The South Florida Hospital and Healthcare Association (SFHHA) recently distributed a 2008 update to their previously conducted Community Benefits and Economic Impact Study that summarized healthcare demographics for the South Florida region. The following statistics were presented for the 47 hospital members of the SFHHA:

  • SFHHA member hospitals directly employ approximately 50,848 people.
  • The total payroll of SFHHA member hospitals in 2006 was about $2.6 billion.
  • Hospital workers are highly skilled and highly paid, with an average salary of $55,381 (about $15,600 higher than Florida’s average wage).
  • The “ripple” effects of member hospital activities translate into an additional 85,000 jobs (a $4 billion payroll).

These statistics do not include non-member hospitals, physician practices, outpatient facilities, or non-member firms that provide goods and services to the healthcare industry.

It is obvious that the economic impact of the healthcare industry in our region is very significant. Given the fact that we will continue to face economic pressures unlike anything we have seen in recent years, we are fortunate to have a vibrant, growing healthcare industry in South Florida. That’s the “good” news.

The “not so good” news is what it is costing these hospitals to recruit, hire, train, and retain employees. It is not uncommon for a hospital to have annual percent turnover rates at 20%, or higher. Take a couple of minutes to think about all of the costs that are incurred to replace a terminated employee. This is not theory; these are the real costs, some of which as Dr. W. Edwards Deming was fond of telling me, are “unknown and unknowable”. Consider the cost of:

  • Temporary employees.
  • Overtime.
  • Lost productivity of the departing employee.
  • Exit interviews.
  • Termination administrative logistics.
  • Severance/benefits continuation.
  • Lost knowledge and skills.
  • Unemployment insurance premiums.
  • Advertising, recruiting, and interviewing.
  • Screening and background checks.
  • New hire administration logistics.
  • Orientation and department training.
  • Supervisory time devoted to new employee.
  • Lost productivity of new employee.

A standard rule of thumb estimate puts the replacement cost of a terminated employee at 1.5 times average annual compensation. For our regional hospitals that works out to a cost per termination of about $83,000. If you do the math just for SFHHA members (50,848 employees), we are talking about 10,170 people a year through the revolving doors of 47 regional hospitals at a cost per hospital of $17.9 million. Some of those costs are controllable by the hospital and some are not.

If you don’t believe those numbers, let’s look at the problem (opportunity) using a much more conservative approach. For the sake of illustration, let’s take a look at an “average” hospital of 1000 employees with annual attrition of only 12%. At that turnover rate the hospital would have to replace 120 people every year. Assume that the standard rule of thumb is wrong and that it only costs $40,000 per termination for a total cost for this hospital, every year, of $4.8 million. Furthermore, let’s assume that the vast majority (90%) of the people who terminate leave for reasons that are desirable or outside of the hospital’s control (poor performance, relocation, etc..). This still leaves a controllable cost (10%) on the table of $480,000, every year (by the way, your real number is much higher than this).

In any case, to save some or all of the $480,000, you would buy all of the tools you could to improve hiring practices, you would have an effective mentoring program, you would demand a formal retention strategy, and you would probably elevate the importance of the issue by appointing a Chief Retention Officer (with accountability for analyzing and reducing attrition). In fact, if it cost you as much as $200,000 (which it won’t) to put these programs in place, you would earn a very attractive return on your investment in the first year and an even more attractive return in subsequent years.

It seems to me that this is a great business opportunity that deserves a hard look. If nothing else, you should complete a cost of attrition analysis for your facility and you should review the effectiveness of your retention program to make sure that these dollars are not slipping through your fingers.



Bruce Janke, M.D.

As Medical Director of the newly opened Joint Replacement Center at Broward Health North Broward Medical Center, Dr. Bruce Janke played a vital role in the process of attaining Joint Commission Certification for hip and knee replacement. NBMC is the first and only hospital in Broward County to achieve this prestigious certification. The Joint Replacement Center features private patient rooms and the latest advances in joint replacement surgery, including Anterior Hip Replacement using the Hana Table® to help surgeons replace the hip without cutting leg and gluteal muscles. This allows for a faster recovery without any post operative precautions.

A board certified and fellowship trained orthopaedic surgeon at East Coast Orthopaedics in Pompano, Dr. Janke has extensive experience in sports related injuries, arthroscopy, knee and shoulder reconstruction and total joint replacement.

