County officials ask UM to promise not to dilute Jackson services
By Ted Carter
Miami-Dade County commissioners don't have a say in the planned University of Miami acquisition of Cedars Medical Center. But the commission's Health & Public Service Committee wants university officials' written promise that county-run Jackson Memorial's commercial viability and national standing won't be diminished.
Four former chairmen of the Jackson Public Health Trust — Larry Handfield, Alan Rosenthal, Amadeo Lopez-Castro and Jose Cancela — have joined commissioners in asking for assurances that Jackson won't be hurt. They say they are worried about a diversion of commercially insured patients to neighboring Cedars and a resulting loss of Jackson's ability to treat the uninsured.
"The reality is that Jackson may not be able to keep its doors open for every patient in need of treatment and healing," the former chairmen said in a joint letter submitted Thursday to the commission's Health & Public Service Committee.
"We believe," the chairmen added, "that the UM and PHT/Jackson want the best for both institutions, and a joint public pledge is an important step toward demonstrating that commitment."
Noting the UM Miller School of Medicine's 52-year-old teaching and care-providing relationship with the Jackson Health System, they said it would be a "tragedy if Jackson's survival is compromised by the institution it has worked with the longest and most closely."
Of the Health panel's members, Commissioner Jose "Pepe" Diaz seemed the most anxious for assurances from the university. "I see us being in a worst situation," Mr. Diaz said, especially when coupled with the likelihood Jackson could lose hundreds of millions of dollars in state and federal assistance.
The commissioner likened UM's deal with Cedars to a shifting — and unsettling — domestic situation. It's like a couple married for a long time and now "they're going to go live in different houses," Mr. Diaz said.
Even living in different houses, the institutions must maintain their responsibilities to each other, said Commissioner Barbara Jordan, who suggested a "prenuptial agreement" that would protect Jackson once Cedars becomes a UM-owned hospital.
She said she wants the agreement to reflect "that all the details" have been worked out.
UM is in due diligence on a plan to buy the 560-bed Cedars from Hospital Corporation of America, a national chain acquired in November by a group of investors who took on a reported $11.7 billion in debt.
The Miller School is in the Civic Center area that is home to Jackson and Cedars. The school's staff of more than 700 physicians practices at Jackson in exchange for payment from the hospital. The fear is that the university's doctors will take their insured patients to Cedars. Pascal J. Goldschmidt, the school's dean and senior vice president for medical affairs, has worked to allay those fears with a promise that UM doctors will fill beds at Cedars through expansion of university programs.
Mr. Diaz said he doesn't see that happening. "I hear the explanations. … The numbers just don't add up," he said during Thursday's committee discussion.
The numbers add up easily for Commissioner Carlos Gimenez, who said Miami-Dade County should see the acquisition as an opportunity for UM and Jackson. He called it a "bold step" that would take the medical school and Jackson "to the next level."
Commissioners should "support the effort," Mr. Gimenez said.
Keep faith in Dr. Goldschmidt and Jackson Health System CEO Marvin O'Quinn to work out the issues, said Commissioner Javier Souto. "We have two heads here who work hard at making things right. No doubt they will keep doing that."
Commissioner Rebecca Sosa said she wants to put her faith in a "memorandum of understanding" that Jackson will continue to receive paying patients treated by UM physicians, especially its specialists.
Trust but verify, urged Commissioner Dennis Moss, chairman of the county health panel. "That verification will come back to us in the form of that agreement."
Today, 70%-75% of people occupying beds at Jackson are paying patients, according to Mr. O'Quinn. By contrast, 70% of people treated in Jackson's primary-care operations, including the emergency room, are charity patients, he said.
In their letter to the committee, the four former chairmen of the Public Health Trust urged that the agreement ensure that:
Profitable services such as neurology, urology and cardiology are not sent exclusively to Cedars.
UM physicians will continue to admit funded patients to Jackson at current levels.
All patients be treated to a single standard of care at both institutions regardless of their ability to pay.
The leaders of UM and Jackson continue to work together to confront the pressing issues and crises facing the health-care system in Miami-Dade County and nationally.