Dr. Nabil El Sanadi has always enjoyed emergency medicine, but he wanted to be an administrator also.
“I always knew medicine was the art of healing and the science of healing, but it’s also a business and that’s why I got my MBA,” he said. “When you practice medicine, you take care of one patient at a time, but as an administrator you get to set policy and affect a much larger population simultaneously.”
El Sanadi now has a chance to do both. He was appointed in December to succeed Frank Nask, who was retiring, as president/CEO of Broward Health, which provides hospital and healthcare services for the northern two-thirds of Broward County. And he plans to still work one or two emergency room shifts a month “to make sure I keep up my skill sets and experience the impact of my administrative decisions as a provider on the front lines.”
His appointment comes at a difficult time for Broward Health, which has been under investigation by the federal government for about the last four years involving allegations that it colluded with doctors to submit tens of millions of dollars in bogus claims to Medicare and Medicaid. FloridaBulldog.org also reported last month that the district had already spent more than $10 million for legal advice in dealing with the investigation. At the same time, Broward Health and other hospital districts in Florida are also having to plan for how to make up for millions of dollars lost if the federal Low Income Pool program ends June 30, as scheduled.
El Sanadi has had unusual life and career paths. He was born in Egypt, but came with his family to Cleveland in the 1960s when he was a child to escape the persecution of Coptic Christians. He was studying to be a chemical engineer at Case Western Reserve University in Cleveland when some fellow students dared him to apply to medical school. He did and was accepted at Ohio State. Still later he received his MBA degree from Case Western.
After serving as chief of emergency services for University Hospitals of Cleveland, El Sanadi came to South Florida in 1994 and became chief of emergency services at Broward Health Medical Center (then Broward General Medical Center) and then assumed the same role for the North Broward Hospital District, now called Broward Health.
And he concedes to having at least one quirk: He won’t reveal his exact age (although he will say he’s in his 50s).
The Miami Herald spoke with El Sanadi by phone recently to discuss his career, his plans for Broward Health and how the system can deal with the financial problems that could result from a possible sharp cut in state and federal funding. Here is a partial transcript of that conversation:
Q. Your family was originally from Egypt. When did you come to the United States and why did they decide to emigrate?
A. We came in the 1960s. My family decided to emigrate because the United States is the land of the free and the brave and there was a lot of discrimination against [Coptic] Christians in Egypt at that point in time.
Q. How was it that you came to apply to medical school?
A. I was a chemical engineering major and was in a commuter club [to get to classes] in Cleveland. There were a bunch of engineering students. We were playing bridge one day. One of them said that the hardest school to get into was medical school, and people were betting on whether I could get into med school. I applied to Ohio State medical school and was accepted.
Q. Of all the medical specialties you could have chosen, why did you choose emergency medicine?
A. Emergency medicine is probably the most exciting field. I get to see everything. I get to do everything. And on top of that, it’s time limited. You work an eight-hour shift. The rest of the day is your own time. You won’t get called afterward. There are no follow-ups. It’s a simple but exciting practice.
Q. You came into this job at a time that Broward Health has been under a federal investigation for quite a while. Has that put you under more pressure or made your job harder, and if so, how?
A. Absolutely not. I walked into this job with my eyes wide open. I chose to apply knowing what the circumstances were. You know, it’s such a great [healthcare] system, and if we showcase all the highlights and the great features that we have — excellent patient care, excellent service, patient satisfaction, the 27 specialties and two trauma centers — that are so good, if we just showcase the healthcare system, we will be able to get through this without internal turbulence and external turbulence. We are a large medical center with a big research arm. We should focus on that. We should focus on over 600,000 patient visits [a year], 60,000 admissions. Just think of that! All of that is overshadowed by this cloud. Despite that, we continue to provide outstanding and distinguished service.
