Jackson’s next leader to be chosen Wednesday

By John Dorschner
jdorschner@MiamiHerald.com

Jackson Health System’s governing board is expected Wednesday to pick a new chief executive who will almost immediately face hard decisions to keep Miami-Dade’s public hospitals alive in the face of severe cash shortages and major cuts in state funding.

The three contenders are a New York public hospital executive accustomed to tough choices, a veteran consultant who has turned around other struggling hospitals and a longtime banker who staved off financial disaster at Miami City Hall.

The decision will be made by the Public Health Trust, 13 volunteers appointed by the County Commission, two commissioners and a member selected by the University of Miami. The new CEO could negotiate a contract paying up to $975,000 a year.

Members of the board are likely to resume a heated discussion from earlier meetings about whether a healthcare novice, banker Carlos Migoya, can deal with Jackson’s complex problems as well as Ram Raju, chief operating officer of New York City’s public hospitals, or Myles Lash, a 40-year hospital administrator who has helped straighten out finances of a big District of Columbia hospital.

Mark Rogers, former chief executive of Duke University Hospital who quit the Trust in disgust last month, wrote in January that “an experienced and innovative healthcare executive” was needed.

Angel Medina, the Trust’s vice chair and a veteran banker, sees it differently: “There are many examples of CEOs that are successful in one industry and then change fields, but not roles, successfully. A great leader is someone that can articulate a vision and execute on the strategy to achieve that vision.”

Here is a look at the three finalists:

Myles Lash

For more than four decades, Lash, 64, has been at the center of the hospital field.

From 1972 to 1979, he was hospital operations administrator for the Ohio State University Hospitals. From 1979 to 1985 he was executive director of the Medical College of Virginia Hospitals.

Since then, he has served as a hospital consultant in the Washington area.

In 2002 and 2003, he served 10 months as interim chief executive of Washington Hospital Center, a large and troubled safety net hospital.

“He’s really a seasoned healthcare professional with big-time experience,” said Kenneth Samet, chief executive of MedStar Health, the company that owns Washington Hospital. He said Lash helped find ways for MedStar facilities to cut costs and find ways to build revenue.

Samet said Lash was crucial in “building trust and confidence with the physicians” who brought patients to the hospital.

In December, Lash became a full-time South Florida resident, moving into a $1.7 million condo on Fisher Island that he had owned since 1999.

In his search committee interview last month, he said that anyone leading a turn-around would look first at expenses — because that’s “easiest to get hold of” — and then at services that could produce revenue. He noted that might be a challenge because he wasn’t certain Jackson has data on revenue producers. The system is still working to get software in place to do that kind of analysis.

Lash told The Miami Herald it would be “very premature” to consider where cuts might come, but said that if he is selected, he would find it “extremely helpful” to sit down with county and state leaders to talk about Jackson.

Carlos Migoya

Except for a brief stint as a Chevrolet dealer in Miami, Migoya, 60, often jokes that he spent more than three decades working “for the same bank with three different names.”

Starting with Southeast Bank in 1974 and going on to First Union and Wachovia, he worked as a regional president, mostly in South Florida, with two-year excursions into the New York area and then North Carolina. He says he learned a lot about turn-arounds and transitions during that time.

Joe Martinez, County Commission chairman and a Trust member, is a strong Migoya backer, praising the banker’s business skills and his government experience.

From February to December 2010, Migoya worked for free as Miami city manager. Facing a $105 million deficit, he fired the budget manager in the first two weeks and starting an overhaul of city finances, zeroing in on a $100 million pension payout due firefighters.

Migoya invoked a little known state law allowing it to recast union contracts, reducing pensions and saving about $80 million. Union leaders were enraged, but the business community praised the move.

“He is smart, dedicated and a top executive,” wrote Jorge Perez, a longtime friend, political powerhouse and chief executive of the Related Group, a major Miami developer. “He works well with people, was a great banker and community leader.”

Migoya said he has been spending a lot of time recently boning up on hospital administration. “Several CEOs have told me that 99 percent of the business is not healthcare-related,” he said.

He said he’d work quickly to hire a chief operating officer with substantial hospital experience, perhaps within 30 days.

“I’m against mass layoffs,” he said. “When I was at the bank and later at the city, I saw you usually cut in the wrong places.” He noted that Jackson last year cut primary care doctors and social workers, people who could help the place run more efficiently. “Frankly, I think those cuts should not have been done.”

Ram Raju

For 14 years, Raju, 59, was a vascular surgeon and a trauma surgeon in New York City. He says it was during his time at Lutheran Medical Center in Brooklyn that he became fascinated with administration, figuring out how to turn an unprofitable surgical center into a money maker by opening a trauma center.

He rose through the administrative ranks of the New York City Health and Hospital Corp., the city’s public hospital group with annual revenue of $6.4 billion and 1.3 million patients a year — a system even larger and more complex than Jackson.

Raju, now the chief operating officer, is in the midst of trying to save $600 million through cuts and improved revenue services. The hospitals have cut 1,900 staff positions, and Raju said he personally approves any new hire. The system has also cut tens of millions of dollars in payments to the city’s medical schools.

But, he emphasizes, the system is also working to gain revenue by creating “medical homes,” a concept for patients to get primary care through accountable care organizations.

Raju was also the only finalist to mention the benefit of the hospitals having an insurance plan. He said the New York hospitals’ Metropass has been growing, becoming a money maker and attracting patients to the city’s public hospitals. Jackson is attempting to do something similar with its Jackson Health Plan.

“He’s an outstanding candidate,” says Kenneth Raske, president of the Greater New York Hospital Association. “A physician, he’s very concerned about quality of care, and he has acquitted himself extremely well’’ in the challenging New York situation.

Raju’s name appears frequently in New York newspapers, usually concerning nuts-and-bolts hospital problems, such as finding translators for patients in a city where residents speak 140 languages.

A story in the New York Post in 2009 said Raju had been one of the most sued doctors in the city, paying out claims in nine lawsuits between 1998 and 2004. Raju responded through a spokeswoman that the number wasn’t high considering he had done 20,000 surgical procedures in the high-risk fields of trauma and vascular surgery. State records indicate he has never been disciplined by medical boards.

During his search committee interview, Raju said that the New York hospitals had gotten hundreds of millions of dollars in new state and city financing after showing the system was moving toward more efficient operations, and he hoped he could do the same in Miami-Dade.

When told that more government funding in Miami-Dade seemed highly unlikely, he said he could plan for a Jackson future without more tax money.

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