Gulf backs dialysis center subsidy, seeks Franklin help

Gulf County could soon see the return of a full-service kidney dialysis center, thanks largely to a generous five-year subsidy from the county to cover start-up costs.

Whether Franklin County is willing to chip in a portion of that subsidy, and what pot of money it might come out of, remains up in the air.

On Dec.14, Jim McKnight, director of the Gulf County Economic Development Coalition, secured county commissioners’ unanimous approval of a resolution in which a $100,000 subsidy, for each of the next five years, would go to Fresenius Medical Center North America, the nation’s largest dialysis provider, to bring service to the medical office building on the campus of Ascension Sacred Heart on the Gulf in Port St Joe.

The half-million dollars, paid for out of Gulf County’s health care trust fund, would offset start-up costs and other expenses at the facility, including the lease of space in the building, which is owned by a private entity, separate from Ascension.

“I think it’s the bottom line what they can do it for,” McKnight told commissioners. “They got to replace all the machines that were in there. They got some start-up costs. And when five years are up, they’ll still be in business because we’re growing like crazy.”

McKnight worked on finding a dialysis provider ever since March 2021, when DaVita Kidney Care, a close second as the nation’s other dominant dialysis provider, pulled the plug on their facility at the same location. The move, which local officials said followed the loss of DaVita’s contract with Blue Cross/Blue Shield, also meant closing down one of two DaVita facilities in Bay County.

Bandied about in these talks were Gulf County’s initial proposal of an annual subsidy of $50,000 for three years, as well as discussion of a possible joint venture between Fresenius and local physicians, which ultimately did not materialize.

Gulf County commissioners praised McKnight for his work, which included an October meeting with representatives of The St. Joe Company as well as Franklin County Commission Chair Ricky Jones, Weems Memorial Hospital CEO David Walker and County Coordinator Michael Morón to discuss Fresenius’ plans. 

Following those talks, McKnight proposed Franklin pitch in one-quarter of the $100,000 annual subsidy.

“This is to help the people, and that’s what we’re supposed to be about,” Gulf County Commissioner Ward McDaniel said Dec. 14, echoing the praise of his colleagues for approving the plan.

“Franklin County, they’re going to benefit from this but they don’t want to put any money in the cookie jar,” he continued. “We need to put some pressure on them, because their people, they have to travel a long way when they can come right here.”

Gulf Commission Chairman Sandy Quinn urged Franklin County to go along. “I hope they would want to chip in on this,” he said.

In his outreach to Franklin, McKnight stressed the county’s annual portion would be tallied based on its percentage of the kidney patients seen annually at the facility, with a maximum of $25,000.

“Our community values dialysis care, it’s a necessity,” he told Gulf County commissioners, noting the facility would employ nine staffers, some likely from Franklin County, and estimating it would have a multi-million dollar economic impact on the area.

In addition, the facility would trim back what had been a $35,000 annual cost by Gulf County to transport dialysis patients to facilities in Bay County.

Franklin as well would see a decline in those transportation costs, as some patients must be ferried to Bay or Leon counties for dialysis, McKnight said.

“It’s a very difficult process,” he said. “Transportation to Panama City may mean an eight or nine-hour-long day. It’s a quality-of-life thing, and they (Gulf County commissioners) were hearing it from their constituents. It’s a good use of the money.”

In his appearance before Franklin County commissioners Dec. 21, Walker said best estimates are DaVita was seeing two dozen patients on average at the facility, with eight of them from Franklin relying on subsidized transportation there. “We don’t know how many are from private vehicles right now,” he said.

Walker acknowledged the need but sought a more exact tally of how many patients the Fresenius facility would serve from Franklin.

“I don’t know if I want to give $25,000 upfront, maybe look at it after the end of the year and find out how many patients are going,” he said. “Gulf County is going to get the center there regardless. We do agree, it is really hard on the body. I have two sisters who are on dialysis, and it’s kind of difficult on the body.”

Chairman Ricky Jones asked questions as to where the money would come from, noting that the county’s property tax dollars have been allocated for the 2021-22 fiscal year, and that the health care trust fund would be the likely source, now that it has beefed up the coffers of the one-cent healthcare sales tax to about $5 million to be spent on building and outfitting a new hospital.

“If we’re going to do it, we have to find a way to do it, not from money for the new building,” he said. “The question is which pot of money we can take it out of to make the deal work.”

Walker was clear where he stood. “Not out of Weems operational, I’m thinking capital outlay money,” he said. 

Commissioner Smokey Parrish, supportive of the plan to diminish travel times, raised the most questions. “I don’t know who might stop going to Tallahassee,” he said. “I don’t know what the data will show after one year.

“I understand what Commissioner Jones is saying, trying to maintain that amount of funding in capital outlay. If we continue to grow that, we may be almost able to pay for it (a new hospital) if we’re frugal how we spend those dollars,” he said.

“Another issue is how much further does this go? If you have indigent patients being seen, how much more do they want to tap into those dollars? Is this just a starting point or is this the end point?” Parrish asked.

He also stressed sharing in the subsidy would not make this a free service for Franklin County residents, as Fresenius would continue to bill for dialysis. He asked for clarity as to the effect an out-of-county provider would have on the growing number of county residents insured through Capital Health Plan, whose networks do not extend west of the Franklin-Gulf county line.

Commissioner Bert Boldt noted that Tallahassee’s Advance Urology Institute comes each week to Carrabelle and that, like Walker, he would like input from Tallahassee Memorial Hospital about the proposal.

The commissioners asked that the Weems Memorial Hospital board of directors review the proposal as its upcoming board meeting, and that County Attorney Michael Shuler to report this month as to the legalities of spending out of the health care trust fund, since inter-local agreements are specific about where monies can be spent.

“We’re supposed to look out for the people of Franklin, I want them to be took care of. it’s a do-or-die situation, if they don’t get that care,” said Commissioner Noah Lockley. 

“Skipping some of their treatment because of the trip, that’s not good for their kidney function,” said Jones. “I do think the board is in favor of doing it. That’s a huge benefit in my eyes, for those with some of the problems they’re having.”