john-degroot.com

Johns vs Whores

John deGroot — Wed, 16 May 2012 13:37:06 GMT

   What Floridians don’t know
      (With healthcare, ignorance is not bliss!)

     Florida Legislature Campaign Contributions*
   Healthcare Industry+
Total               Democrats    Republicans
$84,992,981  $13,452,166  $71,470,815
Percentage    16%                 84%

*2000 through 2012
+Physicians, hospitals, health insurers, drug
companies

The Horror*

John deGroot — Fri, 11 May 2012 12:56:35 GMT

Why Florida Hospital Administrators

     Deserve Front Row Seats in Hell

Florida Emergency Department Charges

                Patient Severity
                Minor
                Avg. Charge                        $563
                Uninsured                          $461
                Low/moderate
                Avg. Charge                        $935
                Uninsured                          $846
                Moderate
                Avg. Charge                        $1,939
                Uninsured                          $1,895
                High – non-immediate
                Avg. Charge                        $5,169
                Uninsured                          $5,057
                High – immediate
                Avg. Charges                      $8,734
                Uninsured                          $7,904

                    SOURCE: Agency for Health Care Administration

*Although the real horror is that so few thought leaders care.

Test Your Health Care IQ

John deGroot — Thu, 10 May 2012 15:56:12 GMT

         True or False
1. A growing number of residents with minor medical issues
    are flooding Florida’s Hospital Emergency Departments. (True – False)
2. The cost of Emergency Room care has increased at a rate far
     below that of the consumer price index. (True – False)
3. Political leaders are correct in maintaining the nation’s health care
    system is market driven. (True – False)
4. Florida hospitals are suffering major revenue losses. (True - False)
5. World class health care for ALL Floridians is one of the primary goals
     for Governor Rick Scott and the Florida legislature. (True – False)
NOTE: The following post contains additional helpful hints for the seriously stupid, which includes the average Florida elected official, thought leader and journalist. JKdeG

Stuff for the Stupid...

John deGroot — Thu, 10 May 2012 15:55:51 GMT

Florida Health Care Trends

      Florida Hospital Adjusted Admissions
            Total Versus Surplus Profits
                                 2005            2010
Adjusted Admissions     3,396,533         3,807,304      12%
Florida Hospital Profits  $1.5 billion      $2.3 billion    51%
Per Adj. Admission         $458                 $618              35%

            Florida Emergency Departments
         Total Visits Versus Average Charge
                                 2005             2010          %
Severity
Minor                              654,751             376,012      (43%)
Avg. Charge                     $449                  $563            25%
Low/moderate               1,399,400           773,097     (45%)
Avg.Charge                      $995                  $935           (6%)
Moderate                       1,447,060           2,064,791    43%
Charge                            $1,571                $1,939         23%
High – non-immediate  726,782              1,455,619    100%
Avg. Charge                    $2,764                $5,169         87%
High – immediate           224,109             506,206       126%
Avg. Charges                   $3,967                $8,734        120%
TOTAL VISITS                   4,452,102          5,175,725    16%

SOURCE: Agency for Health Care Administration

Dystopian Metaphor - #1

John deGroot — Wed, 09 May 2012 14:48:05 GMT

    Royal Flush?

     Marie Antoinette        Zachariah P. Zachariah
  My on-going blog thesis is simple enough:
The increasingly unfathomable complexity of our daily lives has resulted in a paradigm shift from Alvin Toffler’s Future Shock to Future Hysteria.
   Future Shock, as Toffler wrote in 1970, is the result of “too much change in too short a period of time” – which spawns a rising tide of shattering stress and disorientation” in both the individual and society.
    That was then.
    And now?
    Today’s hairless ape is drowning in a mega tsunami of data, with the bewildering Known Unknowns of the 21^st Century having reached quantum proportion.
    All of which explains the current (and growing) deluge of dysfunctional cultural anomalies like:
    Government as the enemy.
  Fear of the educated elite.
    When excess equals success.
    The adoration of mediocrity.
    How the poor have it coming.
    The addictive rapture of childish superstition.
    Jingoistic nationalism as a response to a global economy.
    All of serves an introduction to the first in a series of Metaphors From Dystopia.
    Like:
A Fort Lauderdale physician’s gated $3.2 million residence boasting six bathrooms -- which represents more places to crap under one roof than all of Versailles prior to Marie Antoinette. JKdeG.

