Calling Bullshit

  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
  
     
     
       
      

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...

   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.

   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)

    4. Their legal fees generated during contract negotiations         with the District - as well as the cost of lawyers
        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:

    Specialist earns $284,000 a year.*
    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

     $1,483,664 - 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

     $1,112,239 - Violet McCormack, Cardiologist

     $1,321,810 - Marc Aueron, Cardiologist
     $1,424,225 - Barry Berman, Hematology Oncology

     Obvious question, of course:
     Will the Governor's Inspector General look into the cost of the District's physicians?
     Stay tuned!
                                           *Medscape Magazine - 2015

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.

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
               

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

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

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

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!

The question....

   In his attempt to regain control of the North Broward Hospital District, has the Governor of Florida fucked over two  highly principled and intelligent men who are "true believers"....? 

    Not that Rick Scott, as an obvious Borderline,  would know what a "true believer" is - or what motivates them.
   Stay tuned!

Healthcare and Bobbleheads

This Seriously Stinks

     Florida Governor Rick Scott has (3/14/2016) just removed the only two* District Commissioners with the knowledge and ability to  fathom the current chaos at the tax-supported North Broward Hospital District - one of the  ten largest public hospital systems in the nation.
    Not sure what this means.
    Although I'm deeply troubled by Scott's history as a man who earned his millions (and ability to self-finance his campaign for the Governor's office) as the puppet master founder of the Hospital Corporation of America (HCA) - from which he bailed shortly before the Feds slammed his creation with the biggest health care fraud conviction in the nation's history.
    Anyhow..
    Now Scott's political bobbleheads are running the show at the $1.9 billion public health care system 
    Oh yes.
    Dig deep enough and I'm sure you'll find Scott's long-standing Broward-based HCA Lobbyist Billy Rubin and political sidekick Ken Jenne (of convicted Broward Sheriff jail time fame) involved in all this.
    And  Broward State Attorney Mike Satz says there's no need for a local Grand Jury to look into this local health care train wreck.
    Which is why Courthouse folk call him Mike Sitz.   
    

   *David Di Pietro 
    Chair of the Board of Commissioners
    Chair of Commission Executive Committee
    Chairr Risk Management/Claims Review Committee
    Member of Commission Fiance Committee
    Member of Commission Audit Committee
    Member of Commission Governance Committee
    Member of Commission Compliance Committee
    Member of Commission Legal Affairs and Government                Relations Committee
    Member of Commission Marketing Committee 
   *Darryl Wright
    Chair of Commission Audit Committee
    Chair of Commission Investment and Pension Committee
    Member of Commission Finance Committee
    Member of the Commission Compliance Committee
    Member Commission Legal Affairs and Government                    Relations Committee 
    Member Community Relations Council

Broward Stealth!

    

Populary known as Florida's

Sunshine Law   

 Chapter 119 of the Florida Statutes

requires public officials to

conduct their meetings
in public.

However,

uncomfortable with scrutiny,

the tax-funded 

North Broward Hospital District

Board of Commissioners

has hired a law firm to 

assist them in holding additional

board meetings behind closed doors

and in the "shade".

So much for

accountability.

And in a move filled with irony,

the District Board hired the

lawyer to facilitate more 

closed door meetings  in "shade"

during the state's annual

"Sunshine Law" Week.

    

Where's the Sun-Sentinel?

       Broward Health is not very healthy!

       Fact is, the one of the nation's ten largest public health care systems is suffering from a potentially terminal cash flow problem.

       Which the District's politically-appointed governing board of seven Commissioners don't want either the news media, or the pubic to know about.

        Which is how and why the Commissioners have scheduled a series of emergency closed door meetings this week (Wednesday, March 16).

        Not that South Florida's news media might grok the irony. 

        Especially in the midst of Sunshine Week  which celebrates the importance of "open government" and a Free Press. 

        So what is the story the Sun-Sentinel -- as South Florida's self-proclaimed "most valued information provider" -- will ignore?

