Jackson South Obstetrics Department Closure Decision Review Duane J. Fitch, CPA, MBA President July 8, 2010
Jackson Health System Mission and Vision “ An academic health system with a public healthcare mission” Mission Statement To build the health of the community by providing a single, high standard of quality care for the residents of Miami-Dade County Vision Statement Our strategic vision is to be a nationally and internationally recognized, world-class academic medical system and to be the provider of choice for quality care. Values Service Excellence and Quality, Commitment, Compassion, Teamwork and Communication, Respect, Confidentiality, Integrity and Stewardship, Inclusion 2
Isolated Decision Making No Strategic Plan No Physician Manpower Plan Inconsistent with Mission No Input from County Epidemiologist No Physician Input 3
Isolated Decision Making (cont.) No Town Hall Meetings Out of Sync with Healthcare Reform Focus on Primary Care • Family Practice • Internal Medicine • Pediatrics • Obstetrics 4
Isolated Decision Making (cont.) No Communication with County No Evidence of Prioritization No Re- Examination Based on “Improved” Financial Position • $245MM loss • State of Emergency Declared No Input from Political Community 5
Isolated Decision Making (cont.) Purely Financial Based Analytics Inconsistent with Desire to Build Trust/Confidence After Announcement of Potential Closure Not Included in the Sustainability Documents Consistently Presented 6
Jackson South OB Observations Contradictory Message to Federal and State Funding Sources Huge investment in Political implications – Jackson South while support from key reducing services and stakeholders in access for a vulnerable $250MM request for population additional funding 7
Elimination versus Consolidation Jackson Main is 21 Miles from Jackson South Other Facilities • Baptist Hospital: 5 miles • South Miami: 6 miles • Kendell Regional: 11 miles • Homestead: 16 miles 8
Jackson South OB Talking Points “Prime real estate where we could stage a VIP surgical area” “This could be re -branded as a VIP surgical unit, allowing expansion of surgical services to accommodate new service lines useful to the community . . .” 9
Self-Fulfilling Prophecy Amazed at Current Performance Given Leadership Void • Projected annual $2.57MM loss based on analysis of six months activity • 1495 deliveries in 2008 vs. 1141 in 2001 • No consideration in financial analysis for 52 transfers to Jackson Main NICU and 120 high risk pregnancies transferred 10
Self Fulfilling Prophecy (cont.) Limited Pre-natal Clinic Support No Product Line Director in Several Years Limited Publicity of Pre-natal/Nutrition/and Newborn CPR Classes No Discussions with Physicians Regarding Reasons for Using non-Jackson Facilities No Marketing of Service Line 11
Self Fulfilling Prophecy (cont.) No Accurate and Timely Financial Reports Prepared to Identify Issues and Encourage Course Correction No Good Faith Effort Made to Encourage Utilization and Improve Financial Results No Professional Fee Billing for Services Performed by Midwives No Operational Goals Established and Monitored 12
Jackson South OB Closure Financial Considerations Average Medicaid Reimbursement $6231 per delivery $2.5 MM in additional revenue Assume 400 additional deliveries 13
Jackson South Delivery Statistics Group FY 2007 AFY 2010 Net Difference Community Health 772 526 -246 University of Miami 681 364 -317 Independent OBs 240 237 3 14
Jackson South Physician Commentary Community Health of South Florida • Physicians have not been contacted regarding financial and operational strategy • Feel strongly that Jackson South OB is crucial to serve the poor without transportation • Drs. Tracey and Gabb would like to practice exclusively at Jackson South • Dr. Tracey is new as of 1/1/10 – deliveries estimated at 215 by the end of the calendar year • Dr. Gabb on-call only as of 1/1/10; therefore decline in deliveries • Practice is adding a new MD 8/1/10 – would result in additional deliveries at Jackson South (Not Included in Projections). • Dr. Limousin left CHI and Jackson South 12/31/09 – moved deliveries to Baptist • Dr. Limousin not contacted regarding reason for leaving or to maintain relationship 15
Jackson South Physician Commentary University of Miami Obstetrics Department U of M obstetrics office at Jackson South closed as of 12/31/09 47% Reduction in Deliveries Between 2007 and 2010 Drs. Santiago and Caldera continue to provide services on a limited basis: on-call per diem only 16
Jackson South Physician Commentary Independent OBs Physicians not contacted regarding financial and operational strategy Dr. Berryer pleased with staff and facilities – would like to admit exclusively at Jackson South Dr. Berryer deliveries at 44 FY 2009 – projected at 167 AFY 2010 Dr. Bradley deliveries at 13 FY 2009 – projected at 68 AFY 2010 Physicians feel strongly that Jackson South OB is crucial to the community 17
Jackson South OB Sustainability Recommendations Recruit Effective Product Line Director Recruit Additional OB’s / Optimize Relationship with CHI, UM and Community Physicians Prepare Timely and Accurate Financial Statements to Facilitate Education and Timely Course Correction Advertise Program Including Women’s Health Center Capabilities Assure Billing Procedures in Place as Appropriate Develop Meaningful and Measurable Goals 18
Jackson South OB Sustainability Recommendations Obtain Feedback From All Stakeholders Including Physician Community Review Managed Care Contracts for Improvement Potential 19
Jackson South OB Factors to Consider Performance Not Surprising Given the Factors Discussed Situation Presents an Opportunity for Management to Provide Enhanced Leadership to Reverse the Trend Significant Concern About Default Setting of Clinical Service Eliminations Without Exploring All Reasonable Options Need to Grow Volumes and Community Loyalty to Ensure Sustainability 20
Jackson South OB Sustainability Recommendations OB Services at JSCH should remain open until all revenue enhancing measures and cost-saving strategies have been explored, implemented and evaluated. 21
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