Broward Health – Deja Vu, all over again!

Historically, Florida’s Broward Health was used a cash register for the politically connected where everything from lucrative land deals, insider supply & service procurement’s, to outrageous physician contracts given to cliques of gate-keeping physicians were the rule and not the exception for our public hospital.   Typified by a revolving door of politically appointed CEO’s more interested in their next position than in the mission of Broward Health as one of Broward’s 2 public health care systems, Broward Health thrived as a financial political base for the political aspirations of Florida’s governor’s office.

Then a few years ago, almost by accident, a politically naive chief financial officer was suddenly elevated to the position of CEO (see my previous article).  Not knowing any better, this professional CEO began to put the district on a firm financial footing for the first time in the hospital system’s history.  But because this financial CEO never could master the politics of the system, he failed to correct the legacy of the past misconduct quickly enough, and did not address the dangerous politics of the well connected physician contracts.  This was, in part, due to pressure from the politically appointed Board of Commissioners and the historically absent public oversight.  Instead, this CEO focused on financially strengthening the system and investing in quality health care system initiatives, again largely ignored by absent public oversight.

MoneySuckThe result was a whistle-blower complained to Medicare (OIG – Office of the Inspector General) about the excessive physician contracts at the system, and a federal investigation ensued.  The financial CEO was named in the complaint because he did not confront the improper direction from his political board, and failed to address the problems quickly enough.  In fairness, he was between the proverbial rock and hard place.  Soon you will hear about this OIG investigation because it is widely believed that it is coming to an end with a significant financial penalty in the tens of millions of dollars, against our public hospital for the misdeeds of past politically appointed boards and CEO’s.  A fine, we as taxpayers, must and will pay.

Recall that Broward Health was established many years ago as a tax supported public hospital system to serve the health care needs of Broward residents living north of Griffin Road.  Over the years, with substantial tax support, the system has grown to 4 hospitals, over 50 facilities including urgent care neighborhood centers, close to 8,000 employees and annual billings of close to 4 billion dollars (with a budget of over 1 billion dollars). From every perspective, it has become a substantial economic engine in our county.  Simply put, the money that goes to Broward Health generally stays in Broward – and that’s good.

But because of the governance structure of the hospital system, it essentially operates without effective oversight from those it serves, or the public that owns the system.  Its Board of Commissioners are appointed by the Governor, and so it is no surprise that the Board of Commissioners are either political operatives or simply the unapologetic result of political patronage with little or no relevant experience.

For much of the past year, Broward Health’s 7 member Board of Commissioners operated with only 4 and 5 members because the Governor’s office failed to timely fill vacancies.  3 of these members effectively orchestrated the financial CEO’s ouster and replaced him with a well-connected politically active physician through a sham recruitment and interview process.  2 of the 3 are political operatives, only recent Broward residents, and have no business or public policy experience.  In contrast, the leader of the 3, has an extensive but recent political pedigree – but no previous business or health-care experience.  It is noteworthy that this new CEO – has given tens of thousands of dollars to political candidates, committees and PAC’s in recent years.  It is not a coincidence that the current chair of the Board of Commissioners and the purported architect of the ouster is known as a prolific political fund raiser who maintains a number of political committees and PACs, which have benefited from the largess of the newly appointed CEO. Why else would the Board hire a person with no administrative experience running a hospital system?  It is déjà vu all over again!

We should all be nervous.

Innovative CEO NASK Forced Out, Politics Wins – We Loose!

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In September 2014, I began my Florida Broward Health series with my “Path to Professional Competent Leadership” article.  My “It’s Our Hospital” article followed in October as the second of a planned three article series.  My final series planned for December promised to discuss why Florida’s Broward Health protects physician’s income at the expense of providing health care – but then events in November and December turned Broward Health on its head. The CEO was forced out after an embarrassing and remarkably unprofessional public circus, insiders on the Board forced a physician contract that was privately opposed by the medical staff, two new political appointments were made to the board by the re-elected governor, and in what appeared to be a slick political maneuver, a new CEO was hired with no previous experience managing a hospital let alone one of the largest public hospital system in the country. Each is a story that needs to be told. One of my first resolutions this year is to do my best to tell these important stories.  The result will be a regular monthly Broward Health article, beginning with how and why Frank Nask was forced out as CEO.

In hindsight, it was perhaps inevitable that Frank Nask would be forced out.  His obvious competence as a financial manager of a 4 billion dollar hospital system was ultimately defeated by his inability to understand and cope with a politically appointed board in a public hospital system fraught with pockets of excellence and smothered by layers of incompetence. Although the board approved all of Mr. Nask’s proposals and recommendations throughout his tenure as CEO, his decision making was too often frozen by board level gossip, innuendo, and his irrational fear of denial.  While it was clear he had a vision for Broward Health’s future based on world class health care and real quality metrics far exceeding the requirements of Medicare, it was equally clear that he was unable to communicate that vision successfully to his board members in a decisive manner. As a result, a number of critical innovations and programs that he started will no doubt be put aside for wont of an advocate or uncomfortably delayed while the new CEO learns his job.

