Sunday, August 28, 2016

Metaphors

   Given my life-long relationship with words (from Winnie the Pooh to Joseph Campbell), I'm eternally enraptured with the mystery of metaphors.
    As in what makes the dynamic "work."

    For example:
    There is Donald Trump.
     Or how we've gone from ancient pornography uncovered amid the ruins of Pompeii to "clips" of diverse sex on various internet "sites". (Google free porn)

     Or the matter of Yeats' "Slouching to Bethlehem" as Yin to the Yang of "Casey Jones daughter was deaf and dumb/ and the hair on her poontang was as thick as your thumb/ and if you hit her on the belly/ she went rum-diddley-dum-dum-yum yum!"
     Or Hebron as the new Warsaw ghetto.
     Anyhow...
     No matter where you look, white whales and metaphors lurk.
      At which point, the ghost of as long-dead editor emerges to howl, "So what? Your average reader won't get It!"
      To which I can only reply, "Who says I get It?"

.     Because I sure as hell don't.
      Which brings us to an apt metaphor to "cover" America's greed-driven health care system.

       My personal favorites?
       Another neighborhood bake sale in response to the devastating cost of a local kid's losing battle with terminal cancer.
       Or Florida Governor Rick Scott's fiscal butt fuck of low income health care in the Sunshine State,

       Or the mean-spirited legacy of Scott's "politically active" Republican hack-appointees responsible for governing Broward Health - one of  the nation's ten largest public health care system.
       Or the South Florida Sun-Sentinel's  journalistic impotence in covering the egregious doings of public health care in their own backyard.  
       For example,concerning the above*:
                           North Broward Hospital District
                             A metaphor of the Scott Years
                            2011                   2017 projected

Adjusted 

   admissions        122,327              121,010
Tax Revenue         $154,450,148     $145,198,762
Per adj. admit       $1,263                $1,200

Patient Revenue   $913,553,096      $1,088,153,931
All Patient Care
  Revenue             $1,068,003,244   $1,233,352,693
Surplus                 $97,404,407       $19,572,886
Per adj. admit       $796                   $162            (80%)
Margin                  9.1                      1.6

And Under WTF:
Uninsured Care
  Costs
  Bad Debt            $376,700,276      $408,245,104
  Indigent Care      $350,252,811      $151,358,476

  Total                   $726,953,087      $559,603,580
  Tax Revenue      $154,450,148       $145,198,761

  "Reimbursed"  
  Per $1 charged   21.2 cents           25.9 cents          


District Avg
Daily Patients
      874                     858             (2%)
   Medicare

   Traditional         203                      195             (4%)
   Medicaid
   Traditional         158                       112             (29%)

   Private Insured  360                       461              28%
   Compensated    722                       768              6%
   Uninsured         153                        90              (41%)
   

Thursday, May 26, 2016

Broward Health - Where the buck stops

  With an annual budget of nearly $2 billion, the tax-funded North Broward Hospital District (dba Broward Health) is governed by a handful of politically appointed Commissioners chosen by Fla. Gov. Rick Scott for the membership in the local Republican party -- rather their knowledge of health care (of which they have little, or none).
 Attention District patients and taxpayers - below are the current governing board members of one of the nation's ten largest public health care systems:
 Chair - Rocky Rodriguez, realtor

             1700 NE 18 Street, Fort Lauderdale, 33316
              954 568 4822

Members -
             Maureen Canada, yacht basin owner
             2521 NE 31 Court, Lighthouse Point, 13064

             954 946 6090
             Joel Gustafson, retired lawyer-lobbyist
             100 S. Birch Road, Fort Lauderdale, 33316
             954 463 6900
             Sheela Van Hoose, lobbyist

             1631 NE 28 Avenue, Pompano Beach
             954 438 8066
             Christopher Ure, branch bank employee
             2770 stirrup Lane, Weston 33331
             954 349 2640  

Saturday, April 2, 2016

District Doctor Dollars

     The recent demand for access to Broward Health financial records from Florida Attorney General* Pam Bondi begs certain questions.
    Like:
    What is the difference between a financial relationship, compensation, and enrichment?
    And between the three, which is taxable and which is not?