Dr. Janke received his undergraduate degree in Biology from Florida State University before attending medical school at the University of Miami. He then moved to Ohio where he completed his residency at Saint Luke’s Medical Center in Cleveland before tackling a Sports Medicine Fellowship at the University of Cincinnati. Dr. Janke is a member of numerous professional organizations such as the American Academy of Orthopaedic Surgeons, Broward County Athletic Association and the Florida Orthopaedic Society. He has received several awards including North Broward Medical Center’s “Physician of the Year” in 2002 and North Broward Medical Center’s “Most Valuable Physician” in 2006.

In his free time, Dr. Janke enjoys exercising, boating, golfing and spending time with his wife and three daughters.

Anurag Agarwal, M.D.

The biggest news in the world of radiation oncology in South Florida is the arrival of the CyberKnife® to Broward Health North Broward Medical Center, the first and only in Broward County. Leading the CyberKnife® Team at North Broward Medical Center is Dr. Anurag Agarwal, Medical Director of Radiation Oncology for Broward Health. Before moving back to Florida to join the Broward Health Oncology team, he was at Harvard Medical School’s Mass. General Hospital in Boston.

Originally from Florida, Dr. Agarwal has been treating patients with CyberKnife® Stereotactic Radiosurgery since 2001, bringing unparalleled expertise and experience to Broward Health. While he specializes in the treatment of all types of cancers, he has particular interests in Prostate, Breast, Brain, and Lung cancers. Dr. Agarwal is double board certified in Radiation Oncology and Internal Medicine.

Dr. Agarwal earned a B.A. in Philosophy from the George Washington University. He earned his M.D. from George Washington School of Medicine and Health Care Sciences in Washington DC before moving on to radiation oncology training at The University of Pittsburgh School of Medicine, an internationally recognized center of excellence for Stereotactic Radiosurgery and gene therapy. Dr. Agarwal is Fellowship trained in the ultra sub-specialized field of Proton-beam radiation from Mass. General Hospital, which is part of the Harvard Radiation Oncology Program — the largest academic Radiation Oncology program in the United States.

He currently lives in Boca Raton with his wife who is an Internal Medicine physician, and their two sons. His parents are also retired physicians who have been part of our South Florida community for decades. His mother-in-law is a Pediatrician and also part of our Broward Health family. He is the CEO of HealX Oncology, which has partnered with Broward Health, to provide a comprehensive cutting-edge Radiation-Oncology solution to our South Florida community.



David Zeda, M.D.

Located in MetCare’s Jupiter office, David Zeda, M.D., is board certified in Internal Medicine and has medical staff privileges at Columbia Hospital and Jupiter, Palm Beach Gardens Medical Center, and St. May’s Medical Centers.

Dr. Zeda has been practicing medicine since 1999 and joined MetCare in 2007. He received his undergraduate degree at Cleveland State University and completed his residency at Brooklyn Hospital in New York.

Sandhya Menon, M.D.

Sandhya Menon, M.D., is a primary care physician in MetCare of Florida’s Wellington office. She received her medical degree from Bharati Vidyapeeth’s Medical College in India and completed her residencies at Carraway Methodist Medical Center in Birmingham, AL and at Orlando Regional Medical Center in Orlando, FL.



Growing demand for beauty

In response to declining reimbursements, complicated insurance plans, limits on ancillary service coverage, many physicians are turning portions, if not all, of their practice into aesthetic, cash only, businesses. Unfortunately, many physicians are adding these services without realizing they are also potentially adding multiple new statutory requirements to their practice including licensure, facility upgrades and staffing. By failing to recognize the need to comply with the requirements of various Florida laws and rules, physicians are unknowingly creating potentially serious violations that can result in administrative fines, and even possible criminal sanctions against them, their licenses to practice medicine and their staff.

What is aesthetic medicine?

Aesthetic physician practices are often couched under the title of a medspa, dayspa, laser hair removal center, aesthetic beauty center, cosmetic surgery center, etc. These practices range from specialty boarded physician owned medical practices to mall medspas that are operating without any physician or any licensure at all. You cannot turn a corner these days without seeing one of these new entities in strip malls or in office buildings. Potential customers are not the only ones seeing these new facilities popping up everywhere. The Board of Medicine, as well as other State regulatory boards, is also taking notice.

