| |
REPORT:
Mr. Rolando Rodriguez, President, Jackson Memorial Foundation (JMF), 9 Island Avenue, Miami Beach, appeared before the Board and provided a brief historical overview of the Foundation and its purpose. He described the Foundation as a private 501(C)3, Not-for-Profit, charitable organization that was self-funded and used no tax dollars; rather paid rent for its offices at Jackson Memorial Hospital (JMH). Mr. Rodriguez spoke about the JMF Board of Directors and the annual audit of its financial performance by third-party independent auditors. He noted Jackson Memorial Foundation contributed over $40 million to JMH over the past five years, with its Grants Department managing $29 million. Mr. Rodriguez also discussed the Foundation Health Services (FHS) program and explained that it was a separate from Jackson Memorial Foundation and Jackson Health System. He noted FHS has been paid $18.8 million, since its inception, by JHS; of which $12.6 million was paid within the past two years, bringing the hospital�s gross patient charges to $170 million through September 2009. Mr. Rodriguez noted during that same two-year period, FHS brought in a minimum cash profit of $20.2 million, which was projected to increase to $26 million, once collections on outstanding charges was completed.
Following Mr. Rodriguez� presentation, Chairman Moss opened the floor for questions from Board members. Chairman Moss initiated the process by asking the name of the well-known competitor that had over 80 individuals in business development activities, reflected in the fact sheet he received.
In response, Mr. Rodriguez noted Baptist Hospital was JMH�s closest competitor; however, he added, that was not the only competitor with that number of individuals performing these activities.
Chairman Moss inquired as to whether JMF had a process for determining whether international patients would have not chosen JMH over its competitors even without the efforts of the Foundation.
In response, Mr. Rodriguez advised that patients went to the hospitals that were authorized by their insurance companies. He stated that JMF�s number one job was to make contracts with insurance companies and Third Party Administrators (TPA) acknowledging JMH as the best choice for their patients, based on great rates and location. Mr. Rodriguez noted the secondary market for JMH was the great services provided by highly qualified staff and physicians, particularly the trauma center.
In response to Chairman Moss� inquiry regarding how JMF�s cost structure compared to other organizations providing similar services, Mr. Rodriguez stated because of the competitive market, organizations do not release their internal information, making comparisons impossible. Regarding Chairman Moss� question on how the net profit of $20 million or $26 million was ascertained, Mr. Rodriguez noted the Foundation managed a relatively small number of patients, which were individually managed against the hospital�s records. JMF then created a list of costs and reconciled that list with the hospital�s financial staff, he added.
Pertaining to Chairman Moss� question regarding the offices at Jackson Towers, Mr. Rodriguez explained that JMF had necessary renovations made to the offices at the Jackson Towers, which it rented from JMH. He indicated he felt the cost for the renovations was a bit expensive and pointed out the manager overseeing that project was no longer with JMF. Mr. Rodriguez provided a breakdown of JMF�s 50 employees as follows: 25 Hospitality/Concierge Service staff; 2 Executive Physical Program staff; 12 Medical Operations staff; 4 Business Operations staff; and 8 Marketing staff.
Chairman Moss asked Mr. Rodriguez to provide him with a detailed budget summary, to include a listing of each staff member and the associated salary, operating expenses, and other related budgetary information.
Discussion ensued between Commissioner Diaz and Mr. Rodriguez concerning a breakdown of costs for marketing operations and salaries for the eight marketing staff members. Mr. Rodriguez noted in 2009, JMF�s expenditures totaled $3.3 million, which included $719,000 for direct salaries, benefits, and related expenses and $2.6 million for all other marketing activities, i.e.: conventions, conferences, travel, and other related activities. Mr. Rodriguez explained the process JMF used to negotiate contracts with the insurance companies with respect to international markets.
Dr. Eneida Roldan, M.D., M.P.H., M.B.A., President and Chief Executive Officer, Jackson Health Systems (JHS), appeared before the Board and explained the difference between Jackson Memorial Foundation (JMF) and Jackson International Health Services (JIHS).
