Ranking right up where with the Tooth Fairy and Dealer's Cost is the absurd notion that Americans enjoy the fruits of a consumer-driven "free market" health care system.
As if the critically injured victim of an expressway crash has a choice between life-saving care at Ajax Regional or Acme Medical.
Which they don't.
Reality is, for patients in need of immediate critical care, hospital choices are based on the nearest ER -- ideally designated as a Trauma Center.
And as for a heart attack victim's status as a so-called "health care consumer"...
Well, consider the "spread" in the average retail price charged by various hospitals for a Broward County resident in the midst of congestive heart failure:
Broward Medical $83,645
Cleveland Clinic $52,442
Coral Springs $39,753
Florida Medical $103,908
Holt Cross $65,475
Imperial Point $31,657
Memorial Miramar $72,911
Memorial Pembroke $72,848
Memorial Regional $109,703
Memorial South $51,559
North Broward $48,920
Northwest $104,247
Plantation General $120,293
University $73,869
Westside $103,196
Source - Broward Regional Health
Planning Council
Sunday, May 8, 2016
Sunday, April 10, 2016
Rx for Greed
Fact: The tax-funded North Broward Hospital District has maintained a practice of over-compensating its employed physicians for decades.
And so...
And so...
In 2010, a local orthopedic physician filed a "fair trade" Stark Law violation complaint with the US Department of Justice alleging the District was paying its employed physicians far above "fair market" rates.
This January (2016) -- and without admitting guilt - the District paid a settlement fee of nearly $70 million with the understanding the Justice Department would drop the case.
And now...
District attorneys (at huge costs in legal fees) are attempting to establish new contracts with dozens of Broward Health's physician-employees.
District attorneys (at huge costs in legal fees) are attempting to establish new contracts with dozens of Broward Health's physician-employees.
Trouble is, the District's policy of over-compensating its employed physicians dates back to the 1970's when powerful members of both the local Democratic party and the District's governing Board of Commissioners inaugurated a policy of fat paychecks for its employed physicians in return for the doctors' campaign contributions to select local and state candidates running for office.
Anyhow..
The major obstacle facing any serious attempt to address the historic problem of the District's fat physician paychecks lies in what constitutes "fair market compensation for a doctor employee,
How so?
Consider the varrious ways physicians employed by the District benefit financially:
1. Their basic compensation .
2. The cost of their practice (staff, equipment, supplies,
office, etc.)
3. Their sovereign immunity as public employees (and District-paid malpractice insurance)
3. Their sovereign immunity as public employees (and District-paid malpractice insurance)
4. Their legal fees generated during contract negotiations with the District - as well as the cost of lawyers
representing the hospitals
representing the hospitals
So what kind of dollars are we talking about?
Well, there's the District cost of Dr. Erol Yoldas, a
District-employed local Orthopedic surgeon.
$2,339,178 in FY 2013
$2,526,340 in FY 2014
$2,087,090 in FY 2015
$2,111,298 in FY 2019.
Again, based on current District financial data, the average physician employed by Broward Health earns more than $400,000 a year.
Nation-wide, however, the average:
$2,526,340 in FY 2014
$2,087,090 in FY 2015
$2,111,298 in FY 2019.
Again, based on current District financial data, the average physician employed by Broward Health earns more than $400,000 a year.
Nation-wide, however, the average:
Specialist earns $284,000 a year.*
Primary care physician earns $195,000 a year.*
But...
Primary care physician earns $195,000 a year.*
But...
