Transcript Halifax Health Town Hall Meeting

Halifax Health
Special Taxing District
Impact Study
1
Topics of Discussion
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2008 Property Tax
Fact
Ad Valorem Tax Revenue
Halifax Health Waste
Access to & Cost of Health Care
Financial Review
Board of Directors Fiduciary
Responsibility
Citizens Referendum
2
2008 Property Tax
3
2008 Property Tax %
Daytona Beach District 4
4
Fact
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6
Fact
– Halifax Hospital Medical Center is a
Community owned health care
center, owned by the residents of
the Halifax Special Taxing District.
– The Halifax Special Taxing District is
governed by a seven (7) member
Board of Commissioners
Source of data: Florida House Bill HB 1457
7
Fact
– Board of Commissioners shall be a
resident of the “Taxing District”
– Board of Commissioners are political
patronage appointees, appointed by
the Governor & are accountable to
“NO” one.
Source of data: Florida House Bill HB 1457
8
Fact
– According to The Florida Hospital
Association there are 226 acute care
hospitals in Florida
Source of Data: Florida Hospital Association—fla.org
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Fact
– Of the 226 acute care Florida hospitals:
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34 are Special Districts Hospitals.
– 16 Ad Valorem Tax Authority
 12 Appointed Board of Directors
 4 Elected Board of Directors
– 18 Revenue Sources Varied.
– 85% of all Florida Acute Care Hospitals are
not " Special District Hospitals" they are
Privately held.
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Source of data: MyFlorida.com
Fact
– Of the 16 acute care hospitals with Ad
Valorem Source of Revenue in Florida, 3
are located in Volusia County.
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Halifax Hospital Medical Center
SE Volusia / Bert Fish Medical Center
West Volusia Hospital Authority
Source of data: floridaspecialtaxingdistricts.org
11
Fact
Florida Memorial located in Daytona
Beach, is owned by Adventist Health
Care, is a Not For Profit, Acute Care
Hospital & receives no Ad Valorem tax
revenues.
Source of Data: Hospitalcompares.hhs.gov
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Facts
In 2007 Halifax records show the
Emergency Department Outpatient
Activity exceeded 120,000. National
statistics show 87% of the patients in
the Emergency room did not require
Emergency room services.
Source of Data: The Feasibility of a Managed Indigent Health Care Plan for Volusia County, Fl.; Prepared by:
Health Management Decisions. Inc. and Wittner Companies; October 1993 & Halifax 8/05/08 Financials
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Ad Valorem Tax Revenue
14
Ad Valorem Tax Revenue
Halifax Medical Center approved Ad
Valorem Taxing District revenues for
2008-9 is $41.6 million. Halifax
reports these revenues are used to
provide Indigent Care.
Source of data: Florida House Bill HB 1457
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Ad Valorem Tax Revenue
District Ad Valorem Tax Revenues
can be used for:
Debt Service Payment on Notes & Bonds
 Expenses of Operation
 Maintenance
 Construction & Repairs
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Source of data: Florida House Bill HB 1457
16
(Continued)
Payment of indebtedness
 District expenses
 Downtown redevelopment District fees
 Tax collector fees.
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Source of data: Florida House Bill HB 1457
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Ad Valorem Tax Revenue
Halifax Medical Center Taxing
District Ad Valorem revenue is not
the only source of revenue to pay for
Indigent /Emergency Care.
18
Ad Valorem Tax Revenue
In 1986 Congress enacted the
Emergency Medical Treatment &
Labor Act (EMTALA) and in 2007
Florida Legislature passed Statute
395.1041 which ensures public
access to emergency services & care
regardless of ability to pay.
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Halifax Health Ad
Valorem Tax Revenue
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2003
2004
2005
2006
2007
2008
2009
$23.6
$25.5
$37.6
$45.6
$52.7
$52.8
$41.6
Mil.
Mil.
Mil.
Mil.
Mil.
Mil.
Mil.
