Public hospitals have been in the news a great deal since Florida Gov. Rick Scott appointed a special commission to review taxpayer-funded hospital districts in 2011. According to the governor’s office, “the commission will consider whether government-run hospitals are in the best interest of taxpayers and recommend a cost-effective and efficient model for providing Florida with a health care safety net.”
This type of scrutiny is familiar to Sarasota Memorial, which is continually required to demonstrate its value and fiscal responsibility to the community and taxpayers. The organization’s work is open to the public, by law.
Most experts agree that it is difficult -- if not impossible -- to make statewide generalizations about Florida’s government-run hospitals. While safety-net hospitals provide the majority of Medicaid and uninsured care to their communities, each district has different government, taxing and management structures based on the individual needs of their communities. For example, SMHCS has an independent, unpaid, elected Hospital Board accountable to local voters.
The commission, which did not include any representatives from safety net hospitals, concluded its work at the end of 2011. The group’s report contained positive findings about public hospitals, including:
- Public hospitals provide quality care and innovative programs that improve access to care.
- Public hospitals operate ethically
- Public hospitals are accountable to taxpayers.
The report had no finding that public hospitals are inefficient, wasteful or have an unfair competitive advantage. There also was no finding that public hospitals have outlived their usefulness.
You'll find additional information in the following editorials and articles in local newspapers:
For those who may not be familiar with Sarasota Memorial, here are some frequently asked questions about the organization’s governance, taxing authority, services and more.
Q: Who oversees Sarasota Memorial?
Q: How and why does the hospital levy taxes?
Q: How has Sarasota Memorial adapted over the years to meet community needs?
Q: How does SMH improve access to care for all who need it?
Q: How is SMH transparent and accountable?
Q: Where can I find financial information?
Q: What is the projected impact of suggestions to turn hospital districts into “indigent care” districts?
Q: Who oversees Sarasota Memorial? back to questions
Sarasota Memorial is owned and operated by the Sarasota County Public Hospital District, a special, independent taxing authority created by the Florida Legislature in 1949. The district’s boundaries mirror those of Sarasota County.
Sarasota County voters decide who runs the health system. The district is governed by the Sarasota County Public Hospital Board, made up of nine unpaid citizens who are elected by voters to represent specific areas of the community as well as the district as a whole.
To encourage community representation and participation, local citizens and medical staff are invited to participate in the Hospital’s governance by serving on Board committees.
The Hospital Board complies with laws and regulations governing the hospital and elected officials, including Florida’s Government in the Sunshine and Public Records Act and the Florida Code of Ethics for Public Officers and Employees, to name a few. Upon election, board members receive extensive orientation from legal counsel and subject matter experts in these laws, as well as topics including finance, quality, audit, governance, corporate compliance and human resources.
The Board encourages community participation in the governance of the district to ensure that Sarasota Memorial continues to serve the needs of all of the citizens of Sarasota County.
For more information about the Hospital Board, including profiles of board members, please click here.
Q: How and why does the hospital levy taxes? back to questions
Charged with serving as a good steward of scarce financial resources, the Hospital Board derives its authority to levy ad valorem property taxes from enabling legislation passed by the Florida Legislature and approved at a referendum by Sarasota County voters.
The Board sets the annual tax rate in a fully transparent process that includes a newspaper advertisement of the proposed tax rate and two public hearings (also advertised in the local newspaper) where the public may provide comments before the board votes on the final rate. Despite declining reimbursement from government payors, the Board has kept the levy at 1.08 mills, just over ½ of its 2 mill authority, for five consecutive years (2010-2014).
To ensure the District continues to meet the ever-shifting health needs of the entire community, the enabling legislation does not specify that tax revenue must be allocated to one particular program or demographic. Rather, the district is empowered to levy taxes of up to 2 mills for valid discretionary purposes that include:
- payment of operating expenses, debt service and capital expenditures,
- to establish, construct, acquire, operate and maintain hospitals and health care facilities for limited or extended care and treatment and any facilities that are necessary and incidental to providing care to the community.
To that end, the Hospital Board has made an ongoing commitment to serve as the region's leader in the provision of top-quality health care and the most sophisticated treatments and technology. For instance, the hospital was one of the early leaders in the implementation of the Electronic Medical Record, rolling out the technology in 1998, and was the first in the region to launch a robotic surgery program and patient simulation training lab.
The hospital also remains committed to its safety-net mission of providing care to all who need it.
Q: How has Sarasota Memorial adapted over the years to meet community needs? back to questions
From its humble beginnings in the 1920s to the regional referral center it is today, Sarasota Memorial has remained steadfast in its mission to provide top-quality care to the community, but has evolved over the years to meet the ever-changing needs of the citizens it serves.