Consider the District's generosity in compensating certain physicians as detailed in the current budgeted cost of Broward Health's million dollar-plus docs like:
$1,010,262 - Amy Relkin, Pediatrics
$1,024,639 - Michael Chizner, Cardiology
$1,024,639 - Michael Chizner, Cardiology
$1,483,664 - George Caldwell, Orthopedic surgeon
$1,270,184 - Daniel Kanell, Orthopedic surgeon
$1,854,719 - William Burke, Orthopedic surgeon
$1,645,542 - Dominic Carreir, Orthopedic surgeon
$1,049,355 - Arnaud Blanchard, Cardiologist
$1,055,297 - Kenneth Herskowitz, Heart surgeon
$1,212,505 - Mohammed El Sayed, Cardiologist
$1,122,652 - Lousi Cioci, Cardiologist
$1,532,947 - Ashok Sharma, Cardiologist
$1,532,947 - Ashok Sharma, Cardiologist
$1,112,239 - Violet McCormack, Cardiologist
$1,321,810 - Marc Aueron, Cardiologist
$1,424,225 - Barry Berman, Hematology Oncology
Obvious question, of course:$1,424,225 - Barry Berman, Hematology Oncology
Will the Governor's Inspector General look into the cost of the District's physicians?
Stay tuned!
*Medscape Magazine - 2015
Saturday, April 9, 2016
Stupid is as stupid does
Aside from that Mrs. Lincoln...
So goes the newsroom cliche concerning journalists "blowing" a Big Story by reporting the arcane.
Which brings us to today's (4/9/16) winner:
David Fleshler of the South Florida Sun-Sentinel.
Who, on the front page of the newspaper's local section, wrote:
"A hearing on David Di Pietro's future as chairman of the Broward Health board ended Friday without a decision after a judge heard two hours of arguments about his suspension by Gov. Rick Scott."
I could go on with the 21 inches of type Fleshler devotes to telling his readers little happened concerning the Governor's recent suspension of the head of the nation's ninth largest public hospital system's governing Board of Commissioners.
However...
As a newsroom dinosaur disgusted by the lack of meaning and context in what passes for journalism in the 21st century, Fleshler is the dim bulb sort of reporter who might have written about the "disturbance during Act III" - had he been present at Ford's Theater on an April evening in 1865.
What Fleshler failed to report in his Journalism Lite coverage of Broward's $1.9 billion health care system:
The North Broward Hospital District
dba Broward Health
(First eight months of fiscal years)
2015 2016
Adjusted Admissions 79,200 79,116
Gross Revenue $2,631,100,000 $2,617,805,000
Deductions
Bad Debt ($265,340,044) ($290,539,757
Per adj. admit ($3,350) ($3,672)
Indigent Care ($109,431,449) ($106,341,738)
Per adj. admit ($1,382) ($1,344)
3rd Party Other ($1,619,214,000) ($1,634,465,000)
Per adj. admit ($20,445) ($20,659) Total
Deductuions ($1,993,986,000) ($2,031,346,000)
Per adj. admit ($25,177) ($25,676) Reimbursement
Medicare $143,970,902 $126,516,768
Per adj. admit $1,818 $1,599
Medicaid $44,438,776 $32,254,593
Per adj. admit $560 $407
Private Insured $457,307,551 $457,558,657
Per adj. admit $5,774 $5,783 Minus ($21,898,020) ($16,576,632)
Per adj. admit ($264) ($209)
Total $623,819,209 $599,753,386
Per adj. admit $7,876 l $7,581
Other Revenue $169,756,685 $111,096,465
Per adj. admit $2,143 $1,404
Total Revenue $793,565,894 $610,849,851
Per adj. admit $10,020 $7,721
Total Expenses $738,048.975 $670,053,319
Per adj. admit $9,318 $8,469
Total Surplus $55,516,919 ($59,203,478)
Per adj. admit $702 ($748)
Source: North Broward Hospital District
Board of Commissioners
Finance Committee
So goes the newsroom cliche concerning journalists "blowing" a Big Story by reporting the arcane.
Which brings us to today's (4/9/16) winner:
David Fleshler of the South Florida Sun-Sentinel.
Who, on the front page of the newspaper's local section, wrote:
"A hearing on David Di Pietro's future as chairman of the Broward Health board ended Friday without a decision after a judge heard two hours of arguments about his suspension by Gov. Rick Scott."
