Thursday, June 20, 2024
Lee Health: A Primer for Converting from Public to Private Nonprofit Healthcare
Lee Health, down in southwest Florida, is the largest public hospital system in Florida. It is converting from public hospital status to a private nonprofit hospital. That seems kinda pointless at first. Converting from one nonprofit to another. But some of the reasons given for the conversion include competitive pressures from other healthcare systems of all kinds -- competition is not so much kryptonite to private nonprofit hospitals as it is to public hospitals, I guess -- the associated need for flexibility and nimbleness in responding to changes in the healthcare market, and getting out from under public record and open meeting requirements. Lee Health was already able to solicit deductible donations so it really must have been all the government red tape that was the motivation.
The conversion is almost complete and fortunately there has been 100 miles of transparency throughout. Of course, we can't know whether it will have been worth the trouble for a long time. Will a private nonprofit hospital be less accountable to stakeholders and less providing of charity care than a public hospital? There is a good chance of the latter, let's just keep it real. So anyway, all that remains to be seen. But if you are writing about or involved in a similar public to private nonprofit hospital conversion, bookmark and download Lee Healthcare's conversion files. Lee Healthcare's webpage has everything from the enabling legislation, the conversion agreement, board presentations and minutes, resolutions, consultant reports, and audited financials. There are even projections about future charity care and community benefit. Due diligence has certainly been done and the files makes for a good case study and checklist.
darryll k. jones
https://lawprofessors.typepad.com/nonprofit/2024/06/lee-healths-conversion-from-public-nonprofit-to-private-nonprofit.html
In my consulting practice I have seen several conversions between public (governmental) and charitable status for hospitals.
One instance was inspired by specific treatment of retirement pension funds. This consideration was so important to the hospital's leaders that they reversed the hospital's corporate status when the law affecting the retirement funds was changed.
One troubling model is where the governmental body establishes ownership of the real estate of the hospital and contracts with a 501(c)(3) public charity to operate the hospital.
This makes the hospital's employees and contractors non-governmental, often streamlining HR processes and making it easier for the hospital to respond quickly to changing market conditions. The government benefits because the charity becomes responsible for the net profit or loss on the hospital's operations, protecting the government and its taxpayers. This is no small consideration given that more than half of US hospitals currently operate at a net loss.
Obviously, I have barely scratched the surface of a complex issue deserving of a longer conversation.
Posted by: Michael L. Wyland | Jun 21, 2024 8:35:33 AM