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!