A battle for hearts and $ - Part #2

John deGroot — Tue, 08 May 2012 14:12:02 GMT

Talkin' Real Heart Stoppers!

   First, there's the staggering "spread' between the sticker price for various heart procedures over their cost.
   Because your average uninsured heart patient is legally responsible for the full amount of the sticket price for his care.
   And then...
   The average cost of a Medicare insured cardiology patient at Broward General’s Heart Center of Excellence is 23% higher than the average for a cardiology patient at Holy Cross or Memorial Healthcare.
   Not that any of the seven politically appointed Board of Commissioners governing the North Broward Hospital District have a clue about any of this.
All of which makes them major policy-setting bozos.

             Medicare Insured Heart Patients
                               FY 2010
Broward General
Heart Center of
Excellence                         Patients        Avg. Charge     Avg. Cost
Cardiology                            583                 $34,303            $9,748
Cardiovascular Surgery    294                 $119,287         $30,794
Holy Cross
Jim Moran Heart
And Vascular Center      Patients        Avg. Charge     Avg. Cost
Cardiology                            1,185             $33,248            $7,542
Cardiovascular Surgery    559                 $148,323         $31,205
Memorial Health Care
Cardiac & Vascular
   Institute                            Patients        Avg. Charge     Avg. Cost
Cardiology                            2,228             $35,353            $7,412
Cardiovascular Surgery    781                 $81,441            $26,637

Source:
Data supplied by hospitals to the American Hospital Directory

Seven Chiefs - One Indian

John deGroot — Mon, 07 May 2012 12:44:33 GMT

      Data for the OIG

The Heart Center of Excellence staff of eight physicians, District cost and their patient visits for FY 2011 at Broward General Medical Center. (Seven of the eight are Medical Directors)
                                                        Patient   District                Cost
                                                        Visits       Cost                      Per Visit
Dr. Frank Cantinella#                620         $486,016              $739
Dr. Michael Chizner+^              4,714     $1,528,183           $324
Dr. Kenneth Herskowitz+#      949         $602,954              $635
Dr. Richard Howard +^             1,379     $699,630              $507
Dr. Violet McCormack+^          2,184     $1,341,088           $614
Dr. David Perloff*^                    NA           NA                           NA
Dr. John Rozanski +^                 7,014      $785,321              $112
Dr. Ashok Sharma+^                 9,183      $1,788,715           $195
TOTAL*                                         21,123    $7,231,583           $342
*Excluding Dr. Perloff
+Heart Center of Excellence Medical Director
# Heart surgeon
^ Cadiologist
Source: North Broward Hospital District dba Broward Health
http://www.browardhealth.org/?id=205&sid=2

A battle for hearts - and $ (Part #1)

John deGroot — Fri, 04 May 2012 13:22:56 GMT

   NOTE: More data involving major public policy
   issues about which the North Broward Hospital
   District's governing Board of Commissioners is
   totally uninformed. JKdeG

                                      2005          2011             %
North Broward
Hospital District
Heart Center of
   Excellence*
Open Heart Surgery            272                360              32%
Catheterizations                  1,918              2,028           6%Angioplasties                       702                905              29%
Holy Cross
Jim Moran Heart and
   Vascular Center
Open Heart Surgery          414                 535               29%
Catheterizations                 1,596             2,443            53%
Angioplasties                     0                     0                    0%
South Broward
Hospital District
Cardiac & Vascular
   Institute**
Open Heart                         576                 350             (39)Catheterizations                 4,544              4,349          (4%)Angioplasties                       0                    1,628           !!!

