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

Trends in a new millenium

                Can you read the tea leaves?

                       Broward County
                              2000          2014          +-
Population                        1,632,000       1,748,000       7.1%       
Hospital Beds                   5,549               6,004                8.2%
Hospital Census               2,823              3,153                11.7%
Occupancy Rate              50.9%              53.1% 
Hospital Admissions     200,812          233,311           16.2% 
Pediatric Services 
   Admissions                   10,491             10,271               (2.1%)  
Adult Psych.  Admits     12,599             19,079              51.4%    
ER Admissions               107,987           155,125            43.6%
ER visits                            562,138          1,002,538       78.3%
Surgical Operations      106,166           113,186            6.6%
  Inpatient                         48,807            54,616              11.9%
  Outpatient                      57,539             58,670             1.9%
Open Heart Surgery      3,251               1,930             (40.6%)
Cardiac Cath                   17,852             11,967            (32.9%)
MRIs                                 39,953             85,451            113.9%
  Inpatient                        11,827              28,660           142.3%
  Outpatient                     28,126             58,791            109.0%
Nuclear Medicine         80,499             38,277            (52.4%)
  Inpatient                       35,204             16,980           (51.8%)
  Outpatient                    45,245              21,297            (52.9%)
All Other 
  Radiological                 1,065,806      1,010,945        (5.1%)      
  Inpatient                        412,466          381,483           (7.5%)  
  Outpatient                     653,340         629,462            (3.6%)
      

What we have here is...

I am a resident of the 

North Broward Hospital District.

For decades, a portion of my

 property taxes has gone to support the operations of this public hospital system

created by the Florida legislature

more than 60 years ago.

As one of the nation's ten largest

public hospital systems

with an annual budget of nearly

 $4 billion,

the District is governed by seven 

of my fellow Broward County

residents appointed by

the governor of Florida.

My question:

To whom are the 

District Commissioners

Accountable?

I have repeatedly

asked this question of the

seven District Commissioners

during their regular public meetings.

Each time, the seven Commissioners

have responded to my question

with silence.

John deGroot

There was a plan...

Accountability Not!

Plan A

Theory was, the North Broward Hospital District would develop Community Health Centers to reduce the load of visitors to the system's four Emergency Departments. 

So how's that worked?

                                          

          Visits                         2000           2015          

          Emergency 

          Departments           186,397      293,623     58% 

          Community

          Health Centers       201,503      131,434    (35%)

          Loss per visit          ($78)            ($99)   
Plan B           

In this case, the plan was to open a clinic in Weston which would generate additional District "business" by competing with the  recently opened Cleveland Clinic hospital 
and outpatient clinic.

And how's that worked?

                                               2007              2016

         Weston 

         Health Center

         Visits                            33,566          29,259

         FTEs                             42                  37
         Surplus (Loss)
        Per visit                       ($70)              ($17) 

       Cleveland Clinic
       Adjusted Admits        14,770          19,282
       FTEs                              805               1,105          
        Surplus (Loss)        
        Per adj. admission   $737               $4,171
Plan C
    Given that hospitals are like exotic hotels in the life-saving business, the blunt "bottom line" for most hospitals involves generating revenue from buns-in-beds plus various in-patient and out-patient "ad-ons".
     Which is how and why the Hospitals Gods created the Chargemaster.
     But that's another story.
     Anyhow..
     For decades, the North Broward Hospital District has drawn from an endless river of tax dollars to remain in the black.
     That said, the District's revenue stream fow from two sources:
     1. Four hospitals
     2. Additional Services
     So here's how it's works:
                                               1995         2015
Total System
Adjusted admissions        99,655           119,311
Surplus (Loss)
Per adj. admission            $603              $605
In 2015 $                              $959              $605
Employees                           6,804            7,636
Salary per Employee        $67,911         $85,528
In 2015 $                              $107,299      $85,528

Four Hospitals
Adjusted admissions         89,624         107,218
Surplus
Per adj. admission             $867              $878
In 2015 $                               $1,370           $878       
Employees                            5,303             5,995
Salary per Employee        $65,645        $79,209  
In 2015 $                               $103,719      $79,209

Other Services
Adjusted admissions       10,031          12,093
Surplus                                ($1,776)        ($1,809) 
In 2015 $                             ($2,806)       ($1,809)
Per adj. admission      
Employees                           1,501            1,641
Salary per Employee       $75,919        $92,010 
In 2015 $                              $119,951      $92,010

So what's on the 

snack table?