM IV) The meeting adjourned at 3:00 p.m. Book 61 Page 34271 02/27/12 2:00 P.M. Book 61 Page 34272 02/27/12 2:00 P.M. D E SUZANNE ATWELL, MAYOR ATTEST - Eol W. Noda Xh PAMELA M. NADALINI, CITY AUDITOR AND CLERK