*Opened in 2005
**Memorial Regional and Memorial West

Source: Broward Regional Health Planning Council

WTF Redux?!?!?!

John deGroot — Thu, 03 May 2012 13:06:54 GMT

Heart Center of Excellence

Where Every Doc’s A Boss

      Located at Broward General Medical center, the Heart Center for Excellence suffers from a remarkable infestation of Medical Directors.
      Eight bosses and counting, given how the Heart Center opened in 2005 with only one Medical Director.
      Facts are:
      South Broward Hospital District – dba Memorial Healthcare System
      Cardiac & Vascular Institute – two locations – two Medical Directors
      Open Heart Procedures: 350
      Heart Catheterizations: 3,493
      Angioplasties: 905
     North Broward Hospital District - dba as Broward Health
      Heart Center for Excellence – one location – eight Medical Directors
      Open Heart Procedures: 360
      Heart catheterizations: 2,028
      Angioplasties: 1,628
      The Broward Heart Center’s eight doc roster of Medical Directors and their 2011 compensation include:
       Dr. Michael Chizner – Medical Director Heart Center of
            Excellence - $1,528,183
       Dr. Kenneth Herskowitz – Medical Director Cardiovascular and
            Thoracic Surgery - $602,954
       Dr. Richard Howard – Medical Director Cardio Vascular Lab-
             $699,630
       Dr. Violet McCormack – Medical Director Cardiovascular
             Catheterization Labs and Interventional Cardiology-
             $1,341,088
       Dr. David Perloff – Medical Director Cardio Rehabilitation - NA
       Dr. John Rozanski – Medical Director Clinical Research -
             $785,321
       Dr. Askok Sharma - Medical Director Noninvasive Cardiology -
              $1,788,715
       TOTAL* District compensation for FY 2011 - $6,754,891
       *Excluding Dr. Perloff

WTF?!?!?!

John deGroot — Wed, 02 May 2012 12:27:03 GMT

One Doc Listens,

The Other Cuts*

*More stuff the governing board of commissioners at the North Broward Hospital District doesn't understand.

Dr. Chizner Dr. Herskowitz

            Dr. Michael Chizner
            Diagnostic Cardiologist
                Medical Director
                Heart Center of Excellence
                Broward General Medical Center
                Annual Compensation - $1,528,183
                Meet Dr. Chizner
                     http://www.youtube.com/watch?v=OlUpjLTPqUw

             Dr. Kenneth Herskowitz
             Thoracic Heart Surgeon
                Medical Director
                Cardiovascular and Thoracic Surgery
                Broward General Medical Center
                Annual Compensation - $910,347
                Meet Dr. Herskowitz
                  http://www.youtube.com/watch?v=DP9p3tt15oQ

Fiduciary Mushrooms - #2

John deGroot — Tue, 01 May 2012 14:00:59 GMT

  Mushroom or Tool?
   Pictured above is Richard Paul-Hus, a long-time Broward Republican stalwart, Teaparty activist and one of seven members of the North Broward Hospital District's governing board of commissioners.
     More to the point, Richard Paul-Hus is also chair of the Commission's Finance Committee -- which makes him the alleged fiduciary watchdog over matters involving mega millions of District dollars.
    Bottom line?
    Based on yesterday's post, Richard Paul-Hus is hardly the sharpest tool in the Broward Health shed.
    However, given his mushroom approach to his Fiduciary Responsibilities, little Dickie is clearly a hyphenated tool!

Clueless Fiduciary Mushrooms

John deGroot — Mon, 30 Apr 2012 12:05:18 GMT

                              Farmer Frank
   North Broward Hospital District CEO Frank Nask’s management style is that of a world class mushroom farmer skilled at keeping others in the dark while feeding them a steady diet of Grade A Bullshit.
    This is certainly the case when it comes to the seven politically appointed Hospital District Board of Commissioners, who - while charged with governing the giant health care system - serve as clueless examples of Farmer Frank’s artistry with bullshit.
    For example, earlier this month, the District’s Clueless Commissioners unanimously approved the following WTF Data dished out by Farmer Frank at two separate Board meetings – without question, or comment!

