Check out how illegals in a nursing home are killing us in Miami. This is only one hospital. I one comment made mentioned sending the bill to ICE but I reminded them that it is the government who should get the bill as they are not doing anything to enforce the immigration law and stopped work place raids. When someone else like Arizona decided to enforce the immigration law the government sues them.

http://www.miamiherald.com/2010/08/20/1 ... ggles.html


Jackson Health System struggles to balance its budget.
BY JOHN DORSCHNER

As Jackson's governing board prepares to vote Monday on a proposed budget for 2011, its two money-losing nursing homes stand as a symbol for the challenges the system faces as it attempts to cut losses.

Almost 100 of the 289 nursing home patients in the Jackson Health System are uninsured. Half of those are undocumented immigrants under age 50. Many are quadriplegic, on ventilators -- hugely expensive patients that can cost up to three times as much as regular nursing home residents.

Despite these and other challenges, Jackson must present a balanced budget to the Miami-Dade County Commission. The working proposal as of Aug. 6 projects a loss of $232.2 million if no initiatives are taken. Executives are counting on $221.4 million in new revenue and cost-saving moves to get the bottom line close to zero.

Among the 40-plus initiatives are a $38.4 million estimated savings from more efficient claims recovery, $26.7 million in reduced labor costs (primarily through less overtime and fewer temp workers) and $24.9 million in procurement savings thanks to a new contract with a suppliers' organization.

Planners also hope to save $8 million in outsourcing inmate health and gain $7.9 million through better operations at Jackson Health Plan.

Chief Executive Eneida Roldan said at a board meeting that the projections ``are not signed, sealed and delivered today, but they are on track.''

Board Treasurer Marcos Lapciuc said, ``the budget raises a lot of questions about the long-term sustainability of Jackson.''

Patient admissions continue to drop and planners project a 1.6 percent decrease next year at Jackson Memorial and a 3.2 percent drop at Jackson North. What's more, uninsured or low-paying patients tend to be sicker. ``We're seeing very ill patients that are costing us a lot of money,'' said Ted Shaw, the interim chief financial officer.

Jackson's leaders say the system desperately needs capital investments, such as replacing the aged Jackson Memorial air conditioning system. ``These are not a luxury -- they're a necessity,'' Lapciuc said.

Planners hope to raise $75 million through a bond sale in fiscal 2011, which starts Oct. 1. But that could be a challenge, since the Securities and Exchange Commission has launched an investigation into whether Jackson provided investors with misleading financial information in advance of the last bond issue in 2009.

At a Public Health Trust meeting, Jennifer Glazer-Moon, the county's budget director, said issuing more bonds might be possible, but perhaps at higher interest rates.

At the nursing homes, Jackson hopes to save $4.2 million next year by reducing staffing levels to national standards, moving all uninsured patients to one facility, perhaps moving some patients to hospice units and negotiating with the unions to reduce salaries.

So far, moves to save money at the nursing homes haven't worked.

The central issue is that Jackson can't just drop the ventilator patients -- some of them said to be young men injured in motorcycle accidents. Caring for them in a nursing home at $900 a day is considerably cheaper than treating them at Jackson Memorial at $2,000 to $4,000 a day, said Kevin Andrews, vice president of quality and patient safety.

Last year, the Public Health Trust voted to sell the facilities on the theory that a private company could find cheaper ways of taking care of the patients. The best bid was $24.3 million to take care of the unfunded patients -- considerably more than the $18.9 million Jackson loses on the facilities.

``This is really a unique problem,'' said Abraham Galbut, a Trust member who is on the corporate staff of Hebrew Homes, a nursing home chain.

Galbut believes it best to put all the expensive, high-maintenance patients at the northern facility, near Jackson Memorial, and convert it into a long-term care hospital. That means the nursing staff, earning higher hospital-level salaries, would make economic sense.

What's more, as a government facility, Jackson has limited exposure to malpractice claims -- whereas private nursing homes are required to carry expensive liability insurance. This could give Jackson an advantage in attracting high-maintenance patients from other facilities, Galbut said.

The other nursing home, in an upscale area near Old Cutler Road in southern Miami-Dade, could focus on attracting short-term rehab patients with high-paying Medicare as well as private-insurance patients. At present, the Jackson system has only two Medicare patients and three private insurance patients in its 289 beds.

The problem for Jackson is that it's presently ``paying hospital wages to nursing home nurses and that breaks the back of any nursing home,'' Galbut said. Because Jackson lacks the expertise in managing regular nursing homes, he recommends bringing in an outside management firm to the southern facility and having the staff paid at lower nursing home rates.

Martha Baker, president of SEIU Local 1991, said the union wanted to see the nursing homes run more efficiently, but there were many other issues to consider before thinking of cutting labor costs.