Be Careful With Public Records. By Geniusofdespair

I read John Dorschner's article in the Miami Herald about reducing the number of members of the Public Health Trust from 17 to 7. Dorschner left out how each member of the commission voted. That information is very important to me.

How the Commissioners stack up is my shortcut to figure out how good or bad an item is when I don't know the issue. I see which side the REALLY BAD commissioners are on. In this case, the way the commission voted tells me nothing. You have some of the worst and best on both sides.  I have to assume it is bad with Bell, Martinez and Diaz. But why is Sally Heyman and Rebeca Sosa voting with them? And why is Barreiro on the other side? Maybe he is voting right because he is up for reelection? Anyone have an opinion on the Public Health Trust Membership? I don't want to have to watch the video of the meeting, that is always self-torture.

Anyway, when I went to check the County Website because of Dorschner's omission,  I found it interesting that the draft minutes yesterday are so different from the draft minutes of today on this item. Had I not double-checked today, I would have given you bad info. Here are screen shots of both:

Screen shot I took yesterday County Commission draft minutes.

Screen shot from this morning same website.

How could yesterday's entry be so wrong? even the seconder is incorrect.

Slammed by Aetna Health Insurance: who says we don't need health care reform? by gimleteye

I had a curious experience last week, contesting a health care bill for a CAT scan. My policy with Aetna covers my family. I'm an individual buyer; in other words I don't benefit from buying within a pool like a business or government. I pay close to $1000 per month, with a $5000 deductible. I've never needed-- until recently-- to spend on health care more than the small fortune it costs to insure my family from catastrophe.

Recently I discovered the need for a small procedure, a hernia repair. After a round of calls to find a provider qualified by Aetna, I matched up with a doctor at Jackson and began an uncomfortable round of visits. My doctor ordered a CAT scan. I didn't ask how much it would cost. I had other things to worry about, like my health and believed the cost would be covered or I would owe a reasonable expense. What I discovered was a shock. (click, 'read more')

The bill from Jackson for the CAT scan was $7000. My jaw dropped. Below the line, there was a debit of $3500. It was called a "contract adjustment". Whatever that means, it left me holding a bill for about $3500. I made several phone calls to Jackson to attempt to discuss the bill. It took me more than an hour to find a living person, who claimed to have no direct knowledge how to contest a bill, but finally directed me to a mail address for my outraged "to whom it may concern" letter. A month passed, and still no response.

In the meantime I also called Aetna. That also took more than an hour to obtain a living person with a passing knowledge of how to register a complaint. A few weeks after my phone call to Aetna, a letter arrived by mail notifying me of a time and date for my "Level Two Appeal" conference call. Three phone calls later, I was able to verify the call-in number.

At the appointed time, last week, I had my phone call with Aetna. In addition to the call moderator, there were three other Aetna employees on the call. The call moderator quickly introduced the Aetna participants. She said, after the call within seven to ten business days I would receive a letter informing me of the committee's decision regarding my appeal. I asked for a phone number and name I could call, to follow up. The moderator refused to give me any phone numbers or even to repeat the names of the people on the call. She told me, if you have a question later you can call the 800 number for individual service. I explained that I really wanted someone I could speak with. So much, for that.

I laid out my case to Aetna: that I needed the CAT scan, it was ordered by an Aetna qualified physician at Jackson, that I had never asked before hand what the cost would be, but that I never expected it would be $7000 and $3500 out of pocket or I would have checked other CAT scan imaging services. In fact, after receiving the bill, I did check around and discovered I could have had the CAT scan performed for $250. There was a silence at the end of the line.

The moderator asked me, "Why didn't you try to find a lower cost provider before getting the CAT scan?" I was shocked. "Um," I answered, "I was actually focused on not feeling well. I was relieved I was seeing a doctor who was an Aetna provider and I assumed that Aetna, my health insurance company, was using the same skill set to qualify imaging costs for a CAT scan as it did to qualify its contractual terms with doctors." Silence. When the moderator responded, it was along the lines that I was at fault. In other words, I should not only pay $1000 a month, and be certain that any health care provider is inside the Aetna network, but I should not also assume that I will have a reasonable charge for imaging or testing even if the services are provided within the same facility or hospital as the doctor.

