Thursday, May 26, 2016

Facts & Fart Machines


    Based on a long-standing policy, the North Broward Hospital District's governing board of Commissioners allows members of the public to voice their concerns at the start of every regular commission meeting.
    For three minutes.

    Since former Commission Chair David DiPietro was removed from his post by Florida Gov. Rick Scott, the new Commission Chair Rocky Rodriguez and his fellow District Commissioners have refused to respond to my questions regarding current District budgetary and policy matters impacting both hospital patients and the tax-paying public.
    So it was that I attended the regular monthly meeting of the Distict Commission on May 25 with a fart machine.

    In anticipation of the Commissioners' refusal to answer my questions as a District taxpayer.
    The fart machine worked.

   Which led District officials to:
    (1) Order me to silence the fart machine - which I refused/.
    (2) Order me to leave the Commion meeting - which I refused.
    (3) Request two Fort Lauderale Police officers to order me to leave the meeting - an order which I declined to comply.
     Faced with  the threat of arrest and jail, I surrendered my fart machine to the current District Commission Chair Rocky Rodriguez, a grossly obese Cuban refugee who's found a meaning and purpose to life in food, real estate and the Republican party.  
    For the record, I have obtained a new fart machine for the future gatherings of the North Broward Hospital District Commissioners.
    Call it a metaphorical demand for accountability based on the disturbing budgetary anomalies below:
          North Broward Hospital District
                        Official Budget
       (Expenditures Per adjusted admission)

                                        2011          2016            CPI 

Adjusted admissions     122,327      117,856
Tax Revenue                  $1,263        $1,160         (8%)
Gross Charges                 $30,918      $34,097        10%      
Bad Debt                        ($3,079)     ($3,612)         8%
Charity Care                   ($2,863)     ($1,273)    
Third Party/Other           ($18,067)   ($21,418)     (5%)
Total Deductions            ($24,010)   ($26,303 )      9%

 Medicare                         $1,527        $1,610          5%
 Medicaid                         $937           $402            (57%)

 Private Insurance            $4,495        $5,782          29%
Total Revenue                 $9,018         $10,319        14% 

Total Expenses               ($7,801)      ($10,372)       33%
Total Surplus (Loss)      $1,217        ($53)            (104%
Source - North Broward Hospital District
                                  *10 months of current fiscal year
      That the above data vexes me suggests, after my 78 years on this lonely planet, I still believe there are rational answers to the Five W's and H posed by the nano-second of my life in a 15 billion year-old universe. (Who, what, why, where, when and how.)

      Like  even our late Lord and Savior Jesus Christ died asking questions on the cross.
      So what makes me so special?
      Other than my ego.
      Coupled with the quantum improbability of my life.

      On a personal note, my story involves a life-long battle between my frontal lobe and my amygdala. 
       But then I AM a product of a culture that believes in the notion of Good vs. Evil, diverse Alphas and Omegas, and the absolute superiority of this year's all-new Whatever over last year's obsolete.
       How else could anyone explain the meaning-in-the-metaphor of Candidate Trump, the State of Israel, vaginal deodorant, or Amerika uber alles?      

       Which brings us back to the WTF inherent in what we blithely call the American Health Care System.
        Accompanied  by the righteous braaaaak of a fart machine.
        All in the name of accountability by Browad Health's governing Board of Commissioners.
        Because, as one of the nation's ten largest public health care systems,  the North Broward Hospital District suffers from an epidemic of anomalies. 

        Consider, for example.the absurd Persian Market  in the following Charge-v-Cost "spread" for an Emergency Room visit by a Broward citizen in need of critical are:
                Level 4 ER visit - Average Charge v Cost
                Broward      Memorial   Plantation   Holy

                Medical       Regional     General       Cross
Charge    $722             $639            $1,964         $1,408
Cost         $187             $356            $164            $233
As purveyors of bullshit as well as health care, hospital officials and Chamber of Commerce types love to boast of the so-called Free Market at allegedly work in America's health care system.

         As if some poor bastard slammed by a heart attack has both the time and ability to shop for the "best" ER with the fastest and the mostest level of care.
        The ultimate free market lunacy?
         Broward County highways are festooned with giant billboards alleging "average waiting times" at Ajax Medical Center or Acme General.
         And so on.
         Which suggest it's only a matter of time before hospital billboards will include the average price they charge for various medical services.

