A teaching hospital

Mount Sinai also is a state-designated teaching hospital and currently has 163 residency slots in 18 different training programs. “We also train over 300 allied health students and 500 nursing students every year, so there is a large amount of academic activity that takes place here daily,” Sonenreich said.

Mount Sinai’s educational side has gained from the hospital’s three-year-old relationship with Columbia University, which has research-driven affiliations with Mount Sinai Medical Center and about three dozen other hospitals with a heavy emphasis on training and continuing education. Mount Sinai has “a very comprehensive academic program even if they are not themselves a medical school,” said Doug Levy, a spokesman for Columbia’s medical school. “We’re able to provide additional training and outreach to the physicians there, and we also benefit from what they’re learning from their patient populations. So it’s a two-way information flow. It certainly facilitates research collaboration.”

Still, Mount Sinai faces tough competition from other Miami-area hospitals that draw patients throughout South Florida, said Linda Quick, president of the South Florida Hospital and Healthcare Association. Mount Sinai isn’t a member of the association.

“They aren’t the only ones competing for that larger regional market,” Quick said, citing not-for-profit rivals Baptist Hospital, Jackson Memorial Hospital, Miami Children’s Hospital and the University of Miami Hospital. For example, Baptist Hospital in southern Miami-Dade County has outpatient centers in Broward County “thinking that, if they identify a problem with somebody who needs hospitalization, they will drive all the way to south Miami.”

And some South Florida hospitals offer services unavailable at Mount Sinai. Broward’s Memorial Healthcare System’s highly rated cardiac services include pediatric heart transplants; plans call for adding adult transplant by the end of 2013.

But Quick also said Mount Sinai itself is a formidable, well-regarded player in the hospital business: “It’s a very good institution with a longstanding record of serving its community. Their physicians have excellent reputations. Certainly not all of them but some of them are well known outside the state of Florida.”

Getting support

Not-for-profit Mount Sinai has become more competitive thanks largely to vital financial support from a foundation that exists solely to support the hospital. The Mount Sinai Medical Center Foundation has more than $100 million of highly liquid assets and annually raises about $15 million of donations. Many the hospital’s board members also serve on the foundation’s board.

The foundation guarantees repayment of bonds issued on behalf of the hospital and has provided direct operating subsidies to help Mount Sinai make ends meet. But these subsidies ended in 2011 as the hospital’s financial performance improved. “We would transfer $10 million a year from the foundation to the hospital, and so it was $2.5 million per quarter,” Sonenreich said. After the first quarter of 2011, however, “we said there’s really no reason to do this any longer.”

Nationally, few hospitals have a large foundation like Mount Sinai’s at their side, Quick said, and very few have philanthropic supporters willing to fund hospital operating subsidies rather than buildings bearing their names. “Frequently, large donations are made for a particular thing, a particular program or a building,” she said. At the Mount Sinai Medical Center Foundation, “people have been perhaps a little more flexible with respect to how those resources can be used.”