I could go on with the 21 inches of type Fleshler devotes to telling his readers little happened concerning the Governor's recent suspension of the head of the nation's ninth largest public hospital system's governing Board of Commissioners.
However...
As a newsroom dinosaur disgusted by the lack of meaning and context in what passes for journalism in the 21st century, Fleshler is the dim bulb sort of reporter who might have written about the "disturbance during Act III" - had he been present at Ford's Theater on an April evening in 1865.
The disturbance during Act III
Anyhow...What Fleshler failed to report in his Journalism Lite coverage of Broward's $1.9 billion health care system:
The North Broward Hospital District
dba Broward Health
(First eight months of fiscal years)
2015 2016
Adjusted Admissions 79,200 79,116
Gross Revenue $2,631,100,000 $2,617,805,000
Deductions
Bad Debt ($265,340,044) ($290,539,757
Per adj. admit ($3,350) ($3,672)
Indigent Care ($109,431,449) ($106,341,738)
Per adj. admit ($1,382) ($1,344)
3rd Party Other ($1,619,214,000) ($1,634,465,000)
Per adj. admit ($20,445) ($20,659) Total
Deductuions ($1,993,986,000) ($2,031,346,000)
Per adj. admit ($25,177) ($25,676) Reimbursement
Medicare $143,970,902 $126,516,768
Per adj. admit $1,818 $1,599
Medicaid $44,438,776 $32,254,593
Per adj. admit $560 $407
Private Insured $457,307,551 $457,558,657
Per adj. admit $5,774 $5,783 Minus ($21,898,020) ($16,576,632)
Per adj. admit ($264) ($209)
Total $623,819,209 $599,753,386
Per adj. admit $7,876 l $7,581
Other Revenue $169,756,685 $111,096,465
Per adj. admit $2,143 $1,404
Total Revenue $793,565,894 $610,849,851
Per adj. admit $10,020 $7,721
Total Expenses $738,048.975 $670,053,319
Per adj. admit $9,318 $8,469
Total Surplus $55,516,919 ($59,203,478)
Per adj. admit $702 ($748)
Source: North Broward Hospital District
Board of Commissioners
Finance Committee
Friday, March 25, 2016
Hyppocrates v Hypocrite
NOTE:
Charging the North Broward Hospital District was guilty of over-paying its physician employees, the U.S. Justice Department filled suit against the public health care system under provisions of the Federal Stark Law in 2010.
Six years later, Broward Health's governing Board of Commissioners agreed to pay nearly $70 million to the Federal government in response to the suit.
So...
How did all this impact the level of compensation the District paid to its physician-employees?
North Broward Hospital District
District Employed Physician Program
Fiscal Year 2010 2015
Total Physician
Office Visits 227,901 311,476
Gross Charges $55,800,692 $85,227,315
Surplus (Loss) ($20,763,236) ($28,794,096) Per Visit ($91) ($92)
Employed
Physicians 50 physicians 70 physicians
Physician
Salaries $23,274,475 $32,066,873
Per Physician $465,590 $458,098*
Regular FTEs 163 248
Total Salaries $8,338,046 $11,854,243
Per FTE $51,443 $47,799
*Average Physician Salary
SE United States - $269,000
Source - Medscape magazine
$ Trends - North Broward Hospital District
Charging the North Broward Hospital District was guilty of over-paying its physician employees, the U.S. Justice Department filled suit against the public health care system under provisions of the Federal Stark Law in 2010.
Six years later, Broward Health's governing Board of Commissioners agreed to pay nearly $70 million to the Federal government in response to the suit.
So...
How did all this impact the level of compensation the District paid to its physician-employees?
