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?