60
50
40
East
0
3-D Column 3
30
20
10
0
2003
2005
2007
2009
Source of data: Halifax Health
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Ad Valorem Tax Revenue
From 2003 to 2008:
– Halifax Health Ad Valorem Tax
Revenue increased 224%
– CPI increased 14.4% (2003 to 2007)
Source of data: Halifax 2006 Bonding Data & Halifax Health
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2003-08 Ad Valorem Tax Revenue
Systemic Flawed Model
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Counties of Comparable Size2006 Per Capita Property Tax for
Indigent Care
Volusia $131.00
 Lee
6.00
 Pasco
11.00
 Flagler
10.00
 Brevard
10.00
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2008--09 Special Hospital Taxing District
Gross Ad Valorem Tax per capita
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Appointed Boards:
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–
–
–
–
–
–
–
–
–
–
–
Baker County
Graceville Hospital
Citrus County
Halifax Hospital
Lake County
Lower Florida Keys
Madison County
North Broward
North Sumpter
South Broward
South Lake
Southeast Volusia
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$31.90
$52.25
$91.31
$184.80
$72.79
0
0
$153.67
Elected Board:
–
–
–
–
Hendry Country
$151.34
Indian River County $103.78
North Lake County
$84.23
West Volusia
$79.29
$98.18
$79.45
$274.35
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Ad Valorem Tax Revenue
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2008-09 Halifax Health Ad
Valorem Tax Revenue $41.6
Million.
For 2008-9 Halifax millage is
2.25 mills; $ 184.80 per
(special taxing district) capita.
Source of data: December2, 2007 News Journal; Halifax 2008-09 Budget
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Halifax Waste
26
Halifax Waste
Halifax Marketing expense are about twice
what hospitals nationwide spend on average.
Approx. 1.1% of Gross Revenue.
– Halifax Spent about $1 million for TV
advertisements
– $275,000 in salary for a chief marketing officer,
twice what similar hospitals spend
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$40,000 signing bonus
$127, 000 moving expense
$101,666 severance
$60,000 Country Club Membership
– $45,000 Butterfly Logo
Source of data: The news Journal December 2, 2007
.
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Halifax Waste
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$15 plus million for 220 acres of land
on LPGA Blvd.
(TNJ 1/04/08)
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Federal Medicare administrative costs
are less than 2.0% of gross revenue.
( Source of data: TNJ July 1, 2008)
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In 2007 Halifax administrative cost
exceeds 15% of Gross Revenue.
(2007 Deloitte Independent Audit Report)
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Halifax Waste
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$350,051.00 Tower Ground Breaking
Ceremony.
( Halifax internal Memorandum dated: July 12, 2007)
– Halifax Appears to be in violation of Florida Code of
Ethics. Will File a Form 50 with Commission on
Ethics.
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Due to Halifax Medicare errors &“overbilling”; discovered as part of U.S.
“RAC” Audit Program, Halifax was
required to refund Medicade
$3,867,455.10.
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(Halifax letter dated May 12 & June 13, 2008)
Access to & Cost of Health Care
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Access to Health Care
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For Humana Choice PPO & HMO and
Blue Cross Blue Shield Advantage
Medicare Plans participants
(approximately 35, 000 plan members
in the Halifax Taxing District) Halifax
is considered a “Out of Network”
provider because Halifax & Humana &
BC/BS can not agree to fee for
services.
Source of data: Humana, BC/BS & Halifax Health
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Cost of Health Care
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Florida Ormond Memorial is the “In
Network Provider” for these Medicare
Plan Participants.
With Insurance A “Out of Network”
stay at Halifax will cost the patient
$750.00 per day compared to Ormond
Memorial “In Network” cost of $500.00
regardless of length of stay.
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Cost of Health Care
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Medicare (HUMANA & BC/BS) Plan
Participants living in the Halifax Special
Taxing District & Paying Ad Valorem
Property Taxes, to support the Hospital they
own, can not utilize Halifax Hospital with
out paying “Out of Network” charges.
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Cost of Health Care
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Additionally cost of Hospital services
ONLY (Patient W/O insurance)
depend on family size, patient net
worth & income level and vary
significantly between Halifax &
Ormond Memorial.
Source of data: Halifax & Ormond Memorial Procedures.
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HALIFAX HEALTH
FINANCIAL REVIEW
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Halifax Health 2008 Uses of Tax
Dollars.
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2008 Gross Ad Valorem Property Tax
Less:
 Discounts & Uncollectible Tax
 Tax Collection & Appraiser Comm.