                                                            2011*                   2012*
Cash & Investments                      $580,188,706   $627,703,865
Dividend/Interest Revenue         $6,307,169        $6,684,028
Gain (Loss) on Investments        $61,827,431      $3,475,198
Investment Management Fee    ($1,039,239)    ($2,012,421)
Net Gain                                            $67,095,361      $8,146,805
*First nine months of FY 2011 and FY 2012

    No.
    The seven District Commissioners were not on heavy drugs.
    Nor were they freshly lobotomized.
    Rather, Farmer Frank had carefully buried the above WTF Trends in an impenetrable jungle of arcane line items and data jabberwocky mono-toned by Frank’s fellow world class Mushroom Farmer District CFO Bob “Fine Print” Martin.
    All of which left the Clueless Commissioners convinced – as usual – that all was fine on Frank Nask’s billion dollar Mushroom Farm called Broward Health. JKdeG

QUESTIONS to jumpstart the Clueless Commissioners’ critical thought:
      1.Who is being paid to “manage” the District’s investments?
      2. How much did they invest in Bolivian Licorice Mines?
      3.Do they have photos of Commission Chair Joel Gustafson wearing lipstick, high heels and a lavender bustier?
      4. Who broke their Ouija Board?

Stupid or Apathetic - #2

John deGroot — Fri, 27 Apr 2012 12:55:51 GMT

AND...?
   In Dr. Pangloss Best of All Possible Worlds, the seven politically-appointed Board of Commissioners responsible for governing the $1 billion health care system would understand the profound policy issues revealed by the trends in the data below.
   But unfortunately, they don't.
   Why?
    Because the District''s CEO Frank Nask and his staff are dedicated to keeping their governing Board of Commissioners clueless pilgrims lost in a jungle of unknown unknowns.
     But then dating all the way back to his role in the near-collpase of St. Mary's and Good Samaritan in Palm Beach County, Nask's management-style has been that of a world class mushroom farmer -- dedicated to keeping his governing board in the dark while feeding them a steady diet of bullshit.
     Stay tuned

Broward Health -- Five Year Trends

                                            2007*                2012**
Per Adjusted Admission
Gross Charges                    $31,064        $31,416        1%
Charity Care                         ($2,990)       ($2,663)       (11%)
% of Gross                           9.6%              8.4%
Bad Debt                               ($2,935)       ($3,335)        14%
% of Gross                           9.4%             10.6%
Net Operating Rev.+          $9,596*        $9,214*        (4%)
Total System Surplus        $820              $48                 !?!?!?
+Includes tax revenue
for uncompensated care

FTE Employees                    7,341             7,572             3%
Annual Pay Per FTE           $63,004        $76,352        21%
Average Daily census        927                 875                 (6%)
Avg. Length of Stay           5.4 days        4.9 days        (9%)
Insured                                 757                 743                 (2%)
% Insured                             82%                85%
Uninsured                            170                 132                 (22%)
% Uninsured                        18%                15%

Daily
Adjusted Admissions        290                 334                 13%
Admissions                         184                 177                 (4%)
ER Dept. Admissions         116                 131                 13
Direct Admissions              68                   46                   (32%)
Births                                     16                   16                   0%
Inpatient Surgeries            38                   39                   3%
Outpatient Surgeries        42                   48                   14%
Daily Visits

7%ER Department             626                 757                 21%
Indigent Clinic Visits          423                 426                 1%
Outpatient Med Center    764                 819                 7%
Outpatient Clinic                55                   51                   (7%)
Weston Health Park          92                   96                   4%
Home Health Care             181                 104                 (43%)

*The year before Frank Nask became CEO of the North Broward Hospital District.
** Based on the first nine months of the current Fiscal Year 2012.