         Because the "sticker price" numbers are already there.
         Even though their "spread" is worse than used car lot.

                Medical Service - Congestive Heart Failure
                Broward       Memorial       Plantation      Holy                                   Medical        Regional         General         Cross
2007        $90,589        $62,103          $67,632         $74,445
2014        $89,924        $103,100        $178,587       $64,641
Increase     (1%)             66%             64%             (13%)

            Which explains the findings of Florida Gov. Scott's Commission on Healthcare and Hospital Funding released earlier this year.
            "Healthcare," the Governor's Commission reported, "is not a free market system.
            "Hospital utilization data indicate that more than 70% of all all hospital admissions in Florida during 2013 were covered by a government-sponsored resorce. (i.e Medicare, Medicaid, VA/Tricare or other.)"
              Which suggests hospital care in Broward County is a poster child for - GASP - socialized medicine.
              And then, we have from the January issue of Health Affairs magazine in 2006:

              "Asked by a a Wall Street Journal reporter to explain how U.S. hospitals price their services, William McGowan, cjoef financial officer of the University of California, Davis, Health System and thirty-year veteran of hospital financing responded, 'There is no  method too this madness. As we went through the years, we had the cockamamie formulas, We multiplied our costs to set our charges."
             Which explains the "cockamamie" dynamics at work in the following:
               Diagnostic Cardiac Catheterization - Outpatient

                       Broward    Memorial     Plantation    Holy
                       Medical     Regional       General       Cross
Charge            $10,641     $9,168          $8,658         $22,719  
Cost                $1,589       $1,402          $553            $2,606

               Again, Broward features three Persian Market public hospitals that serve as designated ER Trauma Centers:                      
                    ER patients requiring immediate life-saving care
                 Broward Medical   Memorial Regional Broward North  
                      2005     2014      2005  2014        2005       2014
White            2,150    4,788     NA    2,700        2,037      3,981

Avg. Charge  $3,871  $7,819   NA    $15,544    $3,331    $7,451 
Black            4,007    7,760     NA     1,433        1,800      3,437
Avg. Charge  $3,298  $8,086   NA    $15,752    $2,846    $7,450 

Hispanic        820       1,451     NA    1,011        790         1,350
Avg. Charge  $3,684  $7,801   NA    $16,221    $3,143    $8,296

                And speaking of the above Chargemaster-generated ER anomalies as grist for a Special Grand Jury...
                                         Emergency Room Trends 
                                             Broward                Plantation
                                              Medical                 General

          Severity -               2005        2014         2005       2015
          Minor &
          White                      4,017      5,713           3,450     302 

          Avg. Charge            $578       $320           $1,960   $1,545
          Black                       7,326      9,929         18,102    4,891
          Avg. Charge            $530       $391           $1,625   $1,220
          Hispanic                  1,425      2,051          2,167     337
          Avg. Charge            $535       $484           $1,77     $1,759
          High Severity        
          Non Immediate
          & Immediate Care

          White                      5,757      11,902        248        1,932
          Avg. Charge            $2,972    $5,885        $6,211   $13,148
          Black                      10,848     24,770        874        14,126
          Avg. Charge            $2,536    $4,719        $6,196   $11,083  

          Hispanic                  2,241      5,264          128        1,566
          Avg. Charge            $2,756    $5,115        $6,166   $12,362
                  Of course...
                  Data alone are like blips on a radar screen. or a distant explosion.

                 And thus, the above (data) require an explanation as to their meaning and relevance for both taxpayers and patients. 
                  This is certainly the case with the data and trends for Broward General (a tax-funded public facility) and Plantation General (a for profit hospital scheduled to relocate to a more upscale location with far fewer minority residents).  
                  Trouble is...
                  We have here are arcane data filled with mysteries 
equal to the miracle of  transubstantiation in the conversion of common wine to the Blood of Christ.         
                   Or the North Broward Hospital District's legal expenses  versus the cost of  blood:
               Costs             2008                    2015
               Lawyers        $2,488,334          $9,965,535
               Blood            $10,126,809        $12,217,896
                   Which is a metaphor from hell.