It was the inexperience of the board and the lack of vision of its members that failed to take the opportunity during the final year of Nask’s contract (expires on March 31st 2015)  to negotiate in good faith an extension together with an appropriate succession plan that would maintain organizational stability, programmatic continuity and a smooth transition. Instead they chose to advertise, interview, negotiate and hire the CEO of a 4 billion dollar hospital system in 30 days.  Nask successfully negotiated a severance package and on December 20th, 2014, the old boss was out, and the new boss was in.  Meanwhile, the organization is in shock – as well it should be.

As a backdrop and perhaps even as a contributing factor to the CEO change, a notable physician’s contract was in controversy.  No one could debate that Dr. Michael Chizner had received an overly generous contract several years ago which was, in part, due to pressure put on the board of commissioners by notable people like Wayne Huizenga.  And it was no surprise that it was one of the contracts that had to be renegotiated on the basis of fair market value.  What was a surprise was the Dr. Chizner apparently refused to negotiate and/or agree to a fair market contract and as a result was given notice of contract termination.  Chizner hired republican powerhouse Senator George LeMieux as his attorney and before you knew it – many members of the high-powered Broward Workshop turned up at the November Broward Health board meeting, telling the board how Dr. Chizner saved their lives (in the back of the room, the testimonies were being coordinated by an associate of Senator LeMieux).

While it is clear that Dr. Chizner is a gifted physician, many in attendance at the meeting shared with me their disgust and embarrassment at one of their fellow physicians parading his patients in front of the board to force a contract.  After all, saving people and getting them healthy is the job description of all physicians at Broward Health – and they do it every day.

Dr. Chizner’s circus was successful in that the board pressured Nask into re-offering a contract to him – essentially the same one Dr. Chizner refused to sign previously, but which now he accepted.  The new (old) contract based on fair market value reportedly reduced Dr. Chizner’s annual payments by over $600,000.  Certainly with three highly partisan republican appointees controlling the Broward Health board and the very republican Broward workshop behind Chizner, It was apparent that Nask’s severance package was tied to the re-offer of the Chizner contract.

With Governor Scott’s reelection came two new board appointments, both with impeccable republican political credentials and with little or no real-world business experience.  Is this and are they a harbinger of bad things to come?  I’m not so sure.  These new board appointments are interesting and a subject of a future article.

As usual, I’m out of space well before I am out of story.  I’ll revisit some of this and focus on the new board appointments in my next article.  So, until then – Happy New Year!

Broward Health – It’s Our Hospital

Florida’s Broward Health is about the numbers:  4 Hospitals, 2 trauma centers; over 30 health care and support facilities; 7,000-8,000 employees including close to 1,200 new hires annually; 1,930 physicians in more than 104 medical specialties; and a billion dollar budget (4 billion gross charges).  This article will focus on the Broward Health physicians.

BHMC-homeI thought Florida’s Broward Health’s well-earned reputation for corruption was overstated and based on outside political and moneyed interests.  I was wrong.  If anything, its history is understated, based on a small group of insider politically active physicians and what was in the past a placid administration installed to do little more than facilitate and guarantee physician payments and lucrative real-estate deals.  Those physicians mantra “It’s our hospital!”

Historically, any attempt to change this culture was met with swift political action from the Board of Commissioners for the District after a deluge of “insider” calls demanding that they get the administration back in line.  In fact, the by-laws of the District require the CEO to get board approval before many administrative actions – like the hiring or firing of some senior executives.  After all, the Board wouldn’t want one of their “friends” fired.

So it was remarkable that in June, the Board supported a standard fair market physician contract for the top grossing physicians which, in some case, substantially reduced the physician’s compensation.  Before you shed a tear for these physicians, many of these physicians still make close to a million dollars a year.  Imagine what it was before the adjustment.  Here’s how it happened.

Historically, when the administration wanted to renegotiate a physician’s contract – the physician immediately appealed to both the Board (typically through politically connected intermediaries and lawyers) and insulated and “friendly” senior staff (who would want to stay on the Board’s good side).  Thus too often, the administration representing the public’s interest would be on one side with everyone else on the other.

But this time, because of the unusual independence of most of the current board members, and the regulatory pressure to reduce health care costs, Frank Nask (CEO of Broward Health) brought a blanket physician contract to the Board for approval first which required all contracts to be paid at the 50th percentile regional fair market price for physician services based on an independent evaluation.  Some Board members, having been called by their “friends” rebelled, but in a long and somewhat bizarre board meeting, they ultimately agreed so the policy was set – and the fair market value contract was adopted even though a number of physician’s and physician groups threatened to leave the hospital system if the fair market value contract was imposed on them. In the end, the contract was imposed and no one has, as yet, left.

It is important that what could be perceived as the misbehavior of some Broward Health physicians is the unfortunate exception for a profession undergoing dramatic change.  On August 29th, the Wall Street Journal reported that “physicians are increasingly unhappy with their once-vaulted profession, and that malaise is bad for their patients”. Dr. Jauhar says in his book “Doctored” that many of his colleagues are struggling with the loss of their professional ideals becoming “impatient, occasionally indifferent, at times dismissive or paternalistic”.  “Today medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future”.