In response to Commissioner Diaz� inquiry on the reason JHS owed over $9 million to JIMH, Dr. Roldan noted resulted from the proposed strategic business plan in 2008 projecting certain growth for the business.
In addition to Dr. Roldan�s comments, Mr. Rodriguez explained that JMH funded, on a monthly basis, a $9.7 million budget for JHS, adding that JMH�s net on that operation was a minimum of $20 million after costs.
Commissioner Diaz asked Dr. Roldan to provide him with a detailed schematic of exactly how the flow chart functioned. He asked Dr. Roldan to also include the history on the creation of Foundation Health Services on the flow chart.
Chairman Moss requested clarification on whether $9.2 million or $9.7 million was the correct budget amount.
In response to Chairman Moss� inquiry, Mr. Rodriguez explained that the annual budget for JIHS totaled $9.7 million; however, he noted $800,000 was used for domestic concierge services.
Chairman Moss questioned whether any analysis had been done to determine what was charged by Foundation Health Services versus charges by the normal market.
Responding to Chairman Moss� question, Dr. Roldan advised that informational packages would be provided to the Commission that would provide a full explanation of the international services and market. She noted the numbers provided during presentations of business plans for the international market were developed by their auditors; however, the numbers were reconciled with the JIHS finance team.
Commissioner Heyman expressed concern with JMH obtaining the best service for its money or the best return by comparative analysis to competitors in the market. She noted this was not addressed in the documents provided and stated she would like to see, with regard to the international market, a breakdown of the customers, the payment source, and the payment amount.
In response to Commissioner Gimenez� question of what was meant by �contractual and other discounts� as reflected in the handout, Mr. Rodriguez stated this was the difference between the retail amount and the actual amount paid. He noted over the past two years (2008-09), JMH�s gross billings totaled $170 million, adding that $74.8 million was collected to date, generating a profit of $20.3 million.
In response to Chairman Moss� inquiry as to how much JMH paid JIHS for its services during 2008-09, Mr. Rodriguez answered $11.9 million.
Commissioner Sorenson questioned the discrepancy in Mr. Rodriguez� presentation, which listed international program costs of $11.9 million and the budget of $9.7 million.
In response to Commissioner Sorenson�s concern, Mr. Rodriguez explained that the budgeted amount was the amount approved for the budget; however, the hospital had run short on funds and the JIHS had not received the full amount. He pointed out that the amount of $11.9 million was spent by JIHS over a two-year period; however, this amount was less than the annual budget amount was 9.7 million per year.
Commissioner Barreiro asked Mr. Rodriguez whether there were other entities, apart from JMH and FHS, associated with the Jackson Memorial Foundation; which entity determined what amount of billed charges would be collected and what amount would be written off.
Mr. Rodriguez responded there were no other legal entities and advised that the International Kidz Fund was simply an auxiliary group of the JMF. Regarding collection of billed charges, he explained that the JMF created contracts based on what the hospital allowed. Mr. Rodriguez advised that patient charges were determined based on insurance by insurance basis and also on case by case basis.
Commissioner Barreiro asked Mr. Rodriguez to provide the Commission members with a list indicating the charges the JMF had negotiated with various health insurance companies.
Hearing no further questions or comments regarding to the Jackson Memorial Foundation presentation, Chairman Moss recognized the Chairman of the Public Health Trust to come forward and make a presentation.
Mr. John Copeland, Chairman, Public Health Trust (PHT), appeared before the Board and expressed his appreciation to the County Commission, the PHT employees, the PHT Trustees, the patients, and the management staff for support and trust throughout this process.
Dr. Roldan recognized Ms. Martha Baker, RN, Jackson Memorial Hospital, and President, Service Employees International Union (SEIU) Local 1991; and Mr. David Small, Executive Vice President/Chief Operating Officer (COO), Jackson Health System, and advised that these partners were assisting PHT with the cash plan, which was submitted to the Board 48 hours ago. Additionally, she acknowledged the American Federation of State, County, and Municipal Employees (AFSCME) Union and noted talks were conducted this afternoon and expected an agreement would be reached.