                   And speaking of metaphors, ponder the numbers and trends below - not that any of District's politically-appointed governing Board of Commissioners might grasp the significance of this data tsunami.
                                Broward Medical Center
                                          2000                    2016          CPI %
Adjusted admissions       29,554                 42,151                %
Surplus (Loss)                 $26,470,029        $27,160,258
Per adj. admit                   $997                    $644            
Gross Charges                  $842,550,528      $1,869,517,490
Per adj. admit                   $28,509               $44,353             56%
 Bad Debt                        ($73,997,000)     ($173,611,601)
 Per adj, admit                 ($2,503)              ($3,974)              59%
 Indigent Care                  ($112,026,698)   ($118,959,485)
 Per adj. admit                 ($3,791)              ($2,723)             (28%)
 Other                              ($483,771,990)   ($1,027,911,172)  
 Per adj. admit                 ($16,369)            ($23,528)            44%

Medicare                         $37,993,797         $81,080,853

Medicaid                         $31,103,932         $59,529,164
Managed Care                $77,101,892          $1,027,911,172  
Other                              $26,555,222         ($3,276,608)
Tax Revenue                  $39,588,385          $43,025,063

Grants                             $1,675,622            $755,009
DSH                                None                     $20,890,015
Net Reimbursement       $214,018,849        $422,811,145
Per adj. admit                 $7,242                   $9,115               26% FTEs                               2,046                     2,957
                45%   Salaries                           $83,896,658          $175,711,584
Benefits                          $16,604,486          $52,054,015
Total                               $100,501,144        $227,765,599
Per Employee                 $49,120                 $77,026             58%
Licensed Beds                744                        716
Avg. Daily Census          355                        410                    15%
Occupancy Rate             48%                       57%
Uninsured                        88                          54                     (39%)
Medicare                         86                          79                     (8%)
Medicare HMO/PPO      30                          40                      33%

Medicaid                         76                          105                    38%
Medicaid HMO/PPO      10                          25                      150%
Other Insured                  65                          107                    65%

Admissions                      21,848                  27,116                24%
ER Admissions                12,567                  18,954                51%
ER Visits                         66,069                   123,154             86%
Outpatient Visits             191,948                 217,608             13%
Surgical Operations         9,036                    11,779               30%
Cardiac Cath                   1,684                     1,382               (22%)

MRIs                               3,081                     5,992                 94%
CT Scans                         17,576                   43,245               146%

Lab                                  889,016                 1,624,513          83%

                 And finally...
                 A word about the scourge of  Socialized Medicine.
                 The Dark Side  of the American Healthcare system.
                  Which so many politicians and lobbyists for Big Health would have us believe -- even though 
healthcare in America has been "socialized" for years.
                   Via government programs like Medicare and Medicaid.
                   And most recently, a national health insurance program called Obamacare by its opponents..
                   All of which suggests healthcare in America is already pretty damn socialized  by billions of tax dollars.
                    Time now to close with a mega dose of irony.
                     Coupled with the shameless abuse of the English language.
                      Like right here in Broward County, the non-profit Cleveland Clinic is the county's most profitable hospital.
                     With earnings to revenue numbers like:
                      Net Operating Revenue -      $276,910,861

                      Total Bottom Line Surplus -  $80,421,706 
                      Which comes to "earnings" like 29%
                      Versus Broward's soon-to-be relocated for-profit Plantation General.
                       With earnings-to-revenue numbers like: 

                       Net Operating Revenue -  $369,891,371
                       Total Profit -                      $11,090,935
                        Which comes to "earnings" like 3%
                       Compared to Plantation's future neighbor Westside Regional.
                       With earnings-to-revenue numbers like:

                        Net Operating Revenue -  $186,587,600
                       Total Profit -                       $29,089,726
                       Which comes to "earnings" like 16% 
                        Oh yes.
                        Let's not forget the South Broward Hospital District's Memorial West.

                        With earnings to revenue numbers like:
                         Net Operating Revenue -  $442,389,455
                        Total Profit -                       $91,822,486
                        Which comes to "earnings" like 21%
                        Which ain't all that bad for government work!


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