Action by the Board of Medicine

The Board of Medicine considers these new aesthetic medicine businesses a “huge” issue. One of the ways the Department of Health can deal with these entities is to send Unlicensed Activity Investigators undercover into the field to “patronize” these companies. They then investigate and prosecute any unlicensed activity they find. The Board also identifies these practices through patient complaints filed with the Board by patients who experience bad outcomes. Finally, med spas that are properly licensed often file complaints with the government on their unlicensed competitors. Many questions arise for the Boards and Councils handling this multi-professional practice model, including:

  • Which Board or Council governs imposition of the rules regulating a medical spa practice? Medicine, Electrology, Cosmetology?
  • What is a medical spa?
  • Who can use lasers for treatments and under what level of supervision?
  • What is a medical facial versus a facial that must be done by a cosmetologist?
  • What Board imposes sanctions on practitioners in these facilities?

The answers to these questions vary and any member of the Board of Medicine, Electrology Council and Cosmetology Board will tell you they are being inundated by “how to” questions regarding the practice of aesthetic medicine.

For all medical practitioners who find themselves part of an aesthetic medical practice or are contemplating opening a practice of their own, beware, not all aesthetic care falls under the practice of medicine. Most of the aesthetic medicine practices and med spas are operating under the radar of the various Boards right now; however, the time is coming when the Boards will get coordinated and reach out with their heavy regulatory hand. Don’t get caught by the surprise inspection and find yourself charged with practicing without a proper permit for yourself, your staff or your facility.



Imagine being discharged from the hospital but still needing some type of care by a professional. Then add the challenge of being uninsured. The team of nurses and social workers in St. Lucie Medical Center’s case management department works diligently to arrange healthcare after hospital discharge, even for uninsured patients.

Using its streamlined online process, St. Lucie is getting patients from the emergency room into appropriate post-hospitalization care quicker than ever.

“We can do something now in a few minutes that might have previously taken a day,” said Donna Turner, the assistant director of case management.

St. Lucie’s Allscripts online program acts as a resource center, medical records database and two-way communication medium with providers statewide. The program welds together the time-consuming tasks of making phone calls, scheduling in-person meetings and filling out forms in one simple interface that puts all the information a case manager could need at their fingertips.

The web-based referral program helps St. Lucie connect patients with the best resources available, including home health care, rehabilitation, skilled nursing facilities, medical supplies, extended care facilities, hospice and transportation.

(l-r) Cheryl Phillips, case management director and Donna Turner, asst. manager

Allscripts first pulls up patient information, including history and physical reports and medications. Depending on which type of care is needed after discharge, case managers can pull up the appropriate form required, and Allscripts will automatically fill in the majority of the form.

The program also attaches history and physical information to the forms so the referred doctors and medical professionals can have all the background necessary to process the patient.

Once case managers have their patients’ information ready, they can sift through the various resources available by city, state and county.

And after finding the right fit for a patient, the case managers forward any forms and medical history needed directly to the organization they chose. If the provider doesn’t have Allscripts, the files are faxed to them.

Then providers can respond to the case managers’ requests, and start a two-way conversation between the parties.

Allscripts helps free up extra time for St. Lucie’s case managers, and with 25-30 patients to see daily, they need every minute.

Because about 7 percent of St. Lucie’s patients come in uninsured, and many agencies offering free or low-cost services have cut back during the recession, securing post-hospitalization care for the uninsured has become a tough task, but a worthwhile one.

The hospital also makes lists of $4 medications readily available and coordinates with rehabilitation facilities that perform charity care, for patients who had strokes or traumatic injuries.

Additionally, department leads patients in the right direction if they may be eligible for Medicare, Medicaid or disability.

St. Lucie’s dedication and research have paid off – and put about 150 people in skilled nursing facilities, and 200 in home health care per month.

And the title of case manager isn’t something simply slapped on St. Lucie Medical employees’ ID cards. The work is strenuous, and often difficult, but it’s a calling – and a rewarding one at that, according to Cheryl Phillips, director, case management.

Case in point – a family who had been evicted during the holiday season came to case management in January. Despite difficulty securing outside resources, Phillips’ department was undeterred.

They went through the hospital and took a collection from employees, whose dollar and five-dollar donations helped the family return home and pay their landlord only four hours later.

“We have a lot of caring, compassionate people with a lot of empathy at this hospital,” Phillips said. “This is their community that they’re taking care of, and they treat their patients like their family.”