Ms. Martha Baker, RN, Jackson Memorial Hospital, and President, Service Employees International Union (SEIU) Local 1991, appeared before the Board and noted Local 1881 would contribute to a plan that would not involve cuts, rather would involve building a strong JMH from the inside out. She spoke in support of the experts in the partnership between PHT and Local 1991 moving forward to fix the systems that were broken.
Dr. Roldan noted the PHT would provide the Commission with packages containing the information requested by Commission members at the meeting held two days prior (3/16). She stated she would ensure her availability to meet with individual Commissioner and answer any questions they might have.
Chairman Moss asked Dr. Roldan to describe how the proposed cash advance would help sustain the PHT until September 30, 2010, considering the challenges it faced.
Dr. Roldan indicated that the best way to respond to Chairman Moss� request was through a cash flow analysis, which was prepared with the finance team. She stated that the cash flow analysis reflected the timing of how payments would be received until September 30th. Dr. Roldan pointed out that this analysis considered only the cash acceleration items described in the plan, and noted any additional state infusions or federal funds would add to the amount presented today.
In response to Chairman Moss� concern regarding media reports that the Jackson South facility was losing money, Dr. Roldan explained that the PHT financials centralized all administrative costs at JMH�s main campus. However, she noted, a cost allocation analysis was done, by which costs were allocated across the system to each individual facility.
Chairman Moss asked Dr. Roldan to provide him with a copy of the plan that was implemented involving Greater Memorial in terms of their turn around.
In response to Commissioner Seijas� inquiry regarding a 2008 study by Deloitt Consulting LLP, Dr. Roldan explained that, many of the items identified in the study were implemented as part of the 100-day plan and the successes were reported to this Board in August 2009.
Mr. Angel Medina, Vice Chairman, Public Health Trust, appeared in response to Commissioner Seijas� inquiry on the $80 million Deloitt Consulting, LLP contract. He stated Deloitt contracts, which spanned six years beginning 2004, totaled $97 million, and collectively generated approximately $530 million in economic benefit to PHT through revenues or cost savings. Mr. Medina explained that, included in the contract referred to by Commissioner Seijas, was a project management office and a financial sustainability plan, which generated $106 million in revenue, expense, or process improvements. He pointed out that detailed reports were presented before this Board throughout FY 2008-09. In response to Commissioner Seijas� inquiry on how Deloitt�s findings would differ from what Price-Waterhouse would propose, Mr. Medina explained that the Deloitt findings should be capitalized upon and utilized to complement the Price-Waterhouse study. He stated the financial crisis PHT was currently facing would have occurred three years earlier were it not for the measures implemented from Deloitt studies.
Chairman Moss asked Mr. Medina to provide Commission members with detailed reports on the findings from the Deloitt studies for further review to attain a better understanding of what was accomplished, the actual cost, and what was or was not implemented.
Assistant County Attorney Lee Kraftchick read into the record, the County�s policy for employees promoting to an exempt position from a classified position, as requested by Commissioner Jordan.
Commissioner Jordan recalled the County�s previous approval of the transfer of land for the University of Miami (UM), for specific the purpose of building a small, specialized hospital on the PHT�s campus, to honor Braman�s (please clarify for the reader who is Braman because he is not mentioned in any preceding paragraph) father. Commissioner Jordan inquired whether that land would be returned to the County, considering the UM had since purchased a hospital.
In response to Commissioner Jordan�s question whether the land would be returned, County Attorney Cuevas noted the referenced lease between PHT and UM provided for a number of uses for the property, including medical office building, hospital, and related services consistent with an overall plan. Additionally, he advised the lease provided that if the property was not developed within a certain schedule, the rent payments would increase; however, there was no provision for termination. Mr. Cuevas continued, the Board could insist that the UM proceed in good faith with developing the plan for those uses, and assign consequences to ensure this was accomplished.
Commissioner Jordan expressed her desire to see the County proceed more aggressively in exploring ways to have this land returned to the County for future use.