   Mounting costs v decreasing revenue

    plague nation's tenth largest public                                  hospital system

        Which, reductio ad absurdum, looks like this: 

   

      North Broward Hospital District

                dba Broward Health

                 Revenue per Adjusted Admission

   Fiscal Year*            2015*       2016*                       

   Gross Revenue       $33,090    $33,385       

   Deductions

   Bad Debt              ($3,366)    ($3,742)      11.2%

   Charity Care         ($1,410)    ($1,355)       (3.9%)

   3rd Party/Other    ($20,425)  ($20,703)       1.4%

   Total Deductions  ($25,201)   ($25,800)      2.4%

   Reimbursement

     Partial Breakdown
   Medicare

   (Traditional)          $1,818       $1,597        (12.1%)    Medicaid
   (Traditional)          $541          $424           (21.6%)

   Medicaid Other

      (DSH)                $503           $412           (18.1%)   Private Insurance    $5,763       $5,756               0%

  Grants, etc.            $136          $168             23.5%
  Tax Revenue          $1,185       $1,138           (3.9%)

  Other Revenue       $424          $512             20.7%

   Investment 

       losses                ($44)        ($468)            ! ! ! 

  Total Revenue      $10,309    $9,996     
  Total Expenses     ($9,809) ($10,889)   

  Surplus (Loss)      $500       ($893)     (278.6%)   Minus Investment

     Losses                $466       ($425)     (191.2%)       *Comparison - first seven months of fiscal years     

Well?

                               Broward Health

        Fiscal Year      2015               2016

        (First 7 Months)

        Cash & Cash

          Equivalents     $115,258,627   $94,168,948                     Cash &

          Investments

          Externally       $13,414,255     $15,390,178

        Short Term

           Investments  $460,252,970   $374,569,485

        Total                $588,925,852   $484,128,611  

           
                 So what's up with the
             $104,797,241 loss?
              And how come the
           District Commissioners
          have failed to discuss it?

                   

Complexity Theory v Fact

     Intellectual surrender in the face of increasing complexity seems too extreme and even a bit cowardly, but what should we replace it with if we can't understand our creations anymore?                                       Samuel Arbesman, complexity scientist

      Created in a former Fort Lauderdale apartment building with funds donated by local residents, Broward General Hospital boasted less than 50 beds when it admitted its first patient in 1938.
       It was still hard times in the dregs of the Depression.
       But  most local folks - black and white -- knew right where they belonged, or didn't, in a time when everybody knew everybody.
       However, even dying black folk understood they weren't welcome at Broward General with its all-white staff of doctors and nurses.
       The hospital was still small  and segregated when - by act of the equally segregated Florida legislature - the North Broward Hospital District was created to levy property taxes needed to build a new wing  on the local hospital.
       Like most of Florida's special taxing districts, the hospital district would be governed by local citizens -- in this, seven appointed by the Florida governor.
       By the Fifties, north Broward's population had grown to more than a 100,000 residents -- thanks to the steady stream of Veterans buying homes with government loans close by where they'd been stationed in W-W-Two.  
       Even so, back then and well into the future, Broward General was where white folks had babies or went hoping for a cure.
       But as for open heart surgery or liver transplants...?
       Or today's $3.9 billion District budget...?
       Or how yesterday's 45-bed hospital has mushroomed into one of the ten largest health care systems in the nation....?
        Or that today's $700 million District payroll supports nearly 8,000 FTEs...?
        Or the army of lawyers and purchasing agents required to negotiate and oversee the thousands of contracts needed to provide the system with everything from artificial hearts to Big Macs.    
         Or how and why the mega system's most recent CEO chose to kill himself a few months back...
          Or whatever... 
         Point is, having morphed into a giant, institutionalized  jungle of bureaucracy, Broward Health is still governed by  a politically appointed, seven-member board of Commissioners - each one just as ignorant of hospital operations as their politically appointed predecessor a lifetime ago. 
        Which is so insanely complex as to boggle!
        And why, as any terminally dysfunctional system overtaken by time and complexity, Broward Health doesn't "work" - except as a greed-driven hotbed of political patronage.

Broward General - 1940's