The record will remain open for Mr. Hampton's written statement. STATEMENT OF BILL HAMPTON, ASSISTANT COUNTY MANAGER, DEPARTMENT OF HUMAN RESOURCES, DADE COUNTY, FLA. Mr. HAMPTON. Mr. Chairman, I am assistant county manager for Dade County Manager's Office, speaking on behalf of Human Resources and the Public Health Trust. We operate, through the public health trust, the Jackson Memorial Hospital. It is the largest public hospital in the Southeastern United States, but by tradition and by county policy, no patients are turned away from our hospital, which has the medical service that can help them and we provide a single high standard of care that we think is an example of excellence. To show you that we put our money where our mouth is, I have a recent survey by the State agency known as the Florida Advisory Council on Inter-Governmental Relations, in which they list the 67 counties in Florida and how much they contribute to indigent hospital care. Dade County contributes $51.3 million as of the last fiscal year, and the nearest county contributing money to that is Hillsborough County's, at a rate of $7.6 million a year. The other 65 counties are lower figures than that. That is just an illustration of where Dade County and its people place emphasis on indigent hospital care. Because of our open door policy, we care for patients with the most desperate health problems and with the least in the way of material or financial assets. We had in excess of 45,000 patient admissions last year and about 10.3 percent were medicare, 14 percent medicaid, and half were indigent by county standards, or were catastrophically ill or injured people. Obviously, the portion of the elderly patients in Jackson Memorial Hospital is high, and that goes along with the figures that Senator Gordon gave you in his testimony. We have responded to this by developing an extensive rehabilitation program, a large cancer treatment program, and an extensive effort to transfer recovering patients to nursing homes throughout the county. As a matter of fact, Dade County owns and operates two nursing homes in order to accommodate this process of moving indigent patients where they don't qualify for the private nursing homes or can't meet the costs there into the county nursing homes. Usually, in the nursing homes that we operate, these are patients so severely ill or with such severe problems that the private nonprofit nursing homes won't take them at any cost. So Dade County is left with them in its two nursing homes. Obviously, because of the hemispheric location of south Florida, particularly in relation to Caribbean nations, a continuous stream of foreign visitors and immigrants, legal and illegal, come to our community and to Jackson Memorial Hospital when they need medical care. You have heard Senator Gordon's testimony on the Haitian problem and we do have a count of about 12,000, and we suspect there are a few thousand more that no one observed coming in and are not counted, but are still out there in the Haitian community. When they do seek help and care, the local property taxpayers are absorbing this burden at this point in time because the Federal Government has not been able to determine what they are going to do about the refugee problem other than letting them into the country. Mr. PEPPER. How much has the county spent so far in taking care of the Haitians that have come? Mr. HAMPTON. Senator Pepper, I have some comments that relate to various and sundry costs further on in my testimony and we will cover those figures then. Finally, because of our hospital open-door policy, the underemployed and uninsured come to the county hospital when care is not available to them anywhere else. We see seven major impacts on the urban public hospital which deserve public assistance in our opinion: One: Medicare patients are 10.3 percent of admissions. This is not an unusually large percent, but it indicates that impact of medical care reimbursement policy on the taxpayers. We suggest improvement in the reimbursement policy and ad valorem tax impact on our citizens would be reduced if the Federal Government could improve those types of payments. Two: We have about 100 cancer patients in Jackson Memorial Hospital every day and this means that our program was an $11.25 million activity last year. Only part of this cost is covered by existing Federal reimbursement programs. Three: During last year, 4,734 patients were discharged and transferred to nursing homes; an average of 8 days' delay per patient was necessary to get each patient placed into a nursing home, and our current per day costs at Jackson are over $200 a day; so for those 8 days we are paying that rate, or the public of Dade County is paying that rate, and it wouldn't be necessary if we could get them into nursing homes. Four: The drain on the limited personal resources and strength of the elderly was another result of a weak medicaid program. It is also an abuse of hospital beds and another unnecessary cost of health care. Last year the illegal immigrants and foreign visitors cost the ad valorem taxpayers over $1.2 million