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.
However...
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.
Why?
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.
However...
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%
Deductions:
Bad Debt ($3,079) ($3,612) 8%
Charity Care ($2,863) ($1,273) (55%)
Third Party/Other ($18,067) ($21,418) (5%)
Total Deductions ($24,010) ($26,303 ) 9%
Reimbursement
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
Okay.
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.)
True.
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.
Anyhow...
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.
Like:
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
Average:
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 &
Low/Moderate
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%
Deductions/Costs
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%
Reimbursed
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.
Anyhow...
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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