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.

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”!