North Broward Hospital District
District Employed Physician Program
Fiscal Year 2010 2015
Total Physician
Office Visits 227,901 311,476
Gross Charges $55,800,692 $85,227,315
Surplus (Loss) ($20,763,236) ($28,794,096) Per Visit ($91) ($92)
Employed
Physicians 50 physicians 70 physicians
Physician
Salaries $23,274,475 $32,066,873
Per Physician $465,590 $458,098*
Regular FTEs 163 248
Total Salaries $8,338,046 $11,854,243
Per FTE $51,443 $47,799
*Average Physician Salary
SE United States - $269,000
Source - Medscape magazine
$ Trends - North Broward Hospital District
Monday, March 21, 2016
Adam Smith's Invisible Hand - NOT
NOTE:
Each hospital programs a "Chargemaster" to establish the amount it will charge its patients.
Theory is, this should provide a certain degree of control over the amounts Florida Hospitals charge their patient - and thus combat the historic increase in health care costs.
Following are the trends in Broward County hospital patient care charges for certain specific "Chronic Diseases" tracked by the state's Agency for Health Care Administration.
So, does monitoring hospital patient care costs appear to be working in this case - or do hospitals charges appear to involve the dynamics of a Persian Market as opposed to Adam Smith's "Invisible Hand" allegedly at work in a "Free Market"?
Oh yes.
The amouunts below are gross charges for which uninsured patients are legally responsible!
Chronic Illness - Diabetes
Hospitals 2008 2014
Broward Medical $52,108 $55,357
Coral Springs $35,205 $34,258
Imperial Point $30,610 $27,516
North Broward $35,478 $42,572
Memorial Miramar $33,503 $59,374
Memorial Pembroke $41,183 $63,723
Memorial Regional $49,145 $78,962
Memorial South $33,948 $46,515
Memorial West $39,224 $71,867
Cleveland Clinic $35,750 $47,371
Florida Medical $66,580 $82,482
Holy Cross $61,441 $56,373
Northwest* $46,755 $85,120
Plantation* $50,280 $70,401
University* $39,917 $62,885
Westside* $53,523 $77,742
Chronic Disease - Congestive Heart Failure
Hospitals 2008 2014
Broward Medical $79,280 $83.645
Coral Springs $52,494 $39,753
Imperial Point $37,682 $31,657
North Broward $39,242 $48,920
Memorial Miramar $32,173 $55,673
Memorial Pembroke $34,950 $51,150
Memorial Regional $45,085 $75,090
Memorial South $32,198 $43,394
Memorial West $35,333 $67,625
Cleveland Clinic $43,648 $52,442
Florida Medical $90,418 $103,908
Holy Cross $70,460 $65,475
Northwest* $58,882 $105,247
Plantation* $86,009 $120,293
University* $51,416 $73,186
Westside* $83,095 $101,638
*HCA Hospital - A for profit chain where Florida Governor Rick Scott once served as CEO. JKdeG
Each hospital programs a "Chargemaster" to establish the amount it will charge its patients.
Theory is, this should provide a certain degree of control over the amounts Florida Hospitals charge their patient - and thus combat the historic increase in health care costs.
Following are the trends in Broward County hospital patient care charges for certain specific "Chronic Diseases" tracked by the state's Agency for Health Care Administration.
So, does monitoring hospital patient care costs appear to be working in this case - or do hospitals charges appear to involve the dynamics of a Persian Market as opposed to Adam Smith's "Invisible Hand" allegedly at work in a "Free Market"?
Oh yes.
The amouunts below are gross charges for which uninsured patients are legally responsible!