Commissioner Jordan referenced the term �extem� (phonetic), which she noted was used in relationship with patients who remained in the emergency room for several days before being admitted into the hospital. She pointed out that these patients were processed into the system once they were admitted; however, their days in the emergency room were loss in terms of revenue. Commissioner Jordan suggested that Dr. Roldan investigate this system issue for possible adjustments.
In response to Commissioner Jordan�s comments regarding the system, Dr. Roldan agreed to research random months in the system to determine whether a trend existed.
Additionally, Commissioner Jordan expressed concern that the coding system was extremely flexible, and that the definitions of the codes were constantly changing, which eliminated the possibility of tracking. She further noted there were some instances of system failure altogether.
Dr. Roldan acknowledged Commissioner Jordan�s concerns and noted the payer-mix question regarding patient definition issues was addressed in the data integrity system in 2008, and more adjustments were forthcoming. She offered to meet with Commissioner Jordan to provide additional information regarding this matter.
Commissioner Jordan addressed the issue of the increase in cost from $0.40 per page to $1.00 per page, for copies of medical records at JMH, due to the service now being provided by a contracted company in Atlanta, Georgia. She commented that the same people were making the copies, and questioned the use of an outside company when JMH could perform this operation and retain the profit.
Pertaining to Commissioner Jordan�s concern that the former JMH Human Resources Director remained on administrative leave with pay, Dr. Roldan asserted this was untrue and that individual was completely separated from employment.
Discussion ensued between Commissioner Edmonson regarding personnel issues and what fiscal impact vacant management positions had on the PHT. Other issues involved in this discussion included the average cost per bed for international patients, the impact from privatizing all PHT clinics, and the impact of performing all non-emergency at the JMH Main facility.
Commissioner Edmonson�s asked Dr. Roldan to provide her with the total amounts JMH received in 2009 for the Maintenance of Effort (MOE) and for the half penny sales tax revenues. In addition, she asked that she also be provided with the total amount for the unfunded mandated services proposed by this Commission.
Dr. Roldan recognized Mr. Christopher Bayer to respond to Commissioner Edmonson�s request.
Mr. Christopher Bayer, Interim Chief Financial Officer, PHT, appeared before the Board and stated the 2009 actual half penny sales tax received was $172,816,000, and the MOE property tax received was $177,461,000.
Commissioner Heyman referenced Dr. Roldan�s memorandum dated March 18, 2010, and repeated her request reflected under No. 5, for a report detailing possible duplication of Jackson Hospital�s services. She also requested a breakdown of the referrals to JMH and UM facilities for patient care and services by UM practitioners.
In response to Commissioner Heyman�s question regarding the possibility of the Audit and Compliance Committee reporting directly to the Public Health Trust, Dr. Roldan advised that was the current procedure. She further stated she would provide Commissioner Heyman with next year�s audit report, detailing projects listed for next year.
In response to Commissioner Heyman�s inquiry of whether Price Waterhouse had previously worked for Miami-Dade County, Mr. Bill Luallen, Partner, Price Waterhouse Coopers, LLC (PWC), appeared before the Board and noted PWC performed an impact analysis on the Cedars Hospital transaction in 2007, and an analysis on the expansion at Jackson South and some minor work on the Jackson North acquisition project. Mr. Luallen noted PWC�s current scope of work for JMH was to develop a sustainability plan within 30 days.
In response to Commissioner Heyman�s concern with whether 30 days to develop a sustainability plan for JMH was realistic, Mr. Luallen explained that it was doable to look at what management had done; determine what was or was not in the sustainability plan; and prepare a report on what it would take to do that. Pertaining to Commissioner Heyman�s question concerning PWC�s plans to restructure Grady Health System, Mr. Luallen noted PWC looked at 37 different work screens that were missing several areas, and provided plans to get Grady to sustainability.
