Carlos Migoya leads Jackson Health to a full recovery
Leaving a legacy
Migoya had arrived in Miami in 1961 as an 11-year-old Cuban refugee. He attended Miami Dade College, earned two degrees from local Florida International University and built a 40-year career as a bank executive at Southeast Bank, Florida’s second-largest, which became Wachovia.
Migoya was more than familiar with Jackson. He credits it with helping his wife in 1978 survive a difficult pregnancy that reached fruition with the birth of his second son and helping that son, now 40, survive after being born at 1.25 pounds. His mother donated a kidney to his aunt in 1982 in a Jackson transplant. “I knew how important Jackson was and is,” Migoya said.
Helping Jackson, he said off-handedly at a Miami Heat game one night to an inquiring Miami city commissioner, “would be the biggest legacy I could ever leave.”
He soon had his chance. The trust board gave him the job in 2011 by a 9-to-5 vote over executives with long health care-industry resumes. “Carlos didn’t know a damn thing about running a hospital, but he was a great businessman with a great vision of putting a team together,” says the always-blunt Arriola. “We put a really, really good team in place.”
Migoya says that team extends across Jackson’s thousands of employees, but he highlights “the two Dons … two giants in health care” — COO Don Steigman, whose resume included being a senior executive of hospital chain Tenet, and Donn Szaro, who headed global life sciences for Ernst & Young (he passed away a year into the turnaround) — and Chief Financial and Innovation Officer Mark Knight. They provided the health care know-how that Migoya lacked.
Together, they turned over as much as 80% of management in less than two years, replacing some who had left for crisisfree pastures and laying off others. The new team came up with 1,200 staff cuts. Further breathing room came from Jackson’s unionized employees, which is most of the workforce. Jackson’s two unions agreed to wage freezes and benefit cuts that amounted to $100 million a year for four years, says Martha Baker, president of SEIU Local 1991, the union for most of Jackson’s professionals. “Jackson was failing, and we didn’t want to lose this hospital. Our main goal was to make sure this hospital would be sustainable for the next 100 years,” Baker says.
The trust board was cut to seven. Additionally, Migoya required each department to own its expenses and revenue. He renegotiated the deal that keeps UM at Jackson, providing 90% of the system’s doctors, and he improved relations with union workers, giving them and UM a seat at the table as partners. “Mr. Migoya was willing to do the partnership and has continued to walk the talk,” says Baker. She recalls a meeting for Jackson workers that she and Migoya led about the partnership. “Mr. Migoya said to his senior vice presidents and down to directors, ‘if you can’t get your head around it, there’s the door.’ I’ve been at Jackson 35 years now. He’s by far the most collaborative CEO we’ve ever had.”
Turning a Profit
The first full year under the new regime, Jackson achieved an $8-million surplus. Migoya donated his $160,000 bonus to the hospital foundation.
Voters bought into a vision from Migoya and the hospital trust for a sustainable Jackson buoyed by new and rebuilt facilities. In 2013, with nurses and other workers campaigning door to door, voters approved an $830-million bond issue for the new projects, such as 100-bed Jackson West in Doral, a remodeling that touched every room in each hospital and the new 250,000-sq.-ft. Christine E. Lynn Rehabilitation Center for The Miami Project to Cure Paralysis at UHealth/ Jackson Memorial Medical Center
Annual surpluses, which have reached as high as $64 million, provided more money for improvements. Success bred success. More patients necessitate more staff. Jackson’s payroll recovered to pre-layoff levels and then some. It now employs 12,500, up from 9,500 after the initial cuts, and Migoya expects to add 1,000 more over two years as new facilities are finished. As Jackson’s brand reputation improved, more patients make it their hospital of choice. “We have the Robin Hood mentality,” Migoya says. “We want to attract paying patients to help us pay for the ones who can’t.”
Those who can’t remain numerous. Jackson under Migoya last year spent $382.6 million on charity care — nearly $10 million less, actually, than it spent his first year. Jackson brought in a company to screen patient financial health while doctors screened physical health. It found many of Jackson’s charity care patients qualified for Medicaid, and that brought Jackson some reimbursement for care. Jackson also now treats more indigents in primary care clinics, where they can have a doctor manage their symptoms and hopefully hold off chronic disease rather than have them repeatedly showing up at the ER, which is more costly.
Migoya, in 2017, was given the Greater Miami Chamber of Commerce’s Sand in My Shoes Award, its highest honor, for his contribution to the region. His annual pay, factoring in car allowances and other benefits, tops $1 million, making him Miami- Dade’s best-paid county employee. His pay is comparable to that of CEOs of other South Florida public health systems and substantially less than CEOs make at large private systems.