Q. Have you gotten any idea of whether the government is about to decide whether or not to file charges?
A. That I cannot discuss. Because it’s an ongoing investigation, I can’t discuss any pieces of it.
Q. According to the Safety Net Hospital Alliance of Florida, of which Broward Health is a member, Broward Health will receive a total of $271.9 million in total Low Income Pool program payments for the year ending June 30. LIP is scheduled to end June 30 and no new program has been approved yet to provide supplemental funding for public hospitals like yours. If nothing happens by then, how will you make up the funding? How would the loss of such a program affect your mission to provide healthcare to residents of North Broward regardless of their ability to pay?
A. We are very engaged in the [Florida] legislative process. We’re looking for options to continue to receive funding from both the state and federal level for a population that we are responsible for caring for. We will continue to serve our community in the same capacity. By the way, the most vulnerable population is the population that would be affected by the loss of revenue. Because of that we are exploring alternatives and options to maintain the funding stream from the federal and state level and also pursuing options for more streamlined avenues to access healthcare.
Q. Are you doing anything to persuade state legislators who are meeting now in Tallahassee to expand eligibility for Medicaid as envisioned under the Affordable Care Act? How would Medicaid expansion affect your hospital system?
A. Expansion [of Medicaid] would definitely help our hospital system because we have a lot of patients who won’t be eligible for services [if it isn’t expanded]. As for working with legislators, absolutely yes. We not only are at the table but very involved in lobbying efforts and also myself traveling to talk to legislators to make sure that they hear our voice and our concerns over the potential impact of the loss of revenue on the most vulnerable population of the county.
Q. How much charity care did Broward Health provide last year? How many residents are enrolled in Broward Health’s charity care program?
A. We have about 17 to 18 percent of our care being provided by charity and probably 6 to 8 percent of our citizens are enrolled in our charity care program.
Q. How is Medicaid managed care affecting Medicaid beneficiaries who use Broward Health? Does Broward Health have contracts with all the managed care companies in the program that serve northern Broward County?
A. Medicaid managed care is definitely helping. We do contract with a majority of the managed care providers.
Q. Is Broward Health experiencing an increase in demand as more Floridians gain coverage through the Affordable Care Act exchanges and more people find out that they’re eligible for Medicaid?
A. Absolutely yes. The way we’re meeting the demand is increasing the number of access points to the healthcare system. [Broward Health recently opened urgent care centers in Plantation and Coral Springs in addition to an existing one in Weston.]
Q. If demand for your services is increasing, are patients now having to wait longer to see a doctor or undergo medical procedures?
A. They do not have to wait longer. We’re helping patients access our services by improving services and opening the additional access points.
Q. Is your bad debt increasing as patients in plans with high deductibles find out that they can’t afford to pay?
A. We have been pleasantly surprised. People have been paying their deductibles. The economy has been improving with lower unemployment and patients are acting responsibly.
Q. You have said that despite all the long hours you undoubtedly will be putting in as head of Broward Health, you still plan to work one or two emergency room shifts a month. Why do you believe this will be valuable to you?
A. There are several reasons. One is to make sure that I keep up my skill sets to make sure I experience the impact of my administrative decisions as a provider on the front line. And basically to touch base with my peers and co-workers as to how we can improve our healthcare system.
Q. In all of the biographical information I’ve seen about you, just one things is missing — your age. How old are you, and if you would rather not say, why not?
A. It’s profiling in this day and age. Age is just a state of mind. Age does not matter.
Dr. Nabil El Sanadi
Born: Cairo, Egypt.
Education: Chemistry bachelor’s degree, Case Western Reserve University; degrees in medicine and public health, with honors, Ohio State Medical School; MBA, Weatherhead School of Management, Case Western Reserve.
Current position: President/CEO, Broward Health.
Previous positions: Chief of emergency medicine, University Hospitals of Cleveland; chief of emergency medicine, Broward Health.
Current boards: Chairman, Florida Board of Medicine; board member, Broward County Medical Association, Florida Medical Association.
Age: Somewhere in his 50s.