Later, I wondered how I could be at fault when I have paid nearly $12,000 annually for health insurance, over many years for which I have drawn no benefits. And I wonder how it is even possible to have to cough up another $3500 or $7000 for a CAT scan. There are nearly 80 million CAT scans in the United States per year. I know that this exorbitant bill is how the health care system manages to cope with the enormous number of Americans who cannot afford any of the medical services they need. But if everyone who received a CAT scan DID pay their $3500 bill (I assume I haven't been singled out, just because I'm a good credit risk), then the fully assessed value of CAT scans alone in the United States adds up to more than $30 trillion. I lost track of reality, or am I bad at arithmetic or is the health care system that the Tea Party rails against, insane, or is it the Tea Party'ers who have lost their minds.

I am waiting for the response to my "Level Two Appeal" and, naturally, instructions should I care to push the appeal further up the Aetna food chain. I would invite any member of Congress-- who have the privilege of a health care plan that is gold plated in comparison --to try out Aetna; and I don't mean by taking campaign contributions from the insurance industry.

Carlos Migoya wants the Public Health Trust Post. By Geniusofdespair

According to the Ricker Report and Miami Today, Former Miami City Manager Carlos Migoya said he is considering taking the job vacated by Enedia Roldan. I wonder what George Burgess thinks of his competition? Out of the two, I vote for Migoya. He would stand up to Governor Deadhead Scott and the County Commissioners. Burgess would just try to broker a deal...as always.

Apparently in Miami Dade County, you need NO hospital experience to run a hospital empire.

Update: On My Earlier Post on Rolle and The Public Health Trust. By Geniusofdespair

I said 3 ideas for a board to oversee the Public Health Trust were being floated at the County Commission today. According to the Miami Herald:

Commissioners said they supported instead the idea of a ''management watch'' in which the county would closely watch the public health system but not at this time interfere with its Public Health Trust.

That sounds pretty dumb. Par for the course.

Dorrin Rolle: The Kiss of Death for Financial Health. By Geniusofdespair

County Commissioner Dorrin Rolle for years was the president and CEO of JESCA (The James E. Scott Community Association) making $190,000 a year (see first graphic). He stepped down not long ago under fire. JESCA filed for bankruptcy 8/05/2009 (second graphic).

County Commissioner Dorrin Rolle is ALSO a Board member of the Public Health Trust, overseeing Jackson, which is now in financial melt-down mode.

I already wrote about the futility of the County Commission replacing Jackson's Board with yet another Board but the idea won't die. There are 3 proposals to replace the current Board at Jackson with a new Board that will be considered today at the County Commission. In a bizarre twist Dorrin Rolle will be voting to replace himself (for incompetence) since he is on the existing Board. I don't even trust him to do that. It is painfully clear that he is inept at management decisions. Hasn't he done enough damage? Personally, I don't want him voting on anything.

Here is my advice: If you want a good Board: Don't let the County Commission have a vote on the members. All 3 proposals in consideration today have the County Commission appointing some of the members of the NEW Board (the best proposal of the 3 has them them appointing the least).

It is bad enough that Dorrin Rolle has a hand in a $7.4 billion dollar county budget when he can't even get a handle on 2 non-profit, one of which was paying him almost $200,000 a year that it clearly couldn't afford.

Should there be an Oversight Board Over the Public Health Trust? By Geniusofdespair

The current Board of Trustees of the Public Health Trust consists of the following members:

Chairperson John H. Copeland III (pictured), Vice Chairperson Angel Medina, Jr., Secretary Georgena D. Ford, R.N., Treasurer Marcos Jose Lapciuc. Trustees: Stanley H. Arkin, Jorge L. Arrizurieta, Gladys Ayala, Esq., Rosy Cancela, Ernesto A. de la Fè, Joaquin del Cueto, Abraham A. Galbut, Saif Y. Ishoof, Esq., Dorrin D. Rolle, County Commissioner, Judy Rosenbaum, Ed.D., Sen. Javier D. Souto, County Commissioner, Martin Zilber, Esq.

