Coronavirus

In the face of a pandemic, Miami’s hospitals are going from competitive to cooperative

In South Florida, where healthcare competition can be cutthroat, a group of five non-profit hospitals are creating an informal coalition in response to the novel coronavirus. They’re working together and sharing information — on everything from patients to supplies to financial performance — to ensure that Miami is prepared for a surge of patients due to the pandemic.

Jackson Health System, Miami-Dade’s safety net hospital, is in the consortium. So is Nicklaus Children’s Hospital. Their CEOs said the other members include Baptist Health South Florida, Mount Sinai Medical Center in Miami Beach, and the University of Miami Health System, though executives at those hospitals declined to comment.

“We’re all very competitive people, very competitive organizations,” said Carlos Migoya, CEO of Jackson Health. “But this is, obviously, something much bigger than the needs for each of our institutions. It’s really for the needs of our entire community.”

At Jackson Health, administrators are stocking up on ventilators and expanding the number of available beds. That added capacity could come from the old rehabilitation hospital, which is sitting empty in case of a surge of patients suffering from COVID-19.

Or it could be drawn from another member of the group: Nicklaus Children’s Hospital, where executives are looking at a 67-room facility that was shuttered more than two years ago and needs only minor repairs to reopen.

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As health officials and the media began to warn about the alarming global spread of COVID-19, the disease caused by the novel coronavirus, some Miami-Dade hospital executives began to compare notes on their preparations and experiences, said Matt Love, CEO of Nicklaus Children’s.

“There’s a lot of communication going on,” Love said. “We’re sharing what we’re doing around visitor policies, patient placement and those types of things.”

For the past two weeks, Love has been in conversation with the Agency for Health Care Administration, which regulates Florida hospitals, about using Nicklaus Children’s shuttered facility near Miami International Airport. The building was remodeled and opened in 2016 as a private hospital with 67 patient suites, modern medical equipment and food prepared daily by a chef.

But the hospital, called the Miami Medical Center, suspended operations in October 2017 and later filed for bankruptcy in March 2018. Nicklaus, which had invested in the Miami Medical Center, bought the hospital out of bankruptcy.

The facility, which sits on nearly 10 acres, needs