    Specially, as noted in her letter to Broward Health Attorney Linda Bauman, Bondi's demands are based "upon North Broward Hospital District (dba Broward Healh) having entered into financial relationships with physicians that violated the Physician Self-Referral Law, 42 U.S.C 1395nn, the Florida Anti-Kickback Statute 456.054, Florida Statutes and False Claims  Act 678.081 et seq., Florida Statutes."    
      Specifically, in her 3/10/2016 letter to Ms. Bauman, Attorney General Bondi seeks District records involving nine (9)"physicians whose contracts (with the District) Florida contends were improper and in violation of the Self Referral Law".
   Below are the nine physicians cited in Bondi's letter - and the District-paid (taxpayer) cost of their services:
                                               2010                2016
                                               Spent              (Budget) 

    George Caldwell                  $2,025,461      $1,483,664
   Michael Chizner                   $762,387         $1,024,639
   Violetta McCormack              $1,236,425     $1,112,248
   Hector Rodriguez-Cortez      $769,044        $647,809
   Rudolph Roskos                   $803,109        $645,907
   John Rozanski                      $976,172        $939,067
   Ashok Sharma                      $1,683,368     $1,532,947
   Erol Yoldas                           $2,368,505     $2,111,298
   Shazia Zafar                         $957,375        0
      Source: Commission-approved District Budgets

 
     NOTE - In the interest of full disclosure, I was involved in numerous hospital issues during my four years as a policy analyst employed by and answering directly to then Attorney General Robert A. Butterworth. JKdeG

Friday, April 1, 2016

Where's the Grand Jury?

   Okay.
   So the Plan had some "issues" withFederal anti-trust Stark Laws.
   Which resulted in the North Broward Hospital District paying a penalty of nearly $70 million earlier this year.
   
 Like so many other schemes, the Plan seemed like a good idea at the time.
    Here's how it was supposed to work:
    1.  The tax-funded Hospital District would hire a a bunch of Docs to hondle visits to their offices scattered throughout northern Broward county. .
     2. Unlike the District's four hospitals, the hired Docs would market their services to paying patients - rather than those lacking insurance.
     3. Which would increase the percentage of the District hospitals' paying inpatients.

     So, as the cliche goes...
     Hows that worked out?
     Well, for Starters, the District's hired physician program has been a major money looser from the get-go.
     But, big picture-wise, it gets way, way worse!

     Like:
                          District Employed Physicians
            Fiscal Years         2010                  2016
            Total Visits            227,910             378,220

            Total Employees   218                    403
            Compensation      $35,949,829       $58,973,561

            Per Employee       $164,907           $146,336
            Patient Revenue   $22,732,082

              Per Visit              $100
            Surplus  (Loss)     ($20,763,236)    ($33,332,241)
            (Loss) per Vist       ($91)                 ($88)

                               Four District Hospitals            
            Fiscal Years         2010                  2016 Budget                      Avg. Patient 
               Census              899                    874
            Adjusted 
               Admissions        107,786             109,637
            Total Employees   6,001                 6,057
            Compensation      $456,614,887     $491,945,660 

            Per Employee       $78,090             $81,219
            Total Revenue      $954,401,599     $1,773,723,103

               Per adj. admit    $8,855               $16,178
            Total Expenses    ($877,144,284)  ($1,738,528,718)
               Per adj. admit   ($8,137)            ($15,857)

            Surplus (Loss)      $77,257,315      $35,194,385
            Per Adjusted
                Admission         $717                 $32
      Oh yes.
      Like a proverbial Rube Goldberg machine, the District has a ton of mysterious parts.

