‘They don’t know what they’re doing.’ Miami’s public hospital misses out in CARES Act
South Florida’s safety net hospital administrators have tried everything to make room for more beds and increase the availability of nurses and other staff as their medical facilities swell with COVID-19 patients. They have canceled profitable elective surgeries, transformed auditoriums and classrooms into patient wards, and pitched tents outside emergency rooms to triage patients.
But as more patients with COVID-19 cross county lines for available beds and the region’s taxpayer-supported hospitals struggle to keep up with South Florida’s exponential growth in cases, some medical centers have been shut out of hundreds of millions of dollars in federal CARES Act funds intended to help those that are hardest hit.
U.S. Rep. Donna Shalala, a Miami Democrat and former U.S. Health and Human Services secretary, blames her former agency, saying: “They don’t know what they’re doing.”
At Jackson Health System, Miami-Dade County’s safety net hospital system, the chief executive on Wednesday fired off a letter to local, state and federal elected officials warning that Jackson is “on a disastrous course” financially, even as it works nonstop to carry out its mission to care for the county’s most vulnerable patients.
“We cannot allow the moment in which Jackson is reaching its highest public health calling also be the moment that crumbles its hard-earned financial foundation,” Jackson Health CEO Carlos Migoya wrote in the letter, noting that the hospital system has lost $78 million this year.
He said Jackson Health has received $75 million in CARES Act money so far, helping to offset the loss. But that money has run out, and Jackson Health missed out on the most recent round of CARES Act funds intended to shore up safety net hospitals because of what experts called an error in the way HHS calculated financial eligibility.
The public hospital system is treating about four times the number of COVID patients it had been before the mid-June surge, with 416 admitted on Wednesday alone. As of Wednesday morning, 107 were in Jackson intensive care units.
Safety net hospitals that reported an operating profit margin of more than 3% in 2018 were disqualified from the latest round of CARES Act funding, said Mark Knight, chief financial officer for Jackson Health.
The hospital system had produced a surplus of $30 million that year, Knight said, but HHS calculated it as a $150 million profit due to reimbursements the hospital system received from Miami-Dade County through voter-approved bonds for an expansion and renovation of Jackson Health’s aging facilities.
“It’s an atypical situation,” Knight said.
Shalala, who ran HHS under President Bill Clinton, said she and U.S. Sen. Marco Rubio, a Miami Republican, are trying to talk to the Trump administration about getting Florida’s safety net hospitals the CARES Act funds they need to continue caring for patients.
“I just don’t know what to say about HHS,” Shalala told the Miami Herald on Wednesday. “They’re not checking their numbers when they come up with these formulas.”
Shalala said that when HHS calculated federal funding for safety net hospitals under her leadership, the agency would create a formula for distributing the funds and then make a list of 10 hospitals and see what the impact would be. She believes that in a rush to push out relief funds to hospitals, HHS was not careful.
“They just made a mistake in the criteria they used, which made the safety net hospitals look wealthier than they are,” she said. “The truth is they were doing it too fast and they weren’t careful and as a result we got hurt, and there’s no excuse for that.”
The funding shortfall comes as Florida hits new peaks in COVID-19 infections. The state’s health department confirmed 10,181 new cases of the virus Wednesday, pushing the statewide total past 300,000. In Miami-Dade, which saw more than 2,500 newly reported cases overnight, ICU capacity at county hospitals remained maxed out as a crush of new admissions showed no signs of slowing.
Justin Senior, president of the Safety Net Hospital Alliance of Florida, a lobbying group for public and teaching hospitals, said the group’s members need help to continue serving the state’s rising number of COVID-positive patients who need to be hospitalized.
He said Jackson Health wasn’t the only safety net hospital to get shortchanged by the CARES Act. Tampa General and the University of Florida Health Shands Hospital in Gainesville also have been shut out of CARES Act funding for which they should have qualified, he said.
“We’ve had some frustration,” said Senior, a former director of Florida’s Agency for Health Care Administration, which regulates hospitals. “HHS wants simple criteria that they can check from data they already have so they can get money out quickly. ... We’re starting to get concerned that Florida in general is getting shortchanged and perhaps our safety nets, specifically, are getting shortchanged.”