Source: North Broward Hospital District

Stupid or Apathetic? - #1

John deGroot — Thu, 26 Apr 2012 12:55:49 GMT

Due dilligence?
We don't need no stinkin' due dilligence!
As the governing body for the North Broward Hospital District (dba Broward Health), the giant health care system's seven politically-appointed Commissioners Wednesday unanimously accepted (without question) the data below for the current discal year (2012) totally oblivious to the profound public policy issues raised by the startling trends in the numbers. JKdeG

            North Broward Hospital District
               Inpatient Trends – Five Years
                                                            2007              2012*
Medicare
Average Daily Census                    262                 212                 (19%)
Average Length of Stay                7.4 days        6.3 days        (15%)
Managed Medicare
Average Daily Census                    95                   123                 29%
Average Length of Stay                4.7 days        4.8 days        2%
Medicaid
Average Daily Census                    142                 167                 18%
Average Length of Stay                6.1 days        5.8 days        (5%)
Managed Medicaid
Average Daily Census                    41                   49                   20%
Average Length of Stay                4.8 days        4.5 days        (6%)
Private Insurance
Average Daily Census                    350                 205                 (41%)
Average Length of Stay                4.8 days        4.4 days        (8%)
Indigent
Tax Dollar Funded
Average Daily Census                    95                   63                   (34%)
Average Length of Stay                6.3 days        5.1 days        (19%)
Uninsured
Average Daily Census                    83                   70                   (17%)
Average Length of Stay                4.1 days        3.5 days        (15%)
Total Inpatients
Average Daily Census                    927                 875                 (7%)
Average Length of Stay                5.4 days        4.9 days        (15%)

*FY 2012 – nine months
SOURCE: North Broward Hospital District – dba Broward Health

We don't need no stinkin' transparency....

John deGroot — Wed, 25 Apr 2012 22:25:25 GMT

NOT
     The politically appointed North Broward Hospital District Commissioners Wednesday agreed to pay a Washington-based law firm $1 million-plus on top of the previous millions the firm has received for representing the hospital system in an on-going anti-trust investigation by the Federal Office of the Inspector General and the Department of Justice.
    During the same meeting, District lawyer Sam Goren reported “movement” between the Feds and the District in the on-going probe.
   However, Goren said, he would need to review the latest developments in the Federal investigation with each of the District’s seven commissions in private and individually – this to prevent the media and the public from learning the current status of the anti-trust action.
   The Federal probe involves the District's historic money-losing practice of hiring doctor-employees to generate additional business for the system's four hospitals.
   Also…
   In other business, the seven commissioners agreed to consider reducing the governing board’s public meetings from 12 to six times a year --- which would halve the public’s ability to interact with those governing the $1 billion a year tax-funded health care system.
   Not that the toothless watchdogs in the local news media will report any of this!

When "Health" = Wealth

John deGroot — Mon, 23 Apr 2012 18:48:38 GMT

Must-Read Article From
The West Side Gazette*
http://www.thewestsidegazette.com/news/Article/Article.asp?NewsID=113344&sID=34&ItemSource=L
*Pity the Sun-Sentinel
hasn't looked into this!