that we can easily document. That is a conservative estimate of what it cost our taxpayers. Five: At present over 10 percent of the births at Jackson are to Haitian refugee women. This promises to amount to 750 deliveries this year, an estimated $750,000 outlay to care for women and their children. The Federal title V maternal and infant program will provide much of their prenatal and postnatal care, but there is no Federal aid in sight for the hospital costs that must be carried by the taxpayers of our community. Six: There are 5,678 categorically indigent patients and the cost to the local taxpayers is $11.3 million for inpatient plus another $6.9 million for inventory outpatient care, and another $2 million for emergency medical services. That is a total of $23.3 million that should be carried by the State and Federal medicaid program. Seven: Equally distressing are the problem of patients who are not indigent but whose hospital bills are so large that even on a time-payment plan they cannot pay them off within 24 months of discharge; 39 percent of all admissions fall into that category. These catastrophically ill and injured persons cost the ad valorem taxpayers $34.8 million last year for 17,800 hospital admissions, plus $1.1 million for ambulatory outpatient care, plus $852,000 for emer gency medical services. This amounts to a total of $36.8 million of local taxpayers' support to people who can pay a portion of their hospital bill but not all of it. Three-quarters of the patients at Jackson are paid for by Federal, State, and county appropriations. The medicare and county programs are similar, in that they are based on the principle of reimbursing all costs attributable to patients they are responsible for. The medical program in Florida has too many deficiencies to discuss here. The medicaid program is by comparison to the Florida medical program more adequate; however, the medicare program disallows certain costs which are absolutely necessary to the operation of a major urban medical center. By the way, I am sure someone must have told you that Jackson is a major teaching hospital in south Florida, affiliated with the University of Miami Medical School. A reasonable share of the uncollectable patients' accounts and a portion of the transportation services are two examples. These areas should be reconsidered by Federal policymakers as eligible for reimbursement. On the other hand, the subsidy of catastrophic illness and accident causes the outstanding drain upon local government tax re sources. In the present era of taxpayers' insisting that taxes be cut, Federal responsibility for catastrophic illnesses and for a share of the inevitable uncollected accounts would be an important assistance to all public hospitals. As you can see, improvements in national health policy have a direct impact on local property taxes. Dade County is facing great pressures to find ways to reduce local government costs. As a matter of fact, we had a referendum to reduce by 99.9 percent our ad valorem taxes this past September. Fortunately, that failed, but there is another petition being circulated in the community now to again cut property taxes by 50 percent, and if that is successful, the election would be held in September of this year. We would like to ask the U.S. Congress to make every effort to provide local taxpayers relief by improving reimbursement policies and by expanding Federal interest into new areas of health care responsibility. If there are any questions the committee might like to ask, I am prepared to answer them. [The prepared statement follows:] STATEMENT OF WILLIAM F. HAMPTON, ON BEHALF OF THE DADE COUNTY My name is William F. Hampton and I am assistant county manager of Metropolitan Dade County, Florida. Dade County owns, subsidizes, and operates through a County agency known as the Public Health Trust, the 1200 bed institution known as Jackson Memorial Hospital. By tradition and by County policy, no patients are turned away if our hospital has the service that can help them; and, we provide a single high standard of care that we think is an example of excellence. Because of our open door policy, we care for the patients with the most desperate health problems and with the least in the way of material or financial assets. Of the 45,789 patient admissions last year about 10.3 percent were Medicare, 14 percent were Medicaid, and half were indigent by County standards or were catastrophically ill or injured persons by County standards. Obviously, the proportion of elderly patients in Jackson Memorial Hospital with chronic or terminal illness is high. We have responded to this by developing an extensive rehabilitation program, a large cancer treatment program and an extensive effort to transfer recovering patients to nursing homes throughout the community. And obviously, because of the hemispheric location of South Florida (particularly in relation to the Caribbean nations) a continuous stream of foreign visitors and immigrants, legal and illegal, come to our community and to Jackson Memorial Hospital when they need medical care. And, finally, because of our hospital open-door policy, the working poor, the unemployed and underemployed, the uninsured and the under-insured come to the county hospital when care is not available to them elsewhere. We see seven major impacts on the urban area public hospital which deserves federal assistance: 1. Medicare patients are 10.3 percent of admissions. This is not an unusually large percentage, but it indicates that impact of medicare reimbursement policies on the taxpayer in this community. Improve the reimbursement policy and the ad valorem tax burden is immediately reduced. 