Did I care if the County Commission replaced or put an oversight board over these men and women yesterday? Nope, I didn't care one iota. A new bad board to replace an old bad board is a neutral move. I wrote about Jackson in June 2008 raising some yellow flags. The Commission rejected the idea put forth by the Vile Natacha and the Mayor to appoint a new Board probably in a vote of confidence to Rolle and Souto. The Herald said. The Commissioners rejected it mostly because they saw it as a power grab by the Mayor, who would have made the appointments.

The real state of the economy: Jackson Health System's bottom line ... by gimleteye

The unanticipated $224 million shortfall in the Jackson Health System budget has triggered a reaction by county government: we'll take you over. Jackson spends $85 million a month on salaries and could run out of money by this spring. The sponsor of the proposal is queen of unreality; YMCA no-show employee and county commissioner Natacha Seijas. I don't have much kind to say about the fiscal responsibility of the Public Health Trust. In The Herald the trustees expressed "shock" at the county proposal. Shock? On the other hand, replacing them with seven political appointees whose own appointments depend on the unreal world of county commissioners?

The real world problem did emerge in today's front page story. A trustee, Angel Medina Jr. (area president of Region Bank in South Florida) described the problem as "a lack of funding for a growing community need exacerbated by the current economic environment in our community." Let's try to shine that up a little bit: we are in the midst of a Depression only alleviated by the time-release capsules of trillions of dollars in federal taxpayer bailouts. The Depression, triggered by the fraudulent underpinnings of the housing boom-- that wrapped up lowly county commissioners, their campaign contributors, the banks like the one Medina ran for Regions, the Engineering Cartel and Growth Machine supply chain feeding into Wall Street financial derivatives-- means that tax receipts from real estate transactions are massively reduced at the same time that the shadow unemployment rate in one of the nation's poorest counties is pushing over 20 percent.

The sick hospital that cares for Miami's disadvantaged is an accurate reflection of a sick economy. The Miami Herald needs to write that story. The elected officials who know the extent of the sickness-- ie., enormous deficits that will, at some point, have to be funded by increased taxes-- have been wishing, praying and hoping that demand for all those platted subdivisions and condos will be filled with eager and happy buyers leaning on home equity lines of credit to finance the pool furniture. Ain't gonna happen. No Hail Mary passes. The frickinn chickens have come home to roost.

Jackson Health System: The Superbowl of Errors ... by gimleteye

How does an entity employing 12,000 people-- one of the most important employers in the region-- get its budget deficit so wrong: apparently four times greater than it had anticipated? It is losing $14 million per week. Heads should roll: but whose? I suggest taxing the Florida Marlins.


Posted on Wed, Feb. 03, 2010
No easy fix for troubled Jackson Health System

BY JOHN DORSCHNER
jdorschner@MiamiHerald.com

Miami-Dade's healthcare leaders agreed Wednesday that the county dare not let the beleaguered Jackson Health System fail, but no one yet has a clear idea of how to keep it going.
``This is the safety institution for all of South Florida,'' said Brian Keeley, chief executive of Baptist Health. ``Everybody counts on it. I can't imagine the County Commission letting it fail.''

``I believe the community will figure out a way to make this work,'' said John H. Copeland III, chairman of the Public Health Trust, which governs Jackson. ``But there are communities that have shut down safety net hospitals. It's hard to imagine that happening with Jackson, but it's within the realm of possibility.''

These comments came a day after Jackson executives released revised figures, forecasting that the public system will lose $229 million this fiscal year. It is losing $14 million a month. As of Nov. 30, it had $99.2 million cash. That works out to 22 days of cash on hand to pay bills. At the rate it's losing money, Jackson will be flat broke by the end of June.