County Manager George Burgess noted he wanted to qualify his remarks for everyone�s benefits, and pointed out that he had no way to verify where the numbers presented today originated from. He noted, as of today, he did not think that a plan was in place yet, and advised that he reviewed a version of the information on Monday the 15th (of what?), and a slightly different version on Tuesday, the 16th (of what?). Mr. Burgess explained that staff did have a chance yesterday to spend approximately five hours reviewing all the information in today�s package. He stated that he knew more about the assumptions that were employed, and the realities behind the numbers and how they were driven. Mr. Burgess noted the most significant thing that happened was the $80 million cash advance from this County, which will come with a written agreement defining what the money was for. He explained the process for the Intergovernmental Transfers (IGT); describing how the money would be leveraged and advised that the net of approximately, $80 million would be returned to JMH. Mr. Burgess stated JMH would retain that money in a restricted account reserved for the July IGT, at which time the process would be repeated. He noted this was a way to advance money that JMH would have received from the County at an accelerated rate.
In addition, Mr. Burgess noted the agreement with organized labor was another significant occurrence that contained elements agreeable to both management and labor, and translated into significant monies this year and next year, and on a recurring basis thereafter. He emphasized the importance of focusing on whether the system had enough cash to carry it through this year. Mr. Burgess explained the difference between cash and budget, and noted the cash referred to the University of Miami payment. He noted that UM was providing relief to JMH this year by accepting a lower monthly payment; however, next fiscal year, UM and JMH had agreed to negotiate on a higher payment amount. Mr. Burgess further noted a balloon payment that would have been due from JMH to UM would be forgiven this year and recaptured next year. He noted UM�s deferral of JMH�s obligations would buy additional time and would not waive anything.
Mr. Burgess noted other cash accelerations on receivables laid out by Dr. Roldan would come in as well as other cost report settlements, including Medicaid receivables. Pertaining to operating deficiencies, he noted a commitment by management to a reduction in workforce of approximately 590 full-time positions at JMH and approximately 650 full-time equivalents in contracted labor. He noted approximately $16.5 million was identified for workforce reductions on an annualized basis. Mr. Burgess noted he believed that JMH would have approximately $100 million by the end of the year as a cash balance. He pointed out that the fund balance for the annual period would reflect a positive balance; however, the actual fund balance would be significantly negative. Mr. Burgess stated the financial statements would show a positive fund balance because it reflected both short-term and long-term assets and liabilities; however, it needed approximately $130 million to fill the gap. He stated that closing the cash gap was a good plan that helped contribute to making that negative fund balance smaller than it would be; however, more needed to be done. Mr. Burgess noted JMH would have another large gap next year; however, he suspected the recovery efforts being implemented, including labor cost restructuring and workforce reductions, would impact that gap. He emphasized the need for JMH to fix its revenue side which encompassed various elements including the bad economy, nature of charity care, a non-sustainable business model, and other contributing factors. Additionally, he referenced the complexity of the relationship with UM, and noted this area also needed work. Mr. Burgess also noted the significance of improving JMH�s billing side.
Mr. Burgess stated that JMH had identified approximately $111 million of positive impacts, excluding labor agreements, which included would increase this amount to approximately $180 million of positive improvements to next year�s budget. He advised that dependent upon how the agreement with the consultants evolved, there could be a very expensive price tag that must be built into the numbers for next year. Mr. Burgess noted the management of payables was a real issue. He stated their method of handling and aging receivables and knowing what was in the pipeline, what were 30, 60, and 90 days overdue was very weak because of the way receivables were posted. He advised that approximately $175 million of accrued payables that had yet to be aged. Mr. Burgess also noted some JMH contractors were being paid on the 89th day, which might be understood by the larger vendor partners; however, the small vendors needed to be paid. Mr. Burgess noted comments were made that a plan would be available in 60 days; however, he suggested that the word �plan� be used carefully. He stated what was presented to the Board today was a list of thing to be done to close the gap, and in his judgment was not a plan. He recommended the County engage with staff from JMH on a bi-weekly basis to guide the evolution of a budget for next year rather than waiting for the plan. Mr. Burgess noted this problem would be fixed over a period of more than one year by developing different kinds of strategies. He advised that this was his best effort at assessing the plan.
Commissioner Diaz expressed his concern with the reality of the numbers provided and the Commission putting money into something that was not based on completely truthful amounts.