When President Donald Trump signed the bipartisan CARES Act in March, the federal legislation included $100 billion for hospitals. But after the initial round of $3 billion in funding for Florida hospitals fell short for some medical centers, such as Jackson Health, HHS changed the formula for distributing funds.
HHS later distributed another round of CARES Act funds to hospitals that had a high number of confirmed COVID-19 patients, sending $245.8 million to 15 Florida hospitals, according to HHS data. Jackson Health received about $50 million in so-called “hot spot” funding, while Mount Sinai Medical Center in Miami Beach received $16.6 million, HHS reported.
Baptist Health South Florida, the largest nonprofit hospital system in the region with 11 hospitals from Monroe to Palm Beach counties, has received $155 million in CARES Act funds, said Dori Alvarez, a spokeswoman.
“These funds have helped us to offset the significant drop in revenue from the cancellation of elective surgeries and the decline in patient volume during the pandemic,” Alvarez said in an email.
CARES Act funds have also allowed South Florida hospital systems, such as Baptist Health and Jackson Health, to avoid layoffs and furloughs at a time when nurses and other healthcare workers are in short supply and many are exhausted from months of pandemic response.
Broward Health, the public hospital system for northern Broward County, has received about $18.7 million in CARES Act funds. Jennifer Smith, a spokeswoman for Broward Health, said the system suspended elective surgeries this week to ensure there’s enough space for emergency needs and for COVID-19 patients. On Wednesday, Broward Health had 289 COVID-19 patients, 52 of them in the ICU.
Knight at Jackson Health said more CARES Act money is on the way for Florida, including about $170 million for the state’s safety net hospitals and more dollars for hospitals with high numbers of COVID-19 patients. He expects that more patients with COVID-19 will continue to fill hospital beds, in addition to those with heart attacks, strokes and other emergency needs.
“We are cautiously optimistic,” Knight said of future federal relief funds. “We do know that there’s still a peak coming.”
Not all of South Florida’s safety net hospitals have been shut out of a round of CARES Act funds, however.
Memorial Healthcare System, the public hospital network for South Broward County, has received more than $200 million in CARES Act funds for safety net hospitals and for COVID-19 hot spots, HHS data shows. Memorial Healthcare System had 531 COVID patients, including 85 in ICUs on Wednesday.
At Memorial Hospital West in Pembroke Pines, where the intensive care unit is beyond capacity, CEO Leah Carpenter said she has significantly altered the medical center to accommodate more patients, ordering construction teams to turn the hospital’s auditorium and classrooms into patient wards, adding 54 beds to the 486-bed facility.
A licensed registered nurse, Carpenter has also donned hospital scrubs, a face mask and other protective gear to make rounds in the hospital, which is part of Memorial Healthcare System. Memorial Healthcare canceled all elective surgeries on July 1 in order to prepare for a surge.
“It’s just not business as usual,” she said, “and it hasn’t been for months.”
Carpenter, who was featured Tuesday night on MSNBC’s “The Rachel Maddow Show,” emphasized that she’s not taking on nursing shifts with patient responsibilities. Rather, she’s working to make sure her staff has what they need to care for the growing number of patients, including extra space and equipment.
She estimates Memorial West’s ICU is running at 180% of capacity. Canceling elective surgeries has allowed Memorial West administrators to repurpose post- and pre-operative patient areas into hospital beds and to shift nurses to the ICU.
Carpenter said the best help hospital workers can get right now is for Floridians to wear face coverings, wash their hands frequently and keep their distance. Hospitals also need people who have recovered from COVID-19 to donate plasma that can be used to treat those in the hospital who have the disease.
As she looks ahead to the coming weeks, Carpenter said what worries her most is lack of supplies to treat suffering patients.
“If you would ask me what keeps me up at night, I would tell you the availability of supplies — ventilators, remdesivir, convalescent plasma, dialysis equipment, personal protective equipment, all of the testing equipment. ... We have what we need now,” she said. “But if the trend continues, and this disease and the numbers continue to rise, I’m very worried about what that looks like in the future.”
This story was originally published July 15, 2020 at 7:41 PM.
