MetroHealth is no longer just Cuyahoga County’s public hospital. It will be able to start operating inpatient facilities in eight other surrounding counties —Geauga, Lake, Lorain, Medina, Portage, Stark, Summit and Wayne— as a result of a new law passed by state lawmakers. It’s a major change in the way MetroHealth System has operated for its 181-year history. It raises questions about how the public hospital will finance its expanded services. Cuyahoga County taxpayers currently support MetroHealth through the county health and human services tax. MetroHealth’s CEO Dr. Akram Boutros says the expansion is part of larger effort he's undertaken since coming to the hospital in 2013 to increase its footprint in the region.
So this is really about preserving public health in the region. Today, only seven of the original 23 county hospitals exist. Sixteen have either converted or closed. When that happens you lose the focus and attention on the most underserved. That is one reason why we think we need to do that. The other reason is economies of scale. The more services you provide, the bigger you get, the lower the cost for billing, for IT systems, for purchasing and all those different things.
MetroHealth is funded in part by a health and human services tax paid for by the residents of Cuyahoga County. Voters recently approved a two-year renewal of that 3.9-mil tax in May. Are Cuyahoga County taxpayers paying for this expansion to these surrounding counties?
There’s an extraordinary misconception about health and human services dollars, what they are and what they do. Cuyahoga County executive and Cuyahoga County council invests that $32 million so that we can provide care to the most vulnerable populations in the region. MetroHealth adds another $128 million to care for these populations and cover Medicaid shortfalls. Our expansion has been funded 100 percent —$400 million in past five years —all of it has been funded by MetroHealth. Zero taxpayers dollars have gone in.
So will the residents of these other counties see new tax levies on the ballot to help support MetroHealth services in their area?
I don’t believe so. The other counties, if they want specific services that are underfunded and aren’t financially viable, we will talk to them about ways for us to finance that. But mostly we believe we will be able to provide services that are missing that others aren’t. When you do that, there’s usually a good business case for doing so and you don’t need to go to taxpayers for financial support.
The authorization for MetroHealth’s expansion into other counties was quietly inserted into a larger bill, H.B. 111. That amendment was added to address concerns that Medina Mayor Dennis Hanwell had after the Cleveland Clinic closed its maternity center at Medina Hospital. Were you aware of Mayor Hanwell’s concerns and were you a part of that conversation with legislative leaders?
If Medina was the only concern, they could have easily have said, 'This only applies only to Medina County.' The concern is much greater. So yes we were involved in discussions. There have been no promises made to anybody except that we are going to look at the opportunities and see whether we can help or not. We are currently looking at five different opportunities. I would prefer not to [name the municipalities]. I will leave it up to them to talk about them or not.
It is extraordinarily bothersome to me when a public health system that is focused on the care of the most vulnerable, does well financially, expands and continues to live its mission, we question whether it’s a wise decision and whether they have the skill sets to carry this out. It seems to me like two different standards in assessing the private enterprises and the public enterprises. I think because we naturally think that public entities are not as capable as private entities. We know how to do this. We know how to provide services to people who are very vulnerable at very low cost. People should be celebrating our successes and wanting us to do this more for others and not questioning our decision to do that.
