Gov. Rick Scott, who last week asked the state's hospitals to provide a large amount of financial data by Monday, will not get all that he asked for that quickly. He may not get some of it at all.
Hospital executives and lawyers say they want to cooperate with Scott and his newly appointed Commission on Healthcare and Hospital Funding, which seeks data on services, profits, costs and patient outcomes.
But hospital executives say some of Scott's questions are hard to answer because they're ambiguous or confusing. In those cases, they'll ask for clarification.
Still others are impossible to answer, they say. In some cases, hospitals don't have the information at all, as in the request for survey data from 2006-2013 that wasn't available to hospitals until this year.
And providing answers to some of the questions might make public some payment information from private insurers, which is covered by confidentiality clauses in hospitals' contracts.
“Compliance that violates the contract would open us up to being (legally) challenged by the payer," said attorney Mark Delegal, who represents the Safety Net Hospital Alliance of Florida, a group of 14 hospital systems that treat a large share of uninsured and Medicaid patients.
Gov. Scott’s Communications Director Jackie Schutz questioned this hesitation.
“We are confident public hospitals are not trying to improperly cite some kind of privilege to block the light of transparency into their taxpayer funded operations and the outcomes they provide,” she said in an email.
It’s nothing of the kind, hospital officials say. Privately, they say, they'll bend over backward to avoid a fight with state officials that might make it appear that they're trying to hide something.
“Florida hospitals believe in, and support, price and quality transparency," the Florida Hospital Association said in a written statement Thursday.
Delegal of the Safety Net Alliance said its CEO Tony Carvalho plans to draft a letter to Scott Monday morning that mentions such problems, as well as the fact that the state already has possession of most of the documents it requested.
“It’s a duplication of effort and burdensome to have us dig it out when it’s already in the hands of government,” Delegal said.
Normally when state agencies ask private businesses for information, they provide several weeks for public comment. That gives those affected a chance to point out difficulties.
But that process wasn't followed in the case of the Health Commission, which was rushed into action because of the state’s looming health funding crisis. The Low Income Pool, a federal subsidy program for hospitals and clinics that treat the uninsured, is likely to end on June 30.
Federal officials authorized LIP as a temporary aid until the state’s uninsured were covered through Medicaid expansion. But the Florida House and Scott have opted to not support Medicaid expansion in the past two legislative sessions.
Scott says his commission’s role is to figure out how to make taxpayers’ health dollars stretch farther. Hospitals that accept public money will be asked for a full accounting, to justify how they spend it. An example of such scrutiny is Scott's letter to UF Health-Jacksonville, which says it cannot stay open with the federal subsidies.
The commission may want hospitals to open records that have always been kept under wraps, especially the negotiated payment rates. The rates "are protected jealously" by insurers and health care providers, said Jay Wolfson, University of South Florida professor of health law and policy.
"Many providers might be reluctant to release those data unless they were required by law to do so," said Wolfson, the associate vice-president of Health Law, Policy and Safety at University of South Florida.
The commission lacks authority to compel hospitals to release the data, he said, and even the governor could not do so without getting the attorney general's office involved.
Florida law takes note of the trade-secret nature of managed-care contracts and exempts them from the kinds of Sunshine laws that publicly owned hospitals would otherwise be expected to obey.
And Scott's letter is worded as a request, not a demand. Many hospitals scrambled to comply, even if it meant resending information they already sent to a state agency.
"We're going to try to provide everything they asked for," said Dr. Nabil El-Sanadi, President/CEO of Broward Health, formerly the North Broward Hospital System. "We're going to cooperate."
Still, El-Sanadi worries that his system’s hospitals, which are public, may be asked to share information that might “compromise our internal operations” and make them less competitive.
“The question is, how can we share that information without violating the confidentiality of contracts with managed-care plans?”
Hospital executives said they were surprised that most of the information Scott requested is already in the possession of the Florida Agency for Health Care Administration (AHCA), much of it on a public website called FloridaHealthFinder.gov. AHCA compiles it and posts it from filings that hospitals are legally required to send in.
Some of the questions that are not at AHCA are available publicly elsewhere. For example, non-profit hospitals and insurers have to detail their executive pay in the Form 990 for the Internal Revenue Service each year.
Some of the data that are not at AHCA are available publicly elsewhere. For example, non-profit hospitals and insurers have to detail their executive pay in the Form 990 for the Internal Revenue Service each year. And publicly-traded hospital and insurance corporations answer a lot of the questions in filings with the U.S. Securities and Exchange Commission.
AHCA will provide the staffing for the commission, which will be co-directed by AHCA Secretary Liz Dudek and Surgeon General John Armstrong, according to the meeting agenda. Scott appointed all nine members, most of whom have no connection to or experience in health care.