According to Hospital Administrator David Abercrombie, the hospital groundbreaking ceremony is set for 3 p.m. on Sunday, Nov. 18, at the site of the new hospital (the old Madison High property near NFCC). Everyone is invited to attend. It was changed from the Nov. 4 date due to schedule conflicts.
The process of selecting a general contractor to build the new hospital is somewhat long. First, the District board had to decide whether to use a Lump Sum bid process (the conventional method) or go with a Contractor at Risk (C@R) process. They chose the C@R process because it guarantees a maximum price (GMP). If the project goes over the GMP the contractor “eats” the difference. But really the C@R method of construction has several advantages.
With the conventional Lump Sum approach, the contractor is selected based on low price bid. There is no open book budget and if there is any savings it goes to the contractor, not the owner. In my way of thinking, this can encourage a company to cut corners with quality. Another disadvantage of the Lump Sum Approach is that the owner has no control over subcontractor qualifications; nor does the owner have the ability to fast track the project.
With the C@R process, the Hospital District board selects the contractor based on qualifications and a negotiated fee. There is also the advantage of open book accounting. There is the ability to pre-purchase building supplies and services so if there is a saving on the project it is returned to the owner. There is also much greater owner input into the construction schedule.
The USDA approved using the C@R construction method on March 3, 2011, pending their approval of a selection process based on free and open competition and agreement by the USDA in the actual selection of the contractor.
The District sent out a Request for Proposals (RFP) to find construction companies interested in building the new hospital. Seven major general contracting firms from around the state responded. They were from Tallahassee and surrounding area, Gainesville, Orlando and Jacksonville. The companies submitted very detailed proposals. There were nine key parts to each proposal. An example of a key part is: how the contractor intends to advertise for, qualify, and use subcontractors.
A meeting was then set up with the USDA at their Lake City office to discuss the qualification of the contracting firms who submitted proposals, and to go over the process that would be used to select the contractor. The USDA brought in the head of their architectural office from Gainesville, as well as their regional director, to go over the materials and participate in the discussion. The USDA approved all the companies who submitted proposals. The head USDA architect told hospital representatives that the process was proceeding exactly right.
The District board then spent about 10 days reading the seven proposals. A selection grid was developed to score each key part of each proposal. On May 17, a quorum of board members met in an open meeting and participated in the scoring. The key parts of each proposal were given a number from lowest to highest. Each Board member scored all nine key parts included in all seven different proposals. These scores were counted and the contractor with the highest number of points was put at the top of the list. The contractor with the second highest number was put at number two, and so on.
The Board decided to interview those companies with the four highest scores. The four companies were (in alphabetical order) Ajax, Batson-Cook, Childers/Culpepper and Robbins & Morton.
Representatives from each of these four companies were asked to attend a face-to-face interview to defend their proposals. Another scoring grid was developed. A quorum of district board members participated in the open interview on June 6th and once again gave numeric scores, this time based on the key parts of their proposal defense.
The two total scores (from the proposal and from the interview) were added together to get a total score for each company. The four companies were listed from the highest total score to the lowest total score. The interview questions and other materials and documents were then hand-carried (for the purpose of speed) to the USDA in Lake City for their review.
On July 6, the USDA sent the Hospital District a letter stating that “…the USDA/RD concurs that the selected CM [construction management] firm is qualified for the job and the hospital has gone through the appropriate process and proper due diligence for the selection as required by RD [Rural Development] instructions.” The District immediately began negotiations with the high scoring company, Culpepper/Childers of Tallahassee. Culpepper/Childress is a joint venture between two big and stable companies with 80 and 47 years’ building experience respectively. Their projects encompass nearly 80 healthcare projects, including work for Tallahassee Memorial Healthcare System, Capital Regional Medical Center, and Archbold Memorial Hospital.
The negotiations with Culpepper/Childress are not yet complete, but are expected to be completed this week. Should negotiations not be successful, then negotiations will begin with the contracting company with the second highest total points scored. As you see, the process is a highly weighted process performed at arms-length with the oversight of the USDA. It’s a good process and I think the Board has selected an excellent company to build your new hospital.
The hospital provides about $3,000,000 each year in uncompensated care. These are patient charges, not the actual cost to the hospital. Uncompensated care includes various sub-categories such as charity care, the amount of our actual expense not covered by Medicaid… and about $2,000,000 in indigent care charges. The actual cost to the hospital to provide this care is roughly 75% of these charges. The subject of this article is just this indigent care portion.
