On brink of disaster, Jackson turns profitable thanks to visionary CEO
Instead, as sometimes happens in a crisis, the job fell to an unorthodox candidate:
But Migoya had done this sort of thing before, working for a dollar a year as
"If I could turn around Jackson Memorial, it would be the biggest legacy I could leave for the city," Migoya, who turns 66 this month, remembers thinking about the job.
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Stocky and bald, with the optimistic demeanor of a man who's accustomed to overcoming the odds, Migoya said he took the job against the advice of "some of my very good friends" who told him there was no way to succeed.
"I said, 'Look, if I fail, at least I tried,' " he said. "But we need to give it a shot."
Five years after taking over one of the nation's largest public hospital systems, Migoya, the one-time healthcare neophyte, appears well on his way to leaving an indelible mark on one of
He has set Jackson on a path to financial stability, forged a stronger bond with its labor unions, reinvigorated its affiliation with the
Jackson has more money in the bank now than it did when Migoya took over, even though the hospital spends more to deliver care than it receives in patient revenues. Tax money from the county more than makes up the difference.
More patients with health insurance are choosing Jackson for surgeries and other care. Infections and injuries are dropping, and this month an outside auditor verified the fourth consecutive year of budget surpluses --
To be sure, Migoya also has had the wind at his back.
The Affordable Care Act has led to an increase in the number of people with health insurance in
But despite the healthy reserves built up last year, a minefield of challenges lies ahead. Most urgent for Jackson, federal funds for hospitals to care for the uninsured will diminish once again beginning in July at the same time that public health indicators show a rise in chronic disease deaths and other healthcare needs for the county.
The overwhelming consensus among those who oversee and work at Jackson, however, is that Migoya has been the right man for the job.
"He's guided it through difficult times, and has done a tremendous job," said
"No question,
"He's transformed this place," said
When Migoya started at
Healthcare experts and local elected officials proposed that
He's guided it through difficult times, and has done a tremendous job.
But Migoya pushed back on those proposals. He drew up a plan to rein in costs -- in large part by negotiating more than
"Instead of being a guy walking in and trying to be 'The Guy,'" Arriola said of Migoya, "he put a great staff around him, worked with the staff, let the staff do what they do and Carlos did what he does -- he's more involved in the finance, and vision, and a little bit on the political side."
Migoya wasted no time once
Then he replaced the management team, interviewing candidates and empowering them to establish best practices and processes for measuring productivity and reviewing profits and losses department-by-department.
That was the easy part, Migoya said. "Running a business is running a business," he said. "The need to make sure that everybody is accountable and creating that environment is the same."
More difficult decisions came less than one year into his tenure, when Migoya proposed steep concessions from labor, including furloughs and cuts in pay and benefits, and a reduction of nearly
"As you can imagine, that was not exactly comfortable," said
Soon after, Migoya proposed that
The moves had political support, but they were strongly opposed by labor leaders, who accused Migoya and his executive team of trying to privatize
In hindsight, said Baker, the labor union president, "He was really just establishing himself as the new sheriff in town."
But amid their fight, Baker said, she witnessed a "transformation" in Migoya that convinced her he had the hospital system's best interests at heart: He stood up to the mayor.
"Gimenez was saying maybe
Baker's hunch proved right, she said, because two years after winning labor concessions and imposing layoffs, Migoya would defy
The move angered Arriola and it undercut Gimenez, who had reached an impasse in his own negotiations with the county's other labor unions. They, too, were seeking relief for their contract concessions.
"This is BS," Arriola wrote in a memo that he fired off to Migoya an hour after the deal had been announced, though he has since conceded that the CEO was right. "We have a really nice partnership with labor now," he said.
Looking back, Gimenez said, "It was going to put out of balance what we were trying to do in treating all the unions the same." But he considers it "only a disagreement," and said it did not diminish his respect for Migoya as a professional and personal friend.
Patching up
From the outset, Migoya had said he wanted to find efficiencies in
Weeks of tense negotiations led to a new agreement that would reduce
A member of
"A lot of people at the time, on the board and elsewhere, thought UM was bad," said Goldschmidt, who rejected the accusations that the university's physicians were stealing patients and business from
But he credited Migoya as being "instrumental to changing the chemistry between the two organizations," adding: "He realized that our doctors were bringing private patients, that they were working hard, that they were bringing a lot of revenues to the
It didn't hurt that UM also lent considerable political support to
As a result, Goldschmidt said, "There was an opportunity to envision and strategize the future together. Believe it or not, we did not really strategize together before that."
Goldschmidt readily concedes that "the two institutions will never agree on what is the right level of funding." But he is enthusiastic about future collaborations. Migoya said
UHealth also has begun to staff physicians at
"Carlos has demonstrated he values the long-term relationship between UHealth and
While the future likely holds more partnerships between the two institutions, Migoya and his team have labored to reform
Arriola believes Migoya is succeeding on that front, too. Patient admissions are up by 6.6 percent over the past five years, and more of those patients have health insurance, he said.
"All the growth in admission is from paying clients," Arriola said. "What does that tell you? That we have a hell of a hospital."
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Migoya said he has reduced
But his leadership also has been marked by complaints that
"It's just really hard to get into
Among the documents required for
Migoya counters that he's a steward of public money, and that not everyone who applies for charity care really needs it. He said that some
"Dade County has always been a place where people have learned how to play games," he said. "We're not going to give it away to the people that don't deserve it."
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Harmatz said she understands there's not enough money to care for every uninsured, low-income adult in
Migoya agrees that
"My goal," he said, "is for 15 to 20 years from now for
Financial independence for
Migoya said he doesn't expect to be leading
"Everybody looks at the pretty buildings and they say, 'That's the legacy,' " he said. "To me, it's what's in the buildings that's the legacy. It's the ability to provide world class healthcare in those buildings that's going to be the important piece."
___
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