Chronic Illness - Diabetes
Hospitals 2008 2014
Broward Medical $52,108 $55,357
Coral Springs $35,205 $34,258
Imperial Point $30,610 $27,516
North Broward $35,478 $42,572
Memorial Miramar $33,503 $59,374
Memorial Pembroke $41,183 $63,723
Memorial Regional $49,145 $78,962
Memorial South $33,948 $46,515
Memorial West $39,224 $71,867
Cleveland Clinic $35,750 $47,371
Florida Medical $66,580 $82,482
Holy Cross $61,441 $56,373
Northwest* $46,755 $85,120
Plantation* $50,280 $70,401
University* $39,917 $62,885
Westside* $53,523 $77,742
Chronic Disease - Congestive Heart Failure
Hospitals 2008 2014
Broward Medical $79,280 $83.645
Coral Springs $52,494 $39,753
Imperial Point $37,682 $31,657
North Broward $39,242 $48,920
Memorial Miramar $32,173 $55,673
Memorial Pembroke $34,950 $51,150
Memorial Regional $45,085 $75,090
Memorial South $32,198 $43,394
Memorial West $35,333 $67,625
Cleveland Clinic $43,648 $52,442
Florida Medical $90,418 $103,908
Holy Cross $70,460 $65,475
Northwest* $58,882 $105,247
Plantation* $86,009 $120,293
University* $51,416 $73,186
Westside* $83,095 $101,638
*HCA Hospital - A for profit chain where Florida Governor Rick Scott once served as CEO. JKdeG
Sunday, March 20, 2016
Facts v Opinion & Hearsay
Two Broward Hospital Systems
(Gross Revenue per Adjusted Admission)
Public Private
Tax Supported For Profit
North Broward Hospital Corporation
Hospital District of America*
Broward Health HCA
Broward Medical Plantation General
$39,000 $63,389
Coral Springs Northwest
$25,258 $69,049
Imperial Point University
$23,635 $49,116
North Broward Westside Regional
$42,425 $71,005
Source - Agency for Health Care Administration
Question:
Which private hospital chain was
founded by Rick Scott, current Florida Governor
(Gross Revenue per Adjusted Admission)
Public Private
Tax Supported For Profit
North Broward Hospital Corporation
Hospital District of America*
Broward Health HCA
Broward Medical Plantation General
$39,000 $63,389
Coral Springs Northwest
$25,258 $69,049
Imperial Point University
$23,635 $49,116
North Broward Westside Regional
$42,425 $71,005
Source - Agency for Health Care Administration
Question:
Which private hospital chain was
founded by Rick Scott, current Florida Governor
Saturday, March 19, 2016
Confession
If the old theology holds true. I'm sure there's a place reserved front row center for me to roast in the fires of hell.
How so?
Well, at 78, I'm too old for the more mundane sins like adultery or idolatry.
But as for the shameless pleasure I take from wallowing in the sin of Pride...?
Especially the obscene sense of self-righteous superiority I enjoy while exploring America's greed-driven healthcare system.
Anyhow, here I go again:
As custodians of one of the nation's ten largest public healthcare systems, the folks at the tax-funded North Broward Hospital District take great pleasure in tinkling all over their mission of service to the sick and needy.
And certainly no District program takes greater pride in serving the less fortunate in the northern two-thirds of the county than Broward Health's Division of Community Health Services (CHS).
Now, according to CHS officials, their "mission is to provide a network of family primary health services that offer affordable, comprehensive, quality primary, home health and hospice services in neighborhood community locations, primarily serving indigent, uncompensated care patients and the working poor."
So let's look at the District's CHS Primary Care Centers' service to northern Broward's - uh, well - "less fortunate".
Broward CHS Primary Care Centers*
Fiscal Years 2000 2016
Visits 204,122 126,487 (38%)
Cost per visit ($149) ($362)
In 2016 $ ($206) ($362) 78%
FTEs 262 360 37%
Visits per FTE 779 351 (55%)
Salary
Per FTE $58,631 $78,842
In 2016 $ $80,910 $78,842 (2%)
*NOTE - A major justification for the District's Primary Care Centers was to reduce the "load" of non-emergent patients visiting the system's Emergency Rooms.
However, in comparing the "load" pf patients visiting the District's Emergency Rooms to the its Primary Care Centers we find:
District Visits
Emergency Rooms 186,397 298,223 60%
Primary Care Centers 204,122 126,487 (38%)
Okay.
So shame on me for having fun with these numbers at the District officials' expense.
Mea maxima culpa!
As well as a craven sinner!
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