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%)