October 25, 2014

Exiting from Jackson Health System

Dr. Eneida Roldan talks about Miami-Dade's public

From the moment Dr. Eneida Roldan became CEO of Jackson Health System in 2009, she faced a financial crisis. As the system's losses ballooned and it ran dangerously low on cash, she clashed with its governing board — the Public Health Trust — and the Miami-Dade County Commission. In November 2010, she announced that she would not seek renewal of her contract when it expired at the end of May.

Eneida Roldan
Eneida Roldan was named CEO of Jackson Health System in 2009.

In recent months, the commission has disbanded the trust, replacing it with a seven-member Financial Recovery Board. Longtime banker Carlos Migoya, who was Miami city manager for less than a year, succeeded Roldan as Jackson's CEO.

Despite the system's financial difficulties, U.S. News & World Report named its main hospital, the University of Miami/Jackson Memorial Medical Center, No. 1 in south Florida this year.

Roldan, a Miami native who trained at Jackson and worked in the system for more than a decade, talks about Miami-Dade's public "safety net" health system.

Were you surprised at how bad things were?

"When I stepped in on June 1, there were already issues. I was already facing a deficit, at that point $168 million. (I saw) that we have assets (receivables) that are valued at over $400 million and there is no cash coming in. There's a problem. Within my first 90 days I called in the auditors. Those assets were overvalued."

The receivables had been left behind in an IT systems change, so they had not been billed or collected. Why?

"It was a decision not to run parallel systems. That is something that's a huge mistake. (Those receivables) only have a certain amount of time to be collected."

How did Jackson's governing board react when you brought this information to them?

"Obviously, because it's a public system, the commissioners said, 'What was happening? We thought everything was OK.' And then they wanted to shoot the messenger."

What is Jackson's greatest problem?

"Operationally and as a health system, Jackson needs to transform itself very quickly. Jackson should have been doing a lot of the things that I proposed 10 years ago: The strategy of inpatient to outpatient, the strategy of reducing inpatient beds, looking at physician alignment, more outpatient clinics, more outreach in the inner city so that they don't have to come to the hospital."

Is Jackson's size sustainable?

Jackson Health System
3rd-largest
public health system in the U.S.
67,000
admissions in 2010
216,000
outpatient emergency visits
502
organ transplants
5
hospitals, plus clinics, outpatient centers and other facilities
$747 million
spent on charity care in 2010
$1.75 billion
revenue in 2010
$89 million
loss in fiscal 2010
$245 million
loss in fiscal 2009

"The only way that it can continue is if it's got a funding source — a permanent funding source that doesn't fluctuate with the economic times. Jackson has had economic problems for decades. This is not new, and the reason is because of its noble mission. It's a mission where everyone gets the highest care, regardless of whether you can pay or not. That in itself any financial person, any mathematician would tell you is fiscally unsustainable. How can you continue to keep your doors open? Even if there is public, continuous funding that doesn't fluctuate, it gets to the point that the ceiling is going to break because the needs are great and the resources are few."

Did the size of Jackson's 17-member governing board make it harder to manage the system?

"It was not only the board members. It was the commission and then a mayor and a manager. Political agendas were different. You can have a board of 30 individuals that, if they know the difference between governance and management, you don't have a problem. But that was the icing on the cake. The true essence of what needs to be changed is the healthcare delivery. And that takes cultural transformation, a strategy that needs to be shifted very rapidly, that should have been shifted 10 years ago."

Ultimately, why did you quit?

"After I fought and I fought, one of the commissioners, who's now running for mayor (Carlos Gimenez has since been elected) questioned my integrity for something that he didn't understand. And so that was enough for me. This is my community, and has been for over 50 years. How could I have done anything other than the right thing?"

Was there anything that could have better prepared you for this experience?

"It was the intricacies and the little details, the day-to-day details, that I think I would probably have liked to have spent more time learning."

Do you think Jackson's new CEO, Carlos Migoya, will fare any better?

"I was hand-tied. Now the new CEO is not, because he is almost what I would consider a political appointee. (And) we have initiatives that we have left behind that are now coming into play. I think there is a period where he will be able to maneuver a lot quicker simply because I surfaced a lot of the problems."

What is Jackson doing right?

"This is a tertiary, urban, academic medical center with top-quality, serving inner city and serving everyone, regardless of their ability to pay."

Looking back, what might you have done differently?

"If I were to do it all over again, I would do the same. Maybe the only thing that I would do is have more time to sit down with the politicians, but there was no time. We had a very serious economic fiasco at the hospital, and to me that was my main job. But there was a power that was much stronger than the truth: There was the politics."

Tags: Miami-Dade, Healthcare

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