2. We have about 100 cancer patients in our hospital every day. This means that our oncology program was a $11,250,000 activity last year. Only a part of this cost is covered by existing federal reimbursement programs. 3. During the last year, 4,734 patients were discharged and transferred to nursing homes. An average of 8 days delay per patient was necessary to get each patient placed in a nursing home. This drain on the limited personal resources and strength of the elderly is another result of a weak medicaid program. It is also an abuse of hospital beds and another unnecessary cost of care. 4. Last year, the refugees, illegal immigrants, and foreign visitors in our hospital cost the ad valorem taxpayer over $1.2 million that we can easily document. 5. At present, over ten percent of the births at Jackson Memorial Hospital are to Haitian refugee women. This promises to amount to about 750 deliveries this year; an estimated $750,000 outlay to care for women and their children. The federal Title V, Maternal and Infant Care Program will provide much of their prenatal and postnatal care, but there is no federal aid in sight for the hospital costs that must be carried by the people of this community. 6. The care of 5.678 categorically indigent patients in our hospital cost the local taxpayer $11,327,862 last year for inpatients, plus another $6,968, 549 for ambulatory outpatient care and another $2,007,370 for emergency medical services. This is a total of $20,303,781 that should be carried by the State-Federal medicaid program. 7. And equally distressing are the problems of the patients who are not indigent but whose hospital bills are so large that, even on a time-payment plan, they cannot pay them off within 24 months of discharge. Thirty-nine percent (39 percent) of all admissions fall in this category. These "catastrophically ill and injured" persons cost the ad valorem taxpayer $34,842.661, last year for 17.880 hospital admissions, plus $1,175.194 for ambulatory outpatient care, plus $852,308 for emergency medical services. This amounts to a total of $36,870,163 of local taxpayer support to people who can pay a good part of their hospital bill, but not all of it. Three quarters of the patients at our hospital are paid for by Federal, State, and County appropriations. The Medicare, Medicaid, and County reimbursement formulas are similar in that they are based upon the principle of reimbursing all costs attributable to patients they are responsible for. The medicaid program in Florida has too many deficiencies to discuss here. The medicare program is, by comparison, more adequate. However, the medicare program disallows certain costs which are absolutely necessary to the operation of a major urban medical center. A reasonable share of the uncollectible patient accounts, and a portion of patient transportation services are two examples. They should be reconsidered by federal policy makers. On the other hand, the subsidy of catastrophic illness and accident causes the outstanding drain upon local government tax resources. In the present era of taxpayers insisting that taxes be cut, Federal responsibility for catastrophic illness and for a share of the inevitable uncollectible accounts would be an important assistance to public hospitals. As you can see, improvements in national health policy have a direct impact upon local taxation. Dade County is facing great pressures to find ways to reduce local government costs. We would like to ask the U.S. Congress to make every effort to provide local taxpayers relief by improving reimbursement policies and by expanding Federal interest into new areas of health care responsibility. TABLE 3.-COUNTY HEALTH CARE COSTS BY PROGRAM CATEGORY, 1978-79 1 This figure represents county tax dollar contributions which may include operation, personal service, capital outlay, debt service, building maintenance and in-county indigents. These figures do not include those hospitals that received municipal revenue, out of county indigent reimbursements, tax district hospital revenue, federal revenue sharing, or local medicaid match. 2 Board of County Commissioners had to make an emergency appropriation of $200,000 to keep the hospital operating. 3 The Washington county hospital is receiving a $216,000 appropriation from the county for the principal and interest payment on construction bend. This appropriation will be discontinued after the 1979-80 fiscal year. Sources: ACIR Questionnaire Data, DHRS, District Mental Health Boards, ACIR Computations. |