You might think an indigent hospital patient is simply a person who cannot –or won’t- pay for his or her healthcare services at the hospital. But actually, to be classified as indigent a patient must meet strict State of Florida’s qualifying criteria. It works like this: If a patient comes to the hospital needing healthcare but has no resources to pay for the care, then a financial counselor determines if the patient might qualify for the County indigent care benefit. If so, the patient is asked to complete an application documenting how he or she meets the State of Florida criteria. The criterion the patient must meet includes information on total household income and the number of persons in the family. The only exception to this is if the patient is an emergency, then care is provided before any financial questions are asked. Federal law mandates this.
The hospital provides the care and a bill is generated. The bill, along with required indigent qualifying documentation, is given by the hospital to the County. The County reviews the information and confirms that the patient indeed meets State criteria. If the patient does, and if there is any money in the County’s indigent care fund, then the patient’s bill is paid. If there is no money left in the fund, the hospital isn’t paid.
If a patient meeting the above criteria is classified as indigent and receives care at Madison’s hospital, but is later transferred to another hospital for further treatment, the Madison hospital still gives a bill to the County for payment of the services it provided while the patient was in Madison. It is my understanding that the out-of-county hospital will send a bill to our County too. Our county pays these out-of-the county hospitals an annual total of approximately $35,000 a year for their services to Madison’s indigent patients. Fifty percent of the current fund of about $70,000 annually goes to Madison County’s hospital and 50% of it goes to pay bills from out-of-county hospitals.
On June 29th, the Madison County Commission began the first steps to increase the fund to pay indigent healthcare claims from Madison County Memorial Hospital (MCMH) up $250,000 from its current level of about $35,000 to $285,000 ($35,000 + $250,000) a year. However, if the fund is increased, none of this additional money will be paid to out-of-county hospitals. I think that level will likely still stay at about the $35,000 mark, but that is for the County to determine.
Money received from the County in payment for indigent care will be paid to MCMH on a “one patient-by-one patient” basis. The hospital will not receive a big single or monthly check, for “indigent care.” Each claim must stand alone and make its own case for meeting State of Florida criteria.
MCMH spends about $1,750,000 a year in actual expense to provide care to indigent citizens. This money comes directly out of the hospital’s cash register (operating fund). When the hospital is reimbursed the current $35,000 a year, or the proposed additional $250,000 a year for these services, this money goes (and will continue to go) right back into the hospital’s cash register, just like a payment for services from any other payment source. It will be spent on such operational expenses as food for patients, pharmaceuticals, utilities, et cetera. It is important that everyone understand that even putting $285,000 a year toward the crushing total expense of providing care to indigent citizens, the problem continues. This is will not make it go away.
If the County’s indigent healthcare fund is in fact increased, MCMH will still continue to carry alone the annual actual expense burden of about $1,465,000 for additional indigent healthcare. Again, these are not charges to the patient; this is the actual approximate expense to the hospital.
Madison County is a beautiful place. The canopy trees on Shrine Club Road and the big oaks scattered all around the county never fail to make my heart beat a bit faster. But the fact is that Madison is a poor county and poverty isn’t beautiful. It’s awful. Whether we’re talking about how poverty affects our County’s healthcare or how it affects education, or any other integral part of the lives of its people, we can’t bury our heads in the sand and say that it is someone else’s problem, or that the hospital, or the school system, or the churches handle “that.” The upkeep on poverty is expensive and you and I own it.
Wednesday night, June 29, the Madison County Commission convened its 6 p.m. meeting in front of a standing-room-only crowd. Every seat was taken and nearly a dozen people, including Sheriff Ben Stewart, who led the opening prayer, stood off to the side and leaned against the wall.
The Commission was meeting for two reasons: The first was to pass an emergency measure to begin the process of replacing an old bridge on Highway 150 (Lovett Road) across the Aucilla River.
The second was to decide whether or not to release $250,000 a year of the half-cent sales tax to go to the Madison County Memorial Hospital; the hospital had requested the money to help pay for the three million a year it provides in indigent care, for which it was not reimbursed by any state or federal agency.
After several minutes of discussion as to how the county would go about repairing or replacing the bridge, how long it would take, and what was involved, the measure passed 5-0.
Discussion then turned to the hospital and the meeting became a little more intense.
The audience contained several hospital employees as well as several hospital supporters; at one point Commission Chair Renetta Parrish asked how many in the audience were employees of the hospital and about six people raised their hands. Another in the audience asked, “What does that matter anyway?”
Court Clerk Tim Sanders then explained two options for refinancing another loan that the county had almost paid off, which would free up the money requested by the hospital.
