On Tuesday, the Cuyahoga County Council moved to amend the county's 2023 budget dispersal of more than $32 million taxpayers contribute annually to the operation of MetroHealth, the county’s safety-net hospital.
The change means that the council will release the first quarterly installment of the levy subsidy to MetroHealth, but payments for the final three quarters will be contingent on the council's approval, a council staffer explained during the meeting.
The council members, need "to ensure county tax dollars are being spent appropriately," County Council President Pernel Jones Jr. said.
Jones said the council supports the MetroHealth mission and expects the full budgeted amount to be dispersed, but the council members said they want assurances from the new MetroHealth CEO Dr. Airica Steed that public money is being properly administered.
The move is the latest development in a very public dispute between MetroHealth and its now-fired former CEO Dr. Akram Boutros, who the hospital system says awarded himself more than $1.9 million in unapproved bonuses between 2018 and 2022.
Boutros has denied wrongdoing, repaid the bonuses with interest and filed suit against his former employer to nullify his dismissal, alleging retaliation.
Loren Anthes, a senior policy fellow at the Center for Community Solutions, says the reason this scandal is playing out publicly is that MetroHealth is a public county-run hospital and therefore governed by different rules than private nonprofits.
"These issues always come up in private enterprise all the time," Anthes said. "The difference being that, being a county hospital ... the conditions of how they operate are, by their nature, very different."
County government and MetroHealth are especially intertwined because the rules for how the hospital is run are codified in state law, he said.
"So everything in regards to how they operate is primarily enabled by the state and subject to those laws and regulations which often have a lot of interplay with counties," Anthes said.
MetroHealth receives money from the county to operate but also is paid for services by Medicaid and Medicare as well as private insurance. County money accounts for about 5% of MetroHealth's annual budget, Anthes said.
The difference between a county hospital and its private nonprofit brethren doesn't stop at transparency, said Anthes.
The taxpayer contribution to MetroHealth ensures that the hospital is able to provide services that may not be commercially remunerative, he said.
In Cuyahoga County, MetroHealth does most of the provision of care for low-income people, many of whom rely on Medicaid, he pointed out and county hospitals are often less likely to send patients to collections than their privately run peers.
"The fact that they are public not only creates the accountability that we're talking about, but it also means that as an institution, they're naturally oriented towards the public good," Anthes said. "And that bears itself out in the data, regardless of whatever may be happening in the C-suite or around the board table."
The scandal involving CEO bonuses is obscuring the work that MetroHealth employees provide to the community, Anthes said.
"Whether we're talking about its trauma services or the burn unit or the services for older adults or their approach towards addressing the needs of the for folks on Medicaid or really anyone who served by the MetroHealth system, that work is ongoing and it's of world-class quality," he said. "The rest of it is theater."
