In the Beginning...
Today's North Broward Hospital District (dba Broward Health) was created by an act of the Florida legislature to meet the then major health care needs of some 100,000 all-white, non-Jewish residents living north of today's Dania "cut off" canal in the mid-1950's.
Governance was provided by a seven-member Board of Commissioners appointed by the Governor of Florida.
With less than 50 beds, the original Broward General Hospital provided life-saving care to an all-white patient population suffering from the likes of appendicitis, pneumonia, badly broken bones, gun shot wounds and other grave injuries.
While organ transplants and open heart surgery were the stuff of science fiction.
But then Broward 60-plus years ago was part of the segregated South where Fort Lauderdale police routinely questioned any "colored boy" found east of the Flagler Railroad tracks after dark...
And where:
- Broward's population lived well east of today's Route 441...
- Most tourists arrived by train, car and a few prop-driven aircraft to stay in one of two hotels, or a handful of mom-and-pop motels....
- And local government was run by all-White Good Old Boys called "Dixiecrats."
I know all this having spent much of my boyhood in Broward where everything from drinking fountains, to schools, restaurants, buses, grocery stores, and neighborhoods was sharply divided between "Colored" and "White".
That was then.
And a world away.
Today, as the nation's ninth largest public health care system, the North Broward Hospital District still remains under the jurisdiction of seven Commissioners politically appointed by the Governor of Florida.
Thus, today's District's Commissioners serve as "available" Republicans - despite their total ignorance of institutionalized urban health care in the 21st century.
Which explains the gaggle of lobbyists, stock brokers, lawyers and retired politicians governing a $1.2 billion tax-supported system of urban hospitals and clinics serving an urban population of nearly a million multi racial and ethnic residents.
Which boggles.
So much for the back story...
The Sound of Silence
Each regular monthly meeting of the District's seven-member governing Board begins with an opportunity for visitors to address the Commissioners.
However, by tradition -- but not policy -- the politically-appointed Commissioners routinely (and selectively) decline to respond to questions from District taxpayers.
For example, yesterday (2/24/16), as a District taxpayer, I was met with a wall of silence from the Commissioners after seeking an explanation for the giant health care system's current (and mysterious) financial meltdown.
Like...
A comparison of the first seven months of Fiscal Year 2015 versus Fiscal Year 2016 reveals a stunning $91 million negative "swing" in the District's bottom surplus revenue.
North Broward Hospital District
First Seven Months of Fiscal Year
(Per adjusted admission*)
FY 2015 FY 2016
Adjusted admissions 69,441 68,754
Gross Charges $34,403 $33,385 (2.9%)
Deductions $25,201 $25,800 2.4%
Reimbursement $8,529 $8,168 (4,2%)
Total Revenue $10,265 $9,528 (7.2%)
Total Expenses ($9,765) ($10,331) 5.8%
Surplus (Loss) $500 ($803) (261%) *Adjusted admission - Standard healthcare industry baseline
According to Plan?
The Broward Health's fiscal year runs from July through June of the following year.
However, due to a long-standing anomaly, Commissioners are asked to approve the District budget three months into their current fiscal year -- a policy unquestioned for years.
Anyhow...
Per adjusted admission, the figures reveal what Commissioners approved five years ago ... compared to the District's current numbers.
North Broward Hospital District
Commission approved budgets
(All $ per adjusted admission)
Fiscal Year 2011 2015* 2016*
Gross Charges
Budget $32,098 $30,497 $33,619
Actual $30,917 $33,090 $33,384
Deductions
Budget ($25,007) ($23,087) ($24,461)
Actual ($24,010) ($25,201) ($25,800)
Bad Debt
Budget ($3,168) ($3,371) ($3,223)
Actual ($3,079) ($3,366) ($3,742)
Charity Care
Budget ($2,847) ($1,066) ($1,288)
Actual ($2,863 ($1,411) ($1,355)
3rd Party/Other
Budget ($18,992) ($18.649) ($24,461)
Actual ($18,066) ($20,425) ($20,732)
Total Reimbursed
Budget $7,091 $7,410 $7,745
Actual $6,908 $7,889 $7,585
Total Revenue
Budget $9,392 $9,577 $10,112
Actual $9,878 $9,168 $9,528
Total Expenses
Budget ($9,760) ($9,364) ($10,076)
Actual ($8,110) ($8,668) ($10,331)
Surplus (Loss)
Budget $310 $213 $36
Actual $796 $500 ($803)
The question, of course:
What happened?