Several members of the public took the podium to speak out on the issue, both for and against providing the money. Those against the measure primarily .noted what was referred to as a lack of accountability or transparency of the two-board hospital system, and questioned where the tax money was going and how it was being spent. Those for the measure spoke of Madison hospital being the only hospital in the state that was required to provide indigent care, yet receive no help with the expense other than $35,000 already mandated by the state.
After several people had spoken, the board discussed whether to vote on the matter that night or extended the discussion to two more board meetings that had been advertised. Board member Roy Ellis was ready to take action, however, and made a motion that the board pass the second of two options explained earlier and the money be released to the Hospital. Wayne Vickers seconded the motion. The motion passed with Ellis, Vickers and Hamrick voting yes; Parrish and Board member Alfred Martin voted against it.
The board members of Madison County Hospital Health Systems, Inc., and the Madison County Health and Hospital Board held a noon meeting, one right after the other, at Lee Town Hall, Thursday, June 23.
While meeting as the first board, Board Chair Ben Harris opened the meeting with a big round of “thank you’s,” especially to Administrative Assistant Susan Yonce, who was attending her final Board meeting before “passing the torch to Crystal (Lee).”
Harris then discussed his meeting with Emerald Greene of Greene Publishing, Inc., and talked about the new feature in the Madison County Carrier both had agreed upon, “Hot Questions, Hot Topics,” in which editor Jacob Bembry would bring a question from the public to Hospital CEO David Abercrombie and have him answer it (the first installment has already run in the June 29 edition of the Carrier, where Abercrombie answered the question as to why the hospital has two boards).
Abercrombie stated that the feature was “an opportunity to keep the ball rolling,” adding that he saw it as an educational opportunity for the public as well as an opportunity for the newspaper to get its facts straight. “There is so much misunderstanding out there,” he said. “So much the public needs to know.”
Abercrombie’s remarks also referenced an earlier anecdote related by board member Oliver Bradley that a member of the public had accused the board of “hiding out” by holding their meeting in the Lee Town Hall.
They also discussed doing more advertising, since many people were unaware that they could get many procedures done at the hospital as opposed to driving to Valdosta or Tallahassee. Harris added that changes in the way Blue Cross Blue Shield viewed procedures done in a hospital versus an outpatient facility had led to Blue Cross lowering the required co-pay, a boon for patients with insurance as well as for the hospital. “We’ll be able to collect insurance for those procedures…as opposed to Medicare and Medicaid, where we lose money.”
In addition to Medicare and Medicaid, indigent care the hospital provides is another financial problem the board wants to discuss with the county commissioners at the next County Commission meeting. There is a possibility that part of the one-cent sales tax could help alleviat at least some of the indigent care deficit by at least $250,000 a year, if the Commission votes in favor of it. If it passes, said Abercrombie, “it will be the first time anybody outside the hospital has acknowledged that indigent care is a huge problem that needs to be addressed rather than left for the hospital to deal with.”
Later, during the second meeting, the board also discussed fundraising efforts, but decided that the sheer amount of funds that needed to be raised coupled with board members’ relative inexperience with fundraising of such magnitude meant that this was probably something a professional fundraiser organization should handle.
Howard Phillips proposed renaming the hospital for when the new facility was completed, and Annette Johnson suggested holding a contest to have Madison County residents to come up with a new name. Suggestions for prizes included a cash prize with each board member personally contributing a portion of the prize money, or a collection of gift cards donated by local merchants. Other ideas included getting schools involved by having each class of students come up with names; the winners would get an ice cream social, pizza party or a special field trip, with the cost split among individual board members. When the final details have been ironed out, the board will announce the dates the contest will run and how people can submit their entries.
While on the subject of names, several board members wanted to named at least one wing or some other segment within the hospital after Charlie Moore, who had been at the forefront of the new hospital effort since 1999.
Meeting as the corporate board, Madison County Hospital Health Systems, Inc., the board members noted improvement in the “swing bed” numbers and were pleased with the higher volume of patients using the endoscopy program now the procedure was being offered every other week instead of weekly. Abercrombie noted that “it might be a pretty good fiscal year coming up.”
However, the finances still weren’t good enough for the board to hire an internist who had expressed interest in relocating from Tallahassee to a rural area like Madison. Abercombie and others expressed regret at not being about to afford the doctor yet, but hoped that they could at some point in the near future.
By Jacob Bembry
Greene Publishing, Inc.
The Friends of Madison County Memorial Hospital held a dinner on Thursday evening, April 14, in the hospital’s dining room.
“This will be one of several that will be held over the next few months,” said Vicki Howerton, MCMH Community Relations Coordinator.
Ray Griffin served as chef for the occasion. He prepared a spaghetti dinner with salad, garlic bread, tea and a vast array of special desserts. Helping Griffin were Chris Day, Caitlin Griffin, Hannah Odiorne, Adam Odiorne and Aaron Brown.