 Volusia County Medicare Assessment
 Redevelopment Taxes paid to Cities:
TOTAL DEDUCTIONS:
2008 Net Ad Valorem Property Tax to Halifax:
$52,720,269
($1,845,216)
($1,484,530)
($2,079,000)
($3,333,356)
($8,742,102)
$43,978,166
Sources of Data: Halifax Health
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Halifax 2007 Waste
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Interest on LPGA /Williamson property:
US Government RAC Audit:
TV Advertising Costs
Chief Marketing Officer
Butterfly Logo
Tower Project Groundbreaking
Excess Physicians Salaries (MGMA-95%)
Senior Executive Excess Benefit Plan
Annual Car allowance for 19 Employees
TOTAL
$1,000,000
3,867,455
2,000,000
563,000
45,000
350,000
2,061,796
773,000
151,200
$10,811,451
Source of Data: Halifax Health , MGMA< TNJ
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Halifax 2007 Profit
Reconciliation
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Halifax Health 2006-7 Pre Tax Profit
Less:
–
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2006-7 Net Ad Valorem Property Tax
2007 Pre Tax Profit W/O Ad Valorem Tax
$59,228,000
($43,978,166)
$15,249,834
Source of data: Halifax Health Fiscal 2008-09 Preliminary Operating Budget
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2004 to 2007 Halifax Gains W/O Ad
Valorem Property Tax-($)Millions
Sources of data: 2008-9 Halifax preliminary budget
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Halifax 2004-07 Profit
Reconciliation
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Halifax Cumulative Excess (Deficiency)
of Revenue and Gains Over Expenses
and Losses including Ad Valorem
Property Tax $192,180,000
Halifax Cumulative Net Ad Valorem
Revenue (tax) $132,841,000
Halifax Gains W/O Ad Valorem Tax
Revenue $59,339,000
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Sources of data: Halifax 2008-09 Budget Preliminary Operating Budget
With Out Ad Valorem
Taxes--Cumulative 4
Year Tax District
Savings
$161,540,000
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Use of Funds !!!
•
•
•
•
•
•
•
•
Reduced Property Taxes
City Infrastructure
After School / Summer Programs
Homeless Programs
Additional Police
Attracting New Businesses
Drug rehabilitation
ECT
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Halifax Board of Directors
Fiduciary Responsibility
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Fiduciary Responsibility
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The Halifax Board of Directors has a
fiduciary responsibility to the citizens
of the taxing district they were
appointed to represent.
“A fiduciary is someone who has
undertaken to act for and on behalf of
another in a particular matter in
circumstances which give rise to a
relationship of trust and confidence.”
Defination; Webster,s New Collegiate Dictionary
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The Governor Appointed Halifax
Health Board of Commissioners
has failed the citizens they were
appointed to serve , when
they…
45
Fiduciary Responsibility ?
 Consistently
Approve
Administrative costs in excess of
15% of gross revenue: 13%
points higher than U.S. Medicare.
 Approve Increasing Ad Valorem
tax revenues by 224% over five
years while CPI increased 14.4%
46
Fiduciary Responsibility ?
Approved $15 million purchase of land
on LPGA—Approx. $1 mill. annual
Interest
 Approved Excessive Employment
Agreement for Physicians & Executives
while reducing Nurses Compensation.
 2007 Approved $773,383 for 3 Senior
Executive Retirement Benefit Plans for
12 Senior Executives.
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47
Fiduciary Responsibility ?
Approve Indigent care costs of $131 per
capita: 13 times comparable counties.
 Failed to Implement 1993 Volusia
County Indigent Care Study.
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48
Fiduciary Responsibility ?
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Approved construction of $200 million
“Tower Project” –creating the largest ER in
Florida without addressing 87% of the ER
patients that could have been treated in a
less costly manner
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Fiduciary Responsibility ?
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Deny 35,000 Volusia County Residents
Medicare patients “in network” fees because
Halifax can not agree on “fee for Service”
costs with Humana & Blue Cross/Blue Shield.
50
Faduciary Responsibility
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For 2008-09 approved a 2.25 mil. Ad
Valorem tax on all taxable property
within the taxing district.
$41.6 Million: $184.40 per capita
2.5 Greater than West Volusia
Second highest in Florida
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Legislative / Citizens Action ???
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Legislative & Citizens Actions
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Citizens/Taxpayers have no input or oversight over
the Halifax Special Taxing District.
– Governor Appointed Political Patronage Board of
Directors
– Florida Statute 189.428 Special District;
Oversight, Review Process Excludes Health
Special Districts.
– Florida Statutes 189.4051 & 189.408
“Referenda-Special Districts” applies to Special
Districts with elected Board of Directors &
excludes Governor appointed Board of Directors.
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Citizens Initiatives
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U.S Supreme & Florida Court has
ruled in numerous cases that
“taxation must be proportionate to
representation”
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Legislative & Citizens Actions
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2009 Florida Legislature to introduce / pass
legislation to make all Florida Special District Boards
with taxing authority elected.
Failing to make Halifax Special Taxing District Board
elected pursue legal action to make taxation
proportionate to representation.
Referendum to reduce Halifax Special Taxing
District Ad Valorem Millage Rate form 4 mills to .25
mills.
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