January 27, 2010 -- The Regional Medical Center at Memphis will get $10 million from Shelby County government to keep its emergency room open through June 30, the end of the current fiscal year.

The Shelby County Commissions 9-3 vote this week takes the money from the countys $73 million reserve fund.

But the decision is hardly the end of the debate about the wisdom of the emergency funding. Backers of the plan are counting on federal and state money sources that are tentative at best.

Continuing the funding in the fiscal year that starts July 1 adds $10 million in new funding to another $25 million in red ink from other sources county commissioners will have to compensate for. The $10 million for The MED is the largest single line item that county leaders have on the funding to-do list.

Line items
Some of the other new expenses county government will have in fiscal year 2011 are:

$5 million the county is losing as the city of Memphis stops all funding for the health department.
$5 million the county loses when a five-year state grant is discontinued at the end of June.
$4.5 million to give county employees a 2 percent pay raise.
$2.4 million in a property reappraisal reimbursement from cities that ends in fiscal year 2011.
Shelby County Mayor Joe Ford and county Chief Administrative Officer Jim Huntzicker outlined a plan this week to close the $35.3 million funding gap, including the new MED money, without raising taxes or laying off employees and while preserving the 2 percent pay hike.

Those savings and other fiscal moves include:

$10 million from the $20 million budgeted to handle property reappraisal appeals. Its a move Huntzicker conceded is a wild card based on appeal projections that dont yet include appeals of appraisals on commercial property.
$8.9 million from the county reserve fund, which Huntzicker termed an appropriate use that would not jeopardize the countys bond ratings.
$3.5 million from other expenditure reductions.
$3.3 million by transferring 2 cents of the county property tax rate from debt service to the general fund.
$1 million cut from the countys contribution to the Greater Memphis Chambers Fast Forward economic development initiative.
$400,000 by reducing security the Shelby County Sheriffs Department provides to various judges and courtrooms.
Voting no were commissioners Wyatt Bunker, Mike Carpenter and J.W. Gibson.

Voting yes were commissioners Joyce Avery, Henri Brooks, Sidney Chism, George Flinn, James Harvey, Edith Moore, Steve Mulroy, John Pellicciotti and Mike Ritz.

Commissioner Deidre Malone recused herself from voting because her husband is a doctor at The MED.

Reservations
When different parts of the fiscal outline drew fire from several commissioners, Ford said the plan is open to negotiation before he presents his budget proposal to the County Commission in about two months.

Its coming from our reserves, Ford said after the 9-3 vote.

That buys us time until June 30, said MED Board Chairman Gene Holcomb. July 1  or before  well know what the state is going to do in terms of cuts for TennCare.

Ford, Holcomb, Memphis Mayor A C Wharton Jr. and U.S. Rep. Steve Cohen, D-Memphis, have been talking with state officials about some type of matching funding on a 2-to-1 basis that would come from federal money that passes through the state.

Holcomb said another alternative for long-term, stable funding for The MED is a state hospital bed tax or some kind of provider tax.

Hopefully the distribution would be based on the amount of uncompensated care plus the amount of TennCare volume, he said. The MED would be in a very favorable place in terms of the distribution.

Ritz sponsored a companion resolution that passed Monday urging Shelby Countys delegation to Nashville to push for more federal funding that passes through the state and to push for provider fees on private hospitals.

All of the commissioners expressing an opinion during the debate agreed the county-owned hospital doesnt get a fair share of funding back from the state compared to the millions it sends.

In his coming budget proposal, Gov. Phil Bredesen is expected again to cut state payments to hospitals, including The MED, for uncompensated care.

Ritz was willing to support the temporary infusion of additional county funding. Gibson was not. He said the rapidly forming consensus that emerged just last week and the resolution added onto the commissions agenda wasnt thought through.

Carpenter said the funding and political options needed more work and discussion. The 2-cent shift in the tax rate represented a monumental shift in administration philosophy toward stabilizing the countys debt and gradually reducing it, he said.

Ford was among those who argued it wasnt coming down when he campaigned for the appointment as interim mayor.

Carpenter termed the idea of matching state or federal funding speculative.

I am not convinced that the Tennessee Hospital Association has the juice to get a Republican-controlled House and a Republican-controlled Senate in an election year with a lieutenant governor running for governor to support anything that has the word tax or fee attached to it, Carpenter said.