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A 20-year contract between the West Volusia Hospital Authority and AdventHealth is set to end Sept. 30, with no chance of renewal in sight.

For members of the West Volusia Hospital Authority health-card program — those who fall in the gap between private health insurance and Medicaid — the end of the contract could mean less access to care.

For the 2019-20 fiscal year, which ends Oct. 1, the WVHA gave AdventHealth $5.7 million in taxpayer dollars to pay for hospital care for those who cannot pay for themselves.

That allocation is gone in the tentative 2020-21 WVHA budget. In its place is $3 million for a planned agreement between the WVHA and Halifax Health.

Halifax Health Vice President for Corporate Communications John Guthrie said while the agreement has not been finalized, if it goes through, Halifax Health will step up to serve low-income community members who have WVHA health cards.

“With AdventHealth not applying to serve the residents of West Volusia, who are part of the WVHA benefit program, Halifax Health has proposed to fill a role of health care provider for the WVHA,” Guthrie said.

WVHA and AdventHealth have been negotiating over the soon-to-expire contract for nearly two years now. The two agencies continually hit snags, including disagreements over Medicare reimbursements and whether AdventHealth would offer emergency care to indigent patients once the hospital exceeded its WVHA budget.

AdventHealth confirmed that, regardless of budget or contract status, all patients needing emergency care would receive it, as guaranteed by the Emergency Medical Treatment and Labor Act.

“Anybody that walks through our emergency department, regardless of insurance, receives the same level of care as anybody else,” Kyle Glass, AdventHealth chief financial officer, told WVHA commissioners at an August meeting.

What’s at stake is nonemergency, inpatient hospital care for those unable to pay. Without a contract, AdventHealth will no longer recognize the WVHA health card, as Advent hospitals will be considered out-of-network.

In a letter from AdventHealth CEO David Ottati, issued to the WVHA board in April, Ottati outlined his reasoning for the failure to establish an agreement.

“With the WVHA contract set to expire in September, we entered this period of negotiation with the intention of continuing this partnership. We proposed guiding principles for a new contract that would help lower the overall cost of healthcare and develop new access points to deliver quality care beyond episodic care in the emergency department. We also proposed the WVHA increase its accountability to all parties that receive funds to ensure all dollars follow the patient, regardless of which facility provided care. 

Based on the commission’s decision to not consider those guiding principles and to move to an annual application process with additional requirements, AdventHealth has decided to not submit an application.”

— David Ottati, AdventHealth CEO [The full letter can be read as a PDF document below.]

Discussions regarding the contract between AdventHealth and WVHA had a tendency to get heated. For example, at a meeting in February, a presentation from AdventHealth concerning the need for WVHA funding was followed by a counter-presentation from WVHA Commissioner John Hill, questioning why West Volusia residents had to fund hospitals out of their property taxes when, according to Hill, the hospital did not need the money.

A slide from an AdventHealth powerpoint presentation at a WVHA Board meeting in Feb. 2020.

A slide from an opposing powerpoint presentation created by Commissioner John Hill at the same WVHA Board meeting in Feb. 2020.

WVHA commissioners wanted to require an annual funding application from AdventHealth, in the same way that other organizations must apply for funding from the WVHA, and also wanted to reduce their reimbursement for indigent care to 85 percent of Medicare rates. The original contract, from 2000, provided payment of 105 percent of Medicare rates for inpatient care.

Ultimately, no deal was brokered, and the contract will end without a replacement.

WVHA Chair Dolores Guzman said she wished both agreements had worked out, but she said the Halifax agreement will still offer necessary care for health-card holders.

AdventHealth has hospitals in DeLand and Orange City, while Halifax has one in Deltona.

“My dream was we would have three hospitals that people would be able to choose from, but that’s not the case,” Guzman said.

Instead, WVHA health-card holders will have to rely on just one, the Halifax Health Center in Deltona.

While there will not be a network of hospitals, a partnership between the WVHA and the Employee Benefit Management Services miCare program will oversee a network of new clinics for health-card holders.

The first will open in DeLand on Oct. 1, with two more locations planned for Southwest Volusia and Pierson, set to open by January 2021.

The final budget hearing for the WVHA is scheduled for 5:05 p.m. Thursday, Sept. 24, via teleconference. The number to join the teleconference is 1-339-209-4657, and the access code is 776002.

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