In fact, serious troubles will happen well before that. The system needs about 16 days of cash -- about $70 million -- just to meet biweekly payroll for its 12,000 employees.

Jackson Vice President Christopher Bayer said that the county has agreed to advance Jackson cash to meet payroll, if necessary.

``That's a big commitment,'' said Keeley at Baptist, because payroll is more than half the costs at virtually all hospitals.

But it doesn't solve Jackson's persistent problems, shared by many public hospitals across the country -- serving growing numbers of uninsured while seeing its tax revenue shrink.

``We need help,'' said board member Martin Zilber. ``I don't think that the county can do that much,'' since it's fighting its own budget woes. ``We need federal help. We need state help. Somebody needs to step up to the plate and pay us.''

The Public Health Trust has voted to seek the start of a special hospital taxing district to have access to increased funding, but Mayor Carlos Alvarez and county commissioners have yet to show any enthusiasm for the idea. Even if they did, the initiative couldn't get on the ballot until November. If approved by voters -- a big if -- it would not be until 2011 at the earliest that funds would start flowing.

On Wednesday, Commissioner Rebeca Sosa released a letter to the mayor asking detailed questions about how the county will respond to Jackson's crisis:

``What is our legal responsibility to them? What would happen if the PHT or the hospital were to declare a financial emergency or become insolvent? It is of paramount importance for us to know specifically what is the mayor's and the county administrator's plan and authority to address critical cash flow shortages. . . . We cannot allow time to pass by and see our only public hospital fall apart piece-by-piece.''

County Communications Director Victoria Mallette said neither the mayor or county manager were available. In an e-mail, she wrote: ``Jackson is a critical part of our community's safety net and public health infrastructure. The county is providing $160 million in support to Jackson in the current fiscal year. We will continue to work with Jackson's CEO and Board on strategies for moving forward.''

Copeland said he was confident county commissioners will help maintain Jackson though none have stepped forward till now. ``I think the problem just now is becoming into crystal clear focus, and solutions will be forthcoming.''

Elsewhere, hospitals treating the poor and uninsured have closed. The Martin Luther King Jr.-Charles R. Drew Medical Center in Los Angeles was the most spectacular example, closing in 2007 beset by massive financial losses and accusations of poor quality care. Last week, St. Vincent's in New York City shut down its inpatient services and the governor advanced $6 million so it could meet payroll.

In Atlanta, Grady Memorial was near collapse in 2007, rescued only by a new infusion of government cash. It made national headlines last year as it paid for immigrants to go back to their native countries rather than fund their dialysis treatments. Jackson also is stopping payments for outpatient dialysis.

On Wednesday, Chief Executive Eneida Roldan said, ``We need to start doing things differently. . . . We need to do more with less. We need to be leaner as an institution. We need to tell our constituents that Jackson can't be the all-in-all. We know there are going to be cuts in services.''

Public Health Trust member Zilber said that for some years Jackson had warned that the the system's finances were going down hill, but it was only now, ``in an emergency situation,'' that political leaders were beginning to take note. `If we have to deny service to hundreds and thousands of citizens, they won't be able to ignore it.''

Vice President Bayer said restating financials was not a matter of failing to collect money from insurers and patients, but ``was more of a timing issue.''

Having to see more uninsured patients meant the hospital collected $25.90 of every $100 billed in fiscal 2009, rather than the $29.60 of every $100 it collected in 2008.

``We should have been booking this throughout the year,'' said Bayer of the change, but instead it waited until Tuesday to announce that the loss for 2009 was $203.8 million, rather than the earlier reported $46.8 million.

Because of discounts to insurers and uninsured patients, all hospitals collect a fraction of what's billed. Paul Goldberg, a veteran hospital consultant, said facilities generally collect 10 percent to 30 percent of gross charges, depending on how much they inflate gross charges, the percentage of uninsured and how well they're able to bargain with insurers.