Today, Sarasota Memorial Health Care System offers Southwest Florida’s greatest breadth and depth of inpatient, outpatient and extended care services and has more than 800,000 patient visits a year.
Sarasota Memorial’s 806-bed acute care hospital has been recognized repeatedly as one of the nation’s largest and best, with superior patient outcomes and a complete continuum of outpatient services– from urgent care clinics and physician groups, laboratory and diagnostic imaging centers, to home health and skilled nursing & rehabilitation. Sarasota Memorial is the only hospital in the Suncoast region (Sarasota, Manatee, Charlotte and DeSoto counties) ever to rank in U.S. News’ “Best Hospitals” list.
Earnings are re-invested in patient care for our community, allowing Sarasota Memorial to serve as the region's health-care safety net while providing advanced treatments and technology. In 2013, the hospital opened its new nine-story Courtyard Tower, which replaces outdated 1950s- and 1960s-era facilities. The advanced age of the buildings, combined with rapidly expanding patient needs and the requirements of new medical technologies, ruled out simple updates and expansions. The new tower was financed primarily through uninsured traditional fixed-rate bonds. The remainder of the cost of the project covered by philanthropy and operating profits re-invested into the hospital’s capital budget.
Q: How does SMH improve access to care for all who need it? back to questions
Sarasota Memorial is the health-care safety net for our community, delivering the lion’s share of the county's inpatient Medicaid and charity care.
The organization has a long history of developing and maintaining programs that ensure the broadest number of low-income community members have access to the full complement of inpatient and outpatient care, from disease management to the most advanced diagnostic, surgical techniques and specialty care available.
As private hospitals have eliminated services over the years or chosen not to offer essential programs, Sarasota Memorial continues to provide necessary services.
Examples of the hospital’s efforts to ensure access to care include the following:
- Sarasota Memorial operates a Community Medical Clinic, which provides a wide range of free diagnostic, specialty and surgical care to uninsured or underinsured patients "beyond the hospital's walls." One of only a few of its kind in the nation, the clinic improves access to essential care in partnership with other area health providers. Patients must prove Sarasota County residency and have a household income at or below 200 percent of the Federal Poverty Level. The clinic has seen a 50 percent increase in its patient volumes over the past several years.
- Sarasota Memorial is the only hospital in the county delivering babies and providing neonatal intensive care. Recognizing the necessity of providing high-quality care to local women with high-risk pregnancies, Sarasota Memorial also funds Perinatology care providers. The hospital also has the only inpatient Pediatrics unit in Sarasota County.
- Sarasota Memorial is the only hospital in the county providing the full array of inpatient psychiatric services to patients of all ages, expanding an already unprofitable program to meet community needs since other providers have limited their services. It is the only hospital in Sarasota County with a designated Baker Act receiving facility for non-voluntary patients, including those with medical issues and the frail elderly. SMH also is the sole inpatient provider of psychiatric health care to adolescents and children.
- The hospital provides the community’s largest and most comprehensive spectrum of emergency specialty care available 24/7. Nearly half of the patient visits to the main hospital Emergency Care Center and the freestanding Emergency Room in North Port are Medicaid or self-pay/uninsured. Sarasota Memorial also has been the only hospital to make a significant investment in the medically underserved community of North Port.
Q: How is SMH transparent and accountable? back to questions
Sarasota Memorial is governed and locally controlled by the Sarasota County Public Hospital Board, made up of citizens elected by and accountable to local voters. The Board's hearings and meetings all are subject to “government in the sunshine” laws, unlike private hospitals. Residents are encouraged to come to meetings and participate in our efforts to provide top-quality care to our community.
Q: Where can I find financial information? back to questions
Our independently audited financial statements are posted on our website for anyone to access, and also appear on the DAC (Digital Assurance Certification) compliance reporting platform for the municipal securities industry.
Q: What is the projected impact of suggestions to turn hospital districts into “indigent care” districts? back to questions
Perhaps the Sarasota Herald-Tribune said it best in its Dec. 29, 2011 editorial: “This recommendation could severely limit the ability of public hospitals and districts to invest -- based on local needs -- in facilities and services that benefit all taxpayers, residents and businesses.” The newspaper cited the hospital’s freestanding Emergency Room in North Port and efforts to enhance primary care as examples of programs made possible by the district’s current structure. The newspaper noted “the provision of additional services and cost-effective care could be set back, rather than promoted, by a statewide policy limiting the use of local taxes.”
Several other counties that have indigent care funds now face shortfalls or other issues. In a Jan. 5 article, the Herald-Tribune said, “The model for privatizing a public hospital and using proceeds from the sale to create a trust fund for indigent care seems to be Manatee County’s sale of Manatee Memorial Hospital in 1984, even though that fund is now on the edge of insolvency.”
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