Lawyers, Doctors & Butt-Licking Dogs

John deGroot — Fri, 20 Apr 2012 14:00:19 GMT

    Several readers have asked about yesterday’s North Broward Hospital District post detailing an orgasmic eruption of legal fees worthy of a lawyer’s wildest wet dream.
    Basically, what the readers response was WTF?
    And Why?
   To put it simply, a greedy gaggle of lawyers is knocking down huge legal fees for the same reason dogs are able to lick their butts: Because they can.
   Thus, Tampa lawyer Carlton Fields was able to charge Broward Health $475 an hour – plus expenses – to tell Broward Health CEO Frank Nask how to privatize the giant public health care system.
    While a pack of Washington-based lawyers is earning $455 an hour to help the District cope with an anti-trust investigation by BOTH the Justice Department and the Federal Office of Inspector General.
   Oh yes.
   One cannot forget the $450 hourly fee former Florida Senator George LeMieux earned helping the Distric outsource its money-losing nuclear oncology program – for which the district had spent some $32 million creating a few years ago.
   Anyhow…
    Bottom line-wise, the last several years have seen the District shell out nearly $4 million in legal fees defending itself in the on-going US government’s anti-trust probe of Broward Health.
     The reason?
     Basically because the Feds' anti-trust panties got bunched by the District's hiring doctor-employees to increase its health care business – and better compete with the private hospitals in its market area.
     Naturally, you might ask, why would one of the nation’s ten largest public health care systems hire doctors to generate business at the expense of its private competition?
    Again, for the same reason dogs lick their butts.
    And also because the Hospital District has millions of tax dollars to use – and lose – luring away patients from the private hospitals in its market area.
    For example:
   The District currently has 57-plus physician employees hired to generate business by ordering tests and admitting patients that might otherwise go to other hospitals.
    And how well is the District’s Physician Practice Program working?
    You decide – given the program has lost more than $83 million during the last five years.
                           2007      versus      2011
Physician
Employees         29.5                        57.5
Avg. Dr. Salary   $517,700                $506,700
Patient Visits     135,203                  270,021
Program
Surplus (Loss)    ($10,147,355)       ($22,772,282)
(Loss) per Doc   ($343,978)             ($396,040)
(Loss) per Visit ($75)                      ($84)

Source: North Broward Hospital District

When Hubris ... #8

John deGroot — Thu, 19 Apr 2012 15:45:09 GMT

North Broward Hospital District
  Fees Paid to Lawyers -Per Month
FY   2007           2012
       $123,418    $543,783

   Source: North Broward Hospital District

When Hubris .... #7

John deGroot — Wed, 18 Apr 2012 13:02:38 GMT

Broward Health Commissioners’ Dilemma

Hospitals                      2000                 2010                %
Broward Health
Avg. Daily Census     788                     889                 13%
ER Visits                       180,984            267,131        48%
Admissions                 53,982              65,239           21%
ER Admissions           34,287              49,526           44%
% ER                               64%                   76%
Direct Admissions    19,695              15,713         (20%)
% Direct                       36%                    24%

Memorial Healthcare
Avg. Daily Census     754                     1,014             34%
ER Visits                       159,993            328,063        105%
Admissions                 51,607               78,433           52%
ER Admissions           21,325               43,102           102%
% ER                               41%                    55%
Direct Admissions     30,282              35,331           17%
% direct                        59%                    45%

Private Hospitals
Avg. Daily Census     1,264                  1,083            (14%)
ER Visits                       221,151             259,249        17%
Admissions                 95,223                87,299          8%
ER Admissions           52,375                59,456           14%
% ER                               55%                     68%
Direct Admissions    42,848                27,843         (35%)
% direct                        45%                     32%

Source: Broward Regional Health Planning Council

When Hubris Marries Ignorance - #6

John deGroot — Fri, 13 Apr 2012 12:25:24 GMT

    North Broward Hospital District CEO Frank Nask wants to sell or privatize the giant public hospital system .
    Based on the following bottom line profits, which private hospital group might be a prospective buyer?

   North Broward Hospital District         Avg. Daily Patients
Broward General          $45,267,170                445
   Coral Springs                 $8,272,659                  143
   Imperial point               $2,918,257                  106
   North Broward              $11,827,322                210
Total District                  $68,645,408                904

   For Profit
   HCA*                                                  Avg. Daily Patients
   Northwest                      $8,175,311                 145
Plantation                     ($7,866,153)                153
   University                       $10,631,929               126
   Westside                         $50,865,046              155
   Total HCA*                     $61,806,133               579

   Tenat                                                    Avg. Daily Patients
    North Shore FMC         $4,095,802                  166

Source: American Hospital Directory www.ahd.com

*The hospital chain Florida Gov. Rick Scott created -- and which made him a multi-millionaire, enabling him to bankroll his successful bid for the governor's office..
* District CEO Frank Nask’s former employer
* Represented by Broward’s most powerful local lobbyist.
* Last year raised $3.8 billion with a mega public stock offering.