In response to Commissioner Diaz� concern, County Manager Burgess stated the numbers reflected in the reports would always be provided by the hospital�s staff. He noted the importance of information, however, he noted the importance of folks rolling up their sleeves and working. He recommended that the County lend some very talented people to help JMH. Mr. Burgess stated as the information comes from the hospital, County staff should be engaged more regularly and openly.
Commissioner Diaz concurred with Mr. Burgess regarding the importance of the relationship between the County and JMH, however, he noted he had a big problem with the not knowing the figures. He stated he just reviewed a series of questions that did not add up, so he would be requesting all kinds of information.
Mr. Burgess advised that the numbers are moving and evolving, and again noted the importance of the relationship with staff to know why they are moving. He noted he would rather the numbers be refined and moving in the right direction than not have them move at all. Mr. Burgess stated the real issue was data integrity, and noted this issue would be addressed with short-term, mid-term, and long-term solutions.
Commissioner Diaz noted he would like to have a component of County Administration to work alongside the JHM staff vetting those numbers as this moved forward. He noted he did not feel comfortable voting on this issue until he received some verification of the numbers.
Commissioner Sorenson noted part of the problem was that the true amount of receivables could not be predicted. She advised that a good Chief Financial Officer and a good team were needed. Commissioner Sorenson suggested a status report be provided at each Commission meeting, which would allow the staff to get the work done.
Commissioner Rolle concurred with Commissioner Sorenson�s comments; however, he noted he was concerned that something had impacted service delivery in the inner city. He asked for a written report identifying the cause of the impact, indicating whether the billing receivables played an important part in the decision to close the centers in District 2. Commissioner Rolle noted he was concerned with the affects of the long-term care and the status of the Request of Proposals.
In response to Commissioner Rolle�s question to Ms. Baker of whether she was buying into the $30 million, Ms. Baker replied that and more.
Commissioner Rolle asked what would be done differently with regards to marketing the Jackson Health Plan. He expressed concern that when things became difficult, the inner city centers were closed first. He pointed out that the Liberty Square housing project was one of the poorest in the County and noted this was the first clinic to be closed, followed by the Juanita Mann clinic. Commissioner Rolle asked that he be provided with a report showing numbers that identified these clinics as the most cost consuming clinics. He asked that this report also indicate whether the Board made the decision to close those clinics. Commissioner Rolle noted he wanted to ensure the delivery of services in the inner city.
Commissioner Gimenez noted he understood the County Manager to say that there might be some discrepancies, but this seemed to be a viable plan in terms of cash flow, which Mr. Burgess confirmed. He noted Chairman Moss� proposal to put JMH on management watch, have meetings with updates from the County Manager every two weeks, and take more drastic action if things got worse.
Chairman Moss noted he agreed with Commissioner Gimenez and noted Chapter 25A of the Miami-Dade County Code needed to be changed to include a mechanism that would pursue action if the need arose in the future.
Commissioner Jordan noted she too agreed with Commissioner Gimenez regarding Chairman Moss� proposal and would withdraw her item (Special Item No. 3). She noted with the County Manager�s report giving some comfort level on the feasibility of the resources being generated between $95 and $105 million, it appears to be a viable plan. Additionally, Commissioner Jordan noted the County Manager also reported that at the end of that period, there would still be approximately $130 million shortfall. She noted this Commission needed to come back to the table to look at expectations in terms of the growth in charity care and dwindling of resources and make some hard decisions. She stated a decision needed to be made whether to have a system that addressed resources or get the resources that addressed the system. Commissioner Jordan commended Chairman Moss for coming up with the idea of management watch and noted accurate information was critical. She asked that County support staff be imbedded into the hospital.
County Mayor Carlos Alvarez noted he was familiar with the term management watch; however, he asked the County Attorney how management watch would work in this situation with JMH. He questioned, since JMH was not a County department, what would need to occur to give the Administration the authority to carry out the intent of Chairman Moss� resolution.
Chairman Moss noted the management watch piece would be a condition of the cash advance in the Agreement. He noted this was more suited to this situation than the drastic actions being contemplated; however, he emphasized the need to implement language into Chapter 25A to address this type of problem in the future.
