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Hospital Execs: Healthcare Today Must Be 'Efficient, Low-Cost And Delivered Like You're Going To The Ritz'

Carlos Migoya is widely credited with having turned around the finances and reputation of Miami's public hospital system, Jackson Health, as its president and CEO. He inherited an $82M/year loss when he came on board in 2011 and produced an $8M surplus the following year, then $50M+ in subsequent years.

So many insured or paying patients began choosing the public hospital over its competitors that Migoya has had to fend off criticism that Jackson is not serving enough of the poor and uninsured. 

Jackson Memorial Hospital's Miami campus.

At Bisnow’s State of South Florida Healthcare and Senior Living event last week in Fort Lauderdale, where Migoya was the keynote speaker, he and other healthcare executives said they are meeting the demands of today's complicated healthcare industry with new technology and facilities that lend themselves to personalized care.

Under Migoya’s direction, Jackson is pushing ahead with about $500M in expansion projects, part of a bigger, $1.5B vision, partially funded by an $830M bond that voters approved in 2013. Eighty percent of the children’s hospital is under renovation, 40 new beds will be added to Jackson’s maternity ward, and a 100-bed hospital in Doral will soon provide quicker access to residents of West Miami.

Jackson’s trauma services will be complemented with a 96-bed rehabilitation hospital providing spinal, brain and neurological care, as well as short-term housing where therapists can better help patients and their families adjust to new physical constraints.

Providing the entire population with quality, low-cost healthcare is challenging, Migoya said. Small businesses are exempted from providing insurance to employees, and he said creating incentives for broader coverage will lead to a healthier society, where costs are low and services are more efficient.

"The biggest challenge over the next five to 10 years is regulatory,” he said. 

Migoya said there is no shortage of ideas for public-private partnerships, but a web of rules, however well-intentioned, can preclude implementing many of them.

In Florida, many regulations aim to keep supply and demand in balance so that patients receive the care they need but costs don't spiral out of control. But those regulations also lead to political and legal battles as facilities compete for paying patients. Here, as in 30-plus other states, a "certificate of need" must be issued before new hospitals can be built, and there is a running battle between trauma centers and emergency rooms.  

With Medicare penalizing hospitals for cases in which a patient is treated but must be readmitted, “it’s very critical today in how you get well enough so that you don’t have to get readmitted," Migoya said.

Another Florida health system, nonprofit Baptist Health of South Florida, is pursuing its own innovations. It will soon allow patients to pull their electronic records in lobbies and is starting to monitor health progress with a combination of telemedicine and friendlier facilities.

“The old hospital systems weren’t hospitable,” Baptist Health South Florida Vice President of Real Estate Kathleen Moorman said, noting that they have historically been rather cold and sterile. Today, she said, they must be “efficient, low-cost and delivered like you’re going to the Ritz.”

Dr. Farzanna Sherene Haffizulla, a professor of medicine and the assistant dean for community and global health at Nova Southeastern University, said it is imperative that healthcare planners find ways to weave technology into the system without compromising the “humanistic aspect of medicine.”

Building facilities with LEED certification, increased light and green spaces could brighten the patient experience while cutting overhead costs, and Noah Tolson, a practice leader for planning at Array Architects, spoke of the importance of creating spaces where physicians and patients can look at an iPad or a computer screen together.

“If the patients themselves can see what the physician is looking at, they feel more connected. They’re sharing information,” he said, adding that he would like to see medical services catch up with the kind of technology and innovation that has made modern banking so much easier. “We can make any number of transactions on our phones and shift money from one place to another, but we can’t do any of that in healthcare because they still work in silos."