Miami-Dade County

Jackson approves UM agreement

A long-simmering dispute between Jackson Health System and the University of Miami, partners in healthcare for nearly 60 years, boiled over Thursday during a meeting to renew their annual agreement for UM to provide doctors and medical services to Miami-Dade’s public hospital network.

Under the agreement — which has caused escalating tension over money in recent years — Jackson will pay UM $117.4 million through May 2015, a $3 million increase over the prior year.

But while most Jackson board members voted to approve the deal, one Public Health Trust member, Marcos Lapciuc, lambasted the contract as “horrendous for Jackson.” He said it perpetuates a relationship that prevents Jackson from attracting more paying patients — an explicit goal of last summer’s campaign to win voter approval of $830 million in public financing to upgrade the hospital system.

Lapciuc, a past Jackson board chairman, accused UM of taking lucrative services out of Jackson while also steering insured patients away from the public hospitals and into UM’s private hospital across the street in Miami’s Civic Center.

“The University of Miami made a deliberate and conscious decision to strip Jackson out of five, high-volume Medicare lines,” Lapciuc said, “to rip them out of Jackson and send them to their hospital.”

Pascal Goldschmidt, a physician and dean of UM’s Miller School of Medicine since 2006, sat quietly at a conference table during Lapciuc’s criticism — for a while.

Then he recited the history of financial crises that have hobbled Jackson over the past decade, noting that the public hospital system emerged from near bankruptcy little more than one year ago.

“Throughout that time,” Goldschmidt said, “we diligently, and very carefully kept our eyes on the future of this institution, the future of this community, to make sure that, together, the nurses, the staff, the doctors preserve the quality of care that we provide.”

He concluded by calling Lapciuc “a little bit junior in his opinion — junior to me, anyway.”

Lapciuc shot back.

“That shows a lot of arrogance,” he said, “and I think that’s exactly the problem the University of Miami has.”

He turned to Goldschmidt: “I put money in here. You take money out of here. That’s the difference between you and I — I’m a volunteer.”

Lapciuc, a board member since 2006, spoke after his Public Health Trust colleagues had endorsed the agreement as a vast improvement in the relationship between the two healthcare giants, whose previous contracts have been described as more of a handshake than a legal document.

He has openly opposed the agreement in the past. So when he asked to speak at Thursday’s board meeting, vice chairman Joe Arriola quipped: “The love fest will be over now.”

Darryl Sharpton, Jackson’s board chairman, tried to jump in with a positive spin on the deal: “This is a relationship that has significantly improved over what we had when I joined this board.”

Not according to Lapciuc.

He said UM doctors have been referring patients in need of cardiology, urology, orthopedics, oncology and pulmonology services to UM Hospital , the 560-bed former Cedars Medical Center that the university bought in 2007 for $275 million, a lingering source of friction between the institutions.

Arriola and Lapciuc have expressed their displeasure in the past over Jackson’s relationship with UM, with both men accusing the university of acting more like a competitor than a partner.

But the latest agreement between the institutions ensures fair market value for services, and contains performance measures and transparency, which were lacking from past contracts, Arriola said Thursday.

“The outstanding thing about this … is we break it down. We understand where the money is,” Arriola said. “It was just one big number and we did not understand. We did not know. There’s a lot of clarity here now.”

But Lapciuc called the agreement an invitation for UM to keep the most profitable services for itself.

“It is akin to letting Toyota manage our automobile factory,” he said, “but letting them keep the compact, fuel-efficient cars and SUVs and letting us keep the minivans and sports coupes.”

Goldschmidt noted that UM has helped Jackson reduce the number of catheter-related infections at its hospitals, and that UM physicians provide the services that make the Miami Transplant Institute, which is located at Jackson Memorial, one of the most successful programs in the nation.

“This is not the sedan car that was described before,” Goldschmidt said. “This is a top-of-the-line Rolls Royce for any medical center in the United States.”

Yet while the dispute laid bare an underlying tension in the relationship, it also underscored the extent to which two of Miami-Dade’s oldest and largest institutions need each other. Lapciuc and Goldschmidt even posed for a picture together after the meeting, arms around each other’s shoulders.

UM provides more than 90 percent of the physicians who staff Jackson Memorial’s emergency rooms, trauma center, burn unit and other departments. UM faculty physicians also are paid to teach the hundreds of Jackson-paid medical residents.

But without Miami-Dade’s publicly-owned hospitals, which have sovereign immunity that restricts lawsuits against the government, UM could not feasibly pursue cutting-edge medicine — from organ transplants to spinal surgeries to trauma, all based at Jackson.

“We continue to do groundbreaking research in this hospital,” Goldschmidt said, “and importantly, most importantly, we provide to this region the opportunity to get your life saved when everyone else is giving up.”

The newly-approved agreement pays UM $14 million to care for patients, including the uninsured; $31 million for educational programs, such as clinical instruction for residents and fellows; $4.8 million for administrative support; $24 million for anesthesia, neurosurgery, neurology, pediatrics and other programs; and $39 million for services including organ procurement for transplants and ophthalmology for the uninsured.