Day and Griffin will be on a missions team headed to Haiti, while the Odiornes and Aaron Brown will be on a mission, sharing God’s love with the people of Brazil.
Dr. James Stockwell was one of the speakers at an informational meeting. Stockwell is a noted gastroenterologist who comes to MCMH each Tuesday for endoscopy and colonoscopy procedures.
Rep. Leonard Bembry (D-Greenville) spoke to the group concerning the necessity of the new hospital for all families in the county and in the area.
Kin Johnson, a local businessman, suggested that all local businesses have signs concerning the new hospital displayed, as well as having bumper stickers.
David Abercrombie reminded everyone that Tallahassee Orthopedics Clinic now comes to the Four Freedoms Clinic each week. He also mentioned that Dr. Armond B. Cognetta, Jr. and other dermatologists from his clinic would be coming to Madison in May.
Abercrombie also discussed a working relationship with MCMH and North Florida Community College.
Approximately 75 people gathered to hear plans for a new hospital.
If anyone is interested in going to a community meeting in May, please call Vicki Howerton at MCMH at (850) 253-1917 or email her at vickihowerton@gmail.com.
The Madison County Memorial Hospital Board of Directors meeting for this month has been changed to March 22 at noon in the cafeteria at MCMH. The meeting is open to the public.
Dear Editor,
1. How did the hospital spend the $1,000,000 of sales tax revenue which was voted on by the taxpayers to be used only for the constructing of a new hospital and equipment?
2. Why were some County Commissioners told, before the meeting in which the hospital made their request, that they were there for a loan of $250,000 and yet they really were there for a sum of $1,000,000 which didn’t have to be repaid?
3. When is the constant polling of County Commissioners going to stop and who is gong to tell the one doing the polling that it is illegal?
4. Did the hospital borrow monies from a local bank using the Middle School property as collateral?
Joe Todd
By Lynette Norris
Greene Publishing, Inc.
After listening to concerns from citizens about past funding problems of the Madison County Memorial Hospital, the lack of sufficient transparency in its present dealings, and unforeseen changes to the new hospital, the County Commission voted no (4 to 1) on the interlocal agreement – at least until some adjustments are made concerning accountability, the sunshine law and public records requirements. Attorney Tom Reeves agreed to draw up the new agreement with the modifications and the Commission scheduled another meeting for Friday, March 11, at 5 p.m. to reconsider it.
Joe Todd was the first to speak to the issues of transparency and public records, saying that a lot of people were asking that the hospital publish the salaries of its employees. George Puliotte mentioned past funding problems with the hospital and the ever-increasing figures for costs of the project through the years; he also questioned the legality of the current contract, a “continuation of an old contract with the CRA” from 2000, which prevented the current project from going out for bids. “We probably could have gotten this a lot cheaper (with bidding),” he said, adding that he had been against the half-cent tax “from day one,” calling it an indigent surtax. “I’m against using government funds (for this project). We’ve broken the law and I think we need to start over.”
Tom Gniewek questioned how the new hospital was going to pay for itself when it was already going in the hole half a million dollars a year in spite of lay-offs and other cutbacks; the new facility would have to hire 13 new people in order to operate. “We should have something put in (the agreement) that we have access to their books to see if it’s viable.” Additionally, two-thirds of the beds in the new facility are now “swing beds” not critical care beds. “This is not what we signed up for…I don’t see any advantage over the building we have now.” Warren Irwin asked when the hospital had to begin making payments on the USDA loan, but no one seemed to know the exact date.
David Abercrombie responded that the hospital board meetings every Thursday were open to everyone, but that citizens were not taking advantage of this, and that hospital salaries not protected by contract were already public record. Furthermore, a hospital could not by law disclose everything. There were insurance issues and individual patient privacy rights that were exempt, and a private hospital was not subject to the same requirements as a public one would be, and to get the current hospital under the same requirements as a public hospital would mean changing the ownership, losing the corporate structure and losing the Critical Need Certification they now had.
Ben Harris also defended the hospital as already operating in the sunshine “pure and simple,” relating how his father had survived a massive heart attack in 1963 only because of the Madison Hospital’s proximity. For stroke victims and others, he added, time was also critical. “You know we need a hospital here.”
Addressing the hospital’s operating at a loss, he said, “We provided three million in indigent care last year. We were not reimbursed for that.”
The Commission, after a short discussion, voted against the interlocal agreement in its current form, and agreed to revisit the issue at the special meeting Friday, to hear the new version with a separate agreement addressing some of the concerns that had been voiced.
