While Jackson Health System's governing body struggled Tuesday to find more ways to cut costs and increase revenue, University of Miami President Donna Shalala made a rare appearance before the Public Health Trust to ``personally apologize for statements by members of the university leadership team last week.''

She was referring to UM Board of Trustees Chairman Phillip George's comments to Jackson leaders that he was disturbed about the quality of doctors that Jackson had been hiring in recent years. ``I wouldn't send my family to many of them,'' George said.

Shalala noted that the Jackson doctors, all fully credentialed, were often approved by UM department heads to practice at Jackson. ``If they are good enough for Jackson patients, let me tell you, they are good enough for me and my family.''

Shalala spoke in the gym at Jackson's mental health center, where PHT members spent the day around makeshift tables in committee meetings dealing with the public health system's many problems.

The PHT board heard that Jackson's latest fiscal report indicated that the system lost $46.8 million in the fiscal year that ended Sept. 30.

Leaders are now trying ways to reduce an anticipated loss of more than $100 million this year. On Monday, Chief Executive Eneida Roldan ordered the closing of six units and laying off of 93 employees.

The system's number crunchers are hoping to make up the rest of the shortfall by increasing patient revenue by $53 million. That's a tall order, PHT member Angel Medina pointed out, since the system saw patient revenue decline last year. Another $35 million in cuts and/or revenue growth will need to be found to balance the 2010 budget, board members were told.

The system's quest is to find patients with private insurance to offset the climbing costs of the uninsured and those who have only low-paying Medicaid, the government insurance for the poor.

At Jackson Memorial, the percentage of private-pay patients increased slightly in fiscal year 2008 to 15.3 percent, up 1.8 percent from 2007, even though some PHT board members have suspected that UM doctors, who handle the bulk of Jackson's care, were shifting paying patients to the University of Miami Hospital across the street.

Jackson has purchased two suburban hospitals to improve its payer mix, but at Jackson North, the percentage of commercial pay declined slightly to 13.4 percent in 2008. At Jackson South, private pay was 18.7 percent, down from 19.8 percent the previous year.

The percentages of uninsured approached 20 percent in each of the suburban hospitals, just slightly below the 22 percent at Jackson Memorial.

Both Shalala and Roldan emphasized that their institutions needed a strong partnership to prosper.

The UM president noted that throughout her career, including eight years as secretary of health and human services in the Clinton administration, she has been dedicated to healthcare for the poor. She said that when healthcare reform takes hold, many hospitals will be competing for the newly insured patients, and Jackson-UM will need to be even more concerned about price and quality.

Shalala acknowledged there will continue to be differences between Jackson and UM. ``I'm not going to say there won't be tension in the future, but it will be tension with a smile on the face.''

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