``There are no reliable industry benchmarks in this particular area,'' Goldberg said. The key is for administrators to keep close watch on how much money is really coming in.

Linda Quick, president of the South Florida Hospital and Healthcare Association, said some Jackson services were invaluable to the entire region, such as its trauma center, its spinal chord injuries program and its burn unit -- all of which attract patients from many areas beyond Miami-Dade.

``And then there's its importance as the teaching hospital for the University of Miami,'' Quick said. ``These things are important to the whole community.''

What's With That One Cent Sales Tax to Jackson. By Geniusofdespair

(Hit on images to enlarge them)
South Florida Business Journal writers, Brian Bandell and Oscar Pedro Musibay, have been writing about Jackson Memorial Foundation. Why haven’t I been sending you to these articles? Because they are not online. This is one publication that doesn’t let you read online. It is a shame, this is shaping up to be a good story.

First is, how the hell did Michael Swerdlow get to be director? I have written a lot about him before. Put his name in the search at top (left hand corner of this page) to get some info on him. In any event, even though the Journal says he is a director and others, he (and the others they mentioned) are not on Corporate papers, which say that James Champion, Alan Diamond, Abel Holtz, Rolando Rodriguez and Eugene Conese are the officers.

If you hit “read more” you will see what the articles were about. Remember Jackson's The Public Health Trust -- Dorrin Rolle is a diirector -- has almost a two billion dollar budget mostly from our tax dollars — a one cent sales tax. So this “Arm” of the Jackson Kingdom should be of interest to you, especially since “Miami-Dade County Inspector General Chris Mazzella has said the trust should have followed county rules, which require the management agreement to have been publicly bid.” Look at these graphics I dug up, above, from their 2005 990 Tax Return. The Business Journal calls the Foundation the money making arm of the Hospital (it looks like they know how to spend our money on losers — they hosted 4 events in 2005 and lost over a million and half on them). On the 2005 990 they had $9,859,536 of which $9,222,308 was from direct public support. The remainder of $637,228 is from Government Contributions. I really don’t see them making any money. I do see them spending plenty of it. I found it interesting that a woman with the name “Arriola” is on the Foundation tax return for 2005. I don't pretend to know what is going on here.


Friday, June 20, 2008
Doubts cloud Jackson's realty idea
Brian Bandell and Oscar Pedro Musibay
The fundraising arm of Jackson Memorial Hospital and the University of Miami are considering a joint venture to develop a mixed-use project anchored by a hotel on county land.

In a separate proposal, the hospital would pay the Jackson Memorial Foundation to manage and attempt to upgrade its retail space.

Foundation director Michael Swerdlow, a prominent South Florida developer, is leading the effort and providing counsel on the real estate mechanics. However, a board member for the Public Health Trust of Miami-Dade County, which oversees the hospital, said he is outraged by the retail plan, and some real estate experts say aspects of the retail proposal are unusual.

Under the plan, the Public Health Trust would grant a $1-a-year lease of the vacant hotel site to the foundation so it can attract a developer for the mixed-use project. The project may involve a joint venture with UM, which would share the proceeds with the hospital and the foundation.

and:

Friday, June 27, 2008
Hospital foundation's no-bid negotiation to trigger scrutiny
Brian Bandell and Oscar Pedro Musibay
Jackson Memorial Foundation's no-bid negotiation to build a hotel and manage Jackson Memorial Hospital's retail may require it to pay taxes on real estate-related revenue and trigger federal government scrutiny.

The foundation, the hospital's fundraising organization, has proposed the development of a hotel on hospital property and manage its existing retail.

The details of the agreements are still being worked out, but the Public Health Trust of Miami-Dade County, which oversees Jackson, has voted to negotiate exclusively with the foundation to achieve both tasks. The foundation would be paid to manage both projects, with the profit going back to the hospital, according to interviews, and foundation and trust documents.

Nonprofit expert Dean A. Zerbe, former senior tax counsel for the U.S. Senate finance committee, said federal officials would be interested in the foundation's new direction.