Which I asked.
To which District Commissioners responded with stone-faced silence when I (as a District taxpayer) posed the question during a public meeting on February 24, 2016.
Oh yes.
I was met with the same Sound of Silence when I asked the Commissioners to whom they are accountable.
Which, as an alleged governmental agency by the people, for the people and of the people is bullshit.
The Past as Prologue
Students of History 101 may recall a tired cliche offered by their instructor during an early session:
"It's difficult to know where you're going if you don't know where you've been."
Which is the raison d'etre for the following:
North Broward Hospital District
Commission approved budgets
(All $ per adjusted admission)
(All $ adjusted for 21% inflation)
Total System 2005 2015 +-
Adjusted
Admissions 99,665 119,311 19.7%
Surplus (Loss)
Per adj. admit
Budget $345 $213 (38.3%)
Actual $73 $500 584.9%
District Hospitals
Adjusted
Admissions 89,264 107,218 20.1%
Surplus (Loss)
Per adj. admit
Budget $805 $461 (42.7%)
Actual $1,052 $878 (16.5%)
Non Hospital
Programs
Adjusted
Admissions 10,401 12,093 16.3%
Surplus (Loss)
Per adj. admit.
Budget ($3,634) ($1,922) 47.1%)
Actual ($2,072) ($1,810) 12.6%
Now...
Theory is, the seven politically-appointed District Commissioners are able to understand the budgetary complexities and details where the countless fiduciary devils of accountability lie hidden.
For example...
On page 28 of the current 359-page District Budget for FY 2015-16, we find:
The District has combined Cash and Investments totaling for $730,227,000.
However, turning back to page 25, we discover the this $730,227,000 in Cash and Investements generated $12,796,473 in income.
Which equals a "return" of roughly 1.7% on the District's $730 million dollars.
Which might raise a few fiduciary eyebrows for some folk.
As a relevant aside...
Most hospital systems like Broward Health depend on accounting devices like adjusted patient days and adjusted admissions to serve as baselines needed to track a jungle of revenue sources versus corresponding expenditures.
For example, wading through the countless grey numerical columns in the District's current 359-page Budget, we find:
North Broward Hospital District
Assets Earnings Investment
Cash & Investments Gain (Loss) Mgmt. Fee
FY 2013 $626,815,000 $41,508,009 $1,398,699
FY 2014 $673,611,000 $69,506,728 $2,203,906
FY 2015 $589,852,000 $12,796,475 $3,154,332
FY 2016 $484,128,000 $5,998,789* $3,265,798*
*projected
What happened?
Fair question.
Not that any of the District Commissioners are willing to ask it -- let alone look for an answer.
Anyhow..
Speaking of that which few care to ponder regarding one of the nation's largest public health care systems, we have this fiduciary Rabbit Hole:
Broward County Hospitals
"Bottom Line" Surplus Revenue
2008 2014
Broward Health
Broward Medical $40,510,479 $14,309,647
Coral Springs $6,316,270 $7,652,077
Imperial Point $9,491,128 $1,725,489
North Broward $22,736,076 $7,807,543
Total $79,053,953 $31,494,758 (60%)
Memorial Healthcare
Memorial Miramar $22,457,112 $39,158,503
Memorial Pembroke ($625,310) ($6,509,248)
Memorial Regional $2,928,759 $16,563,035
Memorial West $30,408,322 $91,822,486
Total $55,168,883 $141,034,776 156%
Private Hospitals
Cleveland Clinic $21,528,490 $80,421,706
Florida Medical ($5,901,160) $4,095,802
Holy Cross ($25,063,899) $18,692,140
Northwest ($2,337,650) $13,555,279
Plantation ($10,660,816) $11,090,935
University $1,499,489 $7,605,123
Westside $13,840,999 $29,089,726
Total ($7,094,547) $164,550,711 242%
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