In a 2008 survey of 12,000 physicians, only 6% described their morale as positive.  Eighty-four percent said that their incomes were constant or decreasing. Most said they didn’t have enough time to spend with patients because of paperwork, and nearly half said they planned to reduce the number of patients they would see in the next three years or stop practicing altogether.

Mr. Nask and Broward Health are keenly aware of the importance of and committed to both physician and patient satisfaction as a measure of the quality of health care to the community with a renewed system emphasis on surveys, analytic scores, and data mining.   Notably, Mr. Nask is modelling a modification of his fair market physician contract to include a committed level of service expressed in independently tracked physician minutes with the patient guarantees and non-clinical “paper-work” assistance.  If successful, such a model for health care delivery could serve the dual purpose of improving physician morale in their profession as well as the quality of health care being delivered to the patients of Broward Health.  We’ll see.

The next article in my Broward Health series will discuss why Broward Health protects physician’s income at the expense of providing health care?”  You’ll be surprised and perhaps more than a little angry at the answer.  Hint: it’s about the “Benjamin’s”!

Broward Health Sets New Path to Professional And Competent Leadership

This the first of three feature articles about Florida’s Broward Health, our safety-net hospital, the role it plays in our community from its leadership, its bumpy history, its 8,000 employees, its 4 billion dollar budget, its health care decisions, its physicians and of course the taxes we pay to it and what we get in return. It is a story of pockets of excellence and layers of incompetence seasoned with moneyed “sub-rosa” political intrigue, greed and some remarkable acts of courage and character. An insider’s story told from the outside where the good news is that Broward Health could be entering a time of great challenge and opportunity with exactly the right leadership and resources to become one of the finest public hospital systems in the country. A public health care system of which we can all be proud – provided it can avoid its colorful past missteps.

Nask

I begin with an introductory profile of Frank Nask, the chief executive officer of Broward Health. You might see him around town, but you would not know him if you did. He is quiet, unassuming and politically shy. He does not like nor crave the spotlight. His personality belies his sharp mind and quick wit. Supremely competent, he was recruited to the position of chief financial officer in 2008 from senior leadership in a lucrative nationally recognized turnaround healthcare crisis management firm to address serious financial problems at Broward Health.

Over his 35 year healthcare career, Mr. Nask has managed hospitals and groups of hospitals (mainly in the Northeast) always working for and with senior health care business leaders and hospital system boards where important strategic decisions were made through collaboration. But none of that experience prepared him for the experience of dealing with a politically appointed public hospital board whose primary role is to provide community policy oversight, and not strategic support to senior leadership.

Broward Health’s board of commissioners are appointed by the Governor typically based on political criteria more for their fund raising abilities and party affiliation then health care or business experience. While most appointees certainly want to do a good job and are motivated to represent the community faithfully, too many act as though their appointment to the hospital board magically vested them with experience, knowledge and perspective they previously lacked. The completely predictable result was that Broward Health’s previous boards too often made critical and important business based on political considerations.

The selection of the Hospital’s chief executive officer was generally an example of political as opposed to business calculations. So in 2010, when upon the sudden departure of the previous chief executive officer under unusual circumstances, the position was offered to Mr. Nask – he was justifiably skeptical. He wasn’t comfortable in politics and the position was political – but board members insisted he accept an interim position because of his remarkable success at stabilizing the system’s financial condition – and who better to be in charge during a transition period then the man watching the money? He accepted, and soon after he was asked to accept the position on a permanent basis.

It’s easy to overlook the growth and accomplishments of Mr. Nask’s stewardship because of his low key style and tendency to generously credit his team for the accomplishments, but the successes speak for themselves and could not have occurred without leadership. Among these successes are (but not limited to):

  • Increased the net assets of Broward Health by over 300 million dollars
  • Increased employment by over 250 full time positions
  • Handled more than 50 thousand more ER visits
  • Invested more than 276 million dollars in capital improvements in four hospitals
  • Retooled the non-profit Broward Health Foundation which then raised more than 12 million dollars of charitable giving since 2011 and is projected to receive an additional 9 million dollars in 2015.
  • Created the Broward Health Quality division to monitor and improve the quality of health care provided to patients which has resulted in improvements in all quality core measure scores.
  • Increased the intern and fellowship programs establishing Broward Health as a full teaching hospital system training the healthcare professionals and physicians for our community’s future.

The awards and accomplishments that have piled up for Broward Health in the last few years are too many to list here, but the reason they have is a new attitude at Broward Health that puts the patient and community first. As Mr. Nask is often quoted “Broward Health doesn’t have stockholders, we have patients!”

Well, as usual, I’m out of space. The next feature will talk about how the Broward Health cash register for well- connected insiders has been shut down and replaced with fair market value rules. What a concept for the fifth largest health care system in the country!