Commissioner Jordan withdrew Special Item No. 3 and requested she be listed as co-sponsor to Special Item No. 9.
In response to Commissioner Jordan�s inquiry as to whether the language in Chapter 25A could be strengthened to allow the Board to verify information provided by the PHT, County Attorney Cuevas advised that there was provision in the current language that audits could be performed by the County�s auditor of the Trust Board�s books and records. He noted Commissioner Jordan�s concern with ensuring that all information was verified would be addressed in the terms attached to the advancement of funds that those records are made available on a real-time basis.
County Attorney Cuevas read into the record Special Item No. 9, Chairman Moss� proposal.
In response to Commissioner Seijas� request for clarification on the intent of Special Item No. 9, Chairman Moss asked that discussion on that item be deferred to the next meeting.
In response to Commissioner Seijas� question of whether the MOE to the hospital would be increased in the County�s budget, County Manager Burgess stated no. He explained that the MOE was fixed formula payment that improved with the economy.
Commissioner Seijas expressed concern that JMH was accepting Broward County residents as patients and noted the need for an Interlocal agreement with Broward County addressing this issue, especially for the Burn Unit at JMH.
Dr. Roldan explained that JMH received some form of payments in some of the cases; however, because Broward did not have a burn unit, burn patients were automatically routed to JMH. She explained that a Chief Utilization Officer position was added at the Transfer Center to determine whether the services required for the patient could be provided at the hospital requesting the transfer. Dr. Roldan noted this new position had already saved the hospital between $2 million to $4 million per month.
Commissioner Seijas expressed concern that Broward residents were frequent patients at the Biscayne Imaging Center, and noted the PHT should address this issue to ensure they were paying patients. She recommended the Trust consider using consultants from the County�s pool to perform its audit services.
It was moved by Commissioner Rolle that Special Item No. 5 be withdrawn. This motion was seconded by Chairman Moss, and upon being put to a vote, passed by a vote of 11-0 (Commissioners Martinez and Sosa were absent).
PHT Chairman Copeland noted his organization embraced and understood the expectations of the resolution under Special Item No. 9 and looked forward to working with the County Commission. He expressed appreciation for the engagement to handle the difficult challenges that required all parties to work together. Mr. Copeland acknowledged Commissioner Rolle�s concerns regarding long-term care, the JMH Health Plan, and the Primary Care Centers� closings, and noted he would provide a response to those concerns.
Commissioner Rolle asked that Mr. Copeland�s response also include clarification as to whether revenues from the half penny tax were being allocated to the two hospitals to which costs were being allocated.
There being no further questions or comments, after Chairman Moss relinquished the Chair to Vice Chairman Diaz, the Board proceeded to vote on Special Item No. 9.
Each member of the Commission requested to be listed as a co-sponsor of Special Item No. 9.
At the conclusion of the vote, Chairman Moss resumed the Chair.
Commissioner Souto expressed concern with the excessive media coverage regarding the budgetary issues currently facing the PHT. He expressed his support for the actions taken today and proposed that going forward, the PHT be requested to make regular presentations before the Commission.
Chairman Moss requested that the remaining items on today�s agenda be deferred to the BCC Special Meeting scheduled for April 6, 2010.
Commissioner Heyman recommended the County Manager further solidify the definition of management watch as it pertained to the Public Health Trust. She then moved to withdraw Special Items 8 and 9.
Commissioner Gimenez noted he agreed with Chairman Moss� comments that revisions needed to be made to Chapter 25A at a later time; however, he recognized Mr. William Donelan from the University of Miami to address the issue of payments to the UM.