      Which leads us to the "Bottom Line" trends for the entire district since FY 2010
                 
      Total North Broward Hospital District                                                     FY 2010           FY 2016
            Surplus (Loss)    $76,866,424     ($59,203,478)*
           
Per Adjusted
               admission           $713                 ($748)    ! ! !                                      *First nine months of FY 2016 


                  So where's the Grand Jury?
          Source: North Broward Hospital District Budgets

Calling Horse Shit

   When all else fails and a bad moon's rising, officials running the giant tax-funded North Broward Hospital District will describe their's as a mission from God based on their care for the poor.
   Trouble is, after scraping away all the PR horse shit, it  seems the pony's shrinking.
                 North Broward Hospital District
                   Average Daily Hospital Patient Census   
                Fiscal Year            2010          2016

                Patients                 899           857       (5%)
               
Insured                   751           757        8%
                Uninsured               148          100       (32%)
                 
 Source: North Broward Hospital District
  
   PS - This may be the First of April, but this ain't no April Fool's joke. JKdeG
                                       

Thursday, March 31, 2016

Tracking Hospital Finances

   The problem?
   Hospital financial data often involve millions and even billions of dollars.
   Trouble is, most walk-around folk have trouble relating to amounts of this mega sort.
   Which is how and why the American health care industry
developed baselines like:
   Adjusted Admissions
   Adjusted Patient Days

   Each of which enable policy makers to track hospital financial trends over a period of time -- or compare the financial "health" of one hospital to another.
   FYI - Adjusted Admissions and Adjusted Patient Days are produced using a health care industry-wide formula that accounts for BOTH inpatient  and outpatient populations at a given hospital or group of hospitals.
   Here's how it works using the current financial woes at the North Broward Hospital District (dba Broward Health- with a gross annual budget of nearly $4 billion.
                               
                               Broward Health
                        Financial Trends
                            (Per Adjusted Admission)
                                     Total System
            FY                      2013             2016*
            Adjusted

            Admissions       120,046           79,116
            Gross Charges   $31,702          $33,256
            Deductions
            Bad Debt           ($3,065)        
 ($3,672)
            Charity Care      ($2,711)         ($1,344)
             3rd Party/Other ($18,733)       ($20,659)
            Total                  ($24,509)       ($25,675)

             Reimbursed

             Medicare            $1,552           $1,599
             Medicaid             $794             $408
             Commercial
             Insurance           $4,772           $5,783  

             Other                  $68              ($209)           
             Reimbursed        $7,186          $7,581
             Other Revenue   $1,048          
 $575
             Total Operating  
                Revenue         $8,234           $8,156
             Non-Operating
               Revenue          $1,754           $829

            Total Revenue   $9,988        $8,985
            Expenses           ($9,498)        ($9,733)
            Surplus               $490             ($748)
                                                            *8 months

           Source: North Broward Hospital District
 

    Bottom line?
    The North Broward Hospital District is suffering from some serious financial health  problems. 

Tuesday, March 22, 2016

Broward Health For Sale?

       

    Word persists that Florida Gov. Rick Scott has posted a For Sale sign on the North Broward Hospital District (dba Broward Health).
     Which may explain* how and why the Governor removed two longtime Commissioners for the District's governing board Chair David Di Pietro and Audit Committee Chair Darryl Wright. (*In tossing the two Commissioners, the Governor offered no reason.)        
      This leaves five Commissioners appointed by Scott and thus serve as The Rickster's rubber stamp policy puppets responsible for one of the nation's ten largest public health systems.
      The Governor's five Commissioner minions
      Christoper Ure, 2770 Stirrup Lane, Weston
                                954 349 2640
      Shella VaHoose, 1631 NE 28 Ave., Pompano  Beach 
                                  954 438 8066
      Maureen Canada, 2521 NE 31st Court, Lighthouse Point                                    954 946 6090
     Joe Gustafson, 100 S. Birch Rd., Fort Lauderdale
                               954 463 6900
     Rocky Rodriguez, 1700 NE 18 Street, Fort Lauderdale
                                   954 568 4822
     Naturally, given their role as key policy makers at the $1.9 billion, tax-supported public health system, the Commissioners should welcome input from residents living in North Broward, current employes of the District and - of course - hospital patients.
     Or at least it's pretty to think so.  JKdeG