Expanding Miami-Dade’s public healthcare network with new hospitals, neighborhood clinics and state-of-the-art software and electronic records will not be like building a baseball field in an Iowa cornfield or a theme park in a Florida swamp, Carlos Migoya, chief executive of Jackson Health System, told his board of trustees on Wednesday.
“You can build it,” he said. “But they may not come.”
Migoya was introducing the latest update to Jackson Health’s 10-year building plan, estimated to cost $1.8 billion, including $830 million in debt bonds funded with property tax increases approved by Miami-Dade voters in November 2013.
He assured trustees that the buildings are a “means to an end” — Jackson’s survival in an increasingly competitive healthcare industry, where the Affordable Care Act is accelerating changes.
“The healthcare system we have today is simply not large enough, not broad enough, and not deep enough to meet the demands of a growing community or a changing industry,” Migoya said.
The plans leave little room for financial error because Jackson will fund about $1 billion of the costs with capital reserves, which will require the public hospital system to at least break even or produce a profit each year through 2020. That’s the year when the new facilities and services are expected to begin producing revenues, Migoya said.
William Heffernan, a Jackson trustee and treasurer of the board, noted that the ambitious building plan will require financial discipline and the ability to change if needed.
“There’s going to be pressure on the margin of the hospital,” he said. “The hospital has to be like we talked about —no margin, no mission. This lays that out very succinctly. It’s a big number.”
Jackson Health faces more challenges heading into a year of diminished federal funding for uninsured patients and little to no prospect that Florida's Legislature will expand Medicaid eligibility to help pay for indigent patients.
On Tuesday, trustees proposed a $2 billion operating budget for the coming year — a 9.5 percent spending increase over the current year. Jackson’s budget proposal is based on an expected growth in patient revenues and taxpayer support from Miami-Dade, said Mark Knight, chief financial officer.
But Jackson’s network of hospitals, clinics and other medical facilities cannot turn a profit from operating revenue alone. Knight is projecting Jackson will receive more than $400 million in local taxpayer support next year that will make up the shortfall between costs and revenues.
The building plans presented Wednesday, now in the design stage and ready to begin construction, include:
▪ Jackson West, a new 100-bed hospital, stand-alone emergency room and pediatric outpatient clinic in Doral, estimated to cost $273 million and scheduled to open in November 2019.
▪ Christine E. Lynn Rehabilitation Center, an 80-bed rehabilitation hospital on the Jackson Memorial Hospital campus estimated to cost $185 million and scheduled to open in July 2019.
▪ Jackson Memorial floor modifications, a remodeling of patient rooms and outpatient centers at the main campus, estimated to cost $127 million and scheduled for completion in December 2019.
▪ Jackson North Medical Center, interior renovations and additional operating rooms, emergency room expansion and new patient rooms estimated to cost $121 million and scheduled for completion in November 2020.
▪ Jackson South Community Hospital, an addition of 20 new patient beds, a pediatric emergency room entrance, remodeling of labor and delivery areas, patient rooms and expansion of behavioral health unit estimated to cost $53 million and scheduled for completion in November 2019.
▪ New patient tower and emergency department expansion at Jackson Memorial, shifting the ER entrance to the north, additional exam rooms and operating rooms, a new lobby for the Women’s Hospital estimated to cost $464 million and scheduled for completion in March 2020.
▪ Six new urgent care centers in Miami-Dade, including in North Miami, Miami Gardens, South Beach, Doral and Cutler Bay estimated to cost $5.8 million and scheduled to begin opening in the fall.
Other projects, including replacing elevators and air handlers at Jackson Memorial and purchasing new medical equipment, will cost about $241 million.