Mr. William �Bill� Donelan, Vice President of Medical Administration, University of Miami (UM), appeared before the Board and provided a brief overview of the nature of the 60-year relationship between the UM and Jackson Health System (Jackson). He noted that in 2004, the latest version of the Basic Affiliation Agreement (BAA) was executed, stipulating that Annual Operating Agreements (AOA) defining the services UM would provide to Jackson Memorial Hospital (JMH) be executed. Mr. Donelan explained that one dimension of UM�s relationship with Jackson was being a service provider through the AOA in the following categories: UM faculty physicians provide care, at Medicaid rates, to the uninsured patients covered under the Safety Net Mission of JMH; and compensation for the faculty effort involved in teaching and supervising the residents in training at JMH, which was. He advised that in 2008 AOA, the compensation for these services was $139 million, and that in 2009-10, UM absorbed a $10 million reduction in AOA payments without diminishing services to JMH.
Mr. Donelan advised that, in addition to caring for the indigent population at JMH, UM�s faculty physicians see 500,000 outpatient visits per year in University-owned and operated clinics on the Miami Health District Campus and other South Florida sites. He explained that the elective admissions of insured patients were in JMH because they were visiting UM faculty. Mr. Donelan noted UM agreed to defer, not forgive, $14 million of AOA payments that it expected to receive in a structured payment arrangement as negotiated in the County Manager�s Office in October 2009. He addressed the concern raised at a previous PHT and County Commission meeting regarding the difference between $14 million and $29 million, and concurred with the County Manager�s explanation given earlier in today�s meeting.
Mr. Donelan noted he felt it was important to note that this receivable deferral was on top of the $52 million in outstanding accounts receivable that the UM was currently holding from Jackson. Additionally, he noted the ENY Audit for Jackson�s FY 2009, revealed that the UM was holding the most receivables of Jackson�s payables; more than 20 percent. Mr. Donelan pointed out that UM had cash its own cash issues and would be unable to front this type of accounts receivable (AR) deferral forever and proposed making the AR deferral contingent upon some things. He noted the current JHS management team had shown interest in moving to a Graduate Medical Education (GME) Consortium, a refined approach under Medicare regulations. He explained that this would allow trainees to be distributed across hospitals of agreeing parties, would draw down more dollars from Medicare in support of the overall GME activities, and would allow training slots in the UM/Jackson Training Programs to be preserved, and would allow Jackson to eliminate payroll expenses that could be picked up at other UM facilities. Mr. Donelan noted this was an item worth at least $10 million per year that could be developed in the restructuring plan, and noted UM made its cash deferral contingent upon Jackson continuing to move with UM in the direction of putting this type of program in place. He noted the UM had not had the opportunity to explain its point of view on how it could help and what risk factors it felt as a result of JHS� collapse. Mr. Donelan noted Jackson would be different after its restructuring, in that there would be less access to the uninsured medical care services compared to that of the last ten years in this community. He advised that once JHS was stabilized, the question how to deal with the continuing need should be the main focus. He stated that no legislator in Washington, D.C. or Tallahassee was interested in funding to the problem of undocumented immigrant medical care, which was a special problem in the County.
Hearing no further discussion, the Board voted to defer Special Item Nos. 2-4 and 7 to the next County Commission meeting.
Commissioner Jordan noted she wanted to ensure JMH/PHT clearly understood that the items were being deferred for development of a mechanism to have in place and pointed out that this would not, in any way, change the management watch issue.
Mayor Alvarez recalled the process for County department placed on management watch in 1998; however, he requested clarification on what management watch meant in terms of dealing with the Public Health Trust. He acknowledged the Board�s desire for the County�s Administration to work hand-in-hand with Jackson�s Administration; however, he noted this would be a voluntary relationship. Mayor Alvarez noted Chapter 25 did not lend itself to �the management watch� as the County defined it.
Chairman Moss noted the voluntary relationship was tied to the money the PHT would receive as agreed. He noted the Board�s expectation was for the County�s Administration to consult with the PHT and JHS, assess what needed to be done and develop a plan that would be tied to the release of funds from the County. Chairman Moss noted the Mayor should indicate what he felt was necessary for the Administration to safeguard efforts and ensure things continued moving in the right direction. He added that Chapter 25A needed to be modified so if things did not work out, a mechanism would be in place to address the issue.
PHT Chairman Copeland noted he heard Chairman Moss� statements and looked forward to working with the County.
|
|