Polk may help develop physician-training program at Winter Haven Hospital
By Marilyn Meyer
BARTOW — Winter Haven Hospital may receive funding to help develop a physician-residency program to bring much-needed primary care to uninsured and under-insured residents.
If approved by the Polk County Commission, the $1.25 million for the program would come from county’s half-cent sales tax for indigent health care.
On Friday, the Citizens Advisory Committee approved a proposed $44 million operational budget for the coming year, sending spending plan for all programs to the County Commission for action.
The biggest change from previous budgets is a recommendation to draw down $8 million in excess reserve funds to provide:
• $1.25 million for the planned Winter Haven Hospital residency program in fiscal year 2017-18, which starts Oct. 1. That same amount is expected to be allocated for each of the next two years so that cumulatively the hospital will receive $3.75 million to get the program up and running.
• $1.25 million for an inmate mental health transition program so that when prisoners with behavioral health issues are released from the Polk County Jail, the medications and mental health services they received in jail will not be abruptly cut off.
• $4.12 million for partner agencies to provide additional direct services to indigent, uninsured and under-insured Polk residents.
Steve Nierman, president of Winter Haven Hospital, said the hospital is working on an agreement to partner with Florida State University’s College of Medicine to operate a three-year, family-medicine residency program aimed at providing primary care to underserved, at-risk, rural and elderly residents.
The ratio of primary care doctors to patients in Polk County is lower than the state and national averages — 49.7 primary care physicians for each 100,000 residents in Polk, compared with the state average of 77.1 and the national average of 86.7 family doctors for each 100,000 people.
Because of low reimbursement levels, few doctors in Polk County accept Medicaid patients and this program would help fill the gap, Deputy County Manager Lea Ann Thomas said.
The county’s $3.75 million allocation would cover the start-up costs, including $2.8 million to renovate a building to use as a clinic for academic training.
The rest of the money would pay for faculty and support services until students arrive and start generating government reimbursement, Nierman said. The proposed 12,000-square-foot training facility and clinic will be next to the Winter Haven Hospital Center for Behavioral Health.
If all the approvals come through, the first class of six would arrive in July 2019, Nierman said. Each of the next two years, six more students would be added to the roster so eventually the program would have 18 residents on a continuing basis.
The students would train at the new clinic, Winter Haven Hospital and Winter Haven Women’s Hospital, Bartow Regional Medical Center, federally qualified health clinic sites, which are operated locally by Central Florida Health Care, regional volunteer clinics, and other locations as needed, according to the proposal Nierman submitted to the county. Winter Haven Hospital, Winter Haven Women’s Hospital and Bartow Regional Medical Center are affiliated with the nonprofit BayCare Health Systems.
“For the program to be approved by the Accreditation Council for Graduate Medical Education, we must have adequate infrastructure in place,” meaning the training facility and clinic, Nierman said.
Accreditation is a long, involved process he said.
Nierman assured the committee members that after receiving the $3.75 million over three years to get the program operating, the hospital will not come back asking for operational funds.
There is a complicated payment system for residency programs, including higher rates on Medicare claims, Nierman said, but hospitals typically subsidize residency programs.
The hospital would absorb costs to maintain the program as part of its community health mission and would not ask the county for annual operational funds, he said.
Thomas said the hospital is also applying for grants, which if they come through would mean the county would allocate less toward the start-up costs.
While other budget proposals the committee recommended be approved were voted on without comment, three of the 10 members on the Citizens Oversight Committee recused themselves from voting on the residency proposal because of affiliations with Winter Haven Hospital.
Another member voted against the proposal.
Committee members questioned whether other grants might not be available to fund it and whether BayCare might not step up with funding.
Dr. Thomas McMicken said, “This will bring primary care physicians to Polk County.”
Citing estimates that residency program would conduct 4,654 patient visits in the first year and, when fully operational in three years, the program would handle 14,000 patient visits annually, he said, “this fits within the mission of the half-cent sales tax.”
The county expects to spend about $1.5 million a year on a program to break the cycle of repeated arrests of inmates who have behavioral health needs.
“It is often said that across the country the largest mental health facilities are the prisons,” McMicken said. “It is no different here.
“We have been working quite a while to find a way to break the cycle of arrest, jail, release and re-arrest,” McMicken said. “Currently, adults with mental health issues leave the jail with three days of medication and then have to get refills and follow-care on their own, which seldom happens. In the juvenile justice system, they get 30 days of medication.”
Partner agencies, including Peace River Center and Tri-County Health Services, will collaborate with the Polk County Jail to begin planning early for inmates transitioning out and will make sure provisions are in place so the inmate will receive behavioral health services and medications after release.
The money to expand services would come from a draw-down on approximately $42.2 million in reserves, Thomas said.
The county had built up some $29 million extra in reserves in case voters had failed to extend the half-cent sales tax another 25 years when the issue went to the ballot last November. The tax, which was originally enacted in 2004, passed by a comfortable margin.
County staff made calculations assessing how much of the money needs to stay in reserves and how much could be spent on recurring expenses, Thomas said.
“If the economy remains stable, we could spend about $8 million a year out of the reserves for the next 12 years and we should not run into problems,” Thomas said. “Of course, if we have another recession, or there are changes, we would make adjustments.”
The calculation was based on the half-cent sales tax bringing in an additional 4.5 percent in funds each year, she said.
“If our estimates remain perfect, at the end of 12 years, the 4.5 percent extra revenue a year would outpace the $8 million being taken out each year,” she said. Again, she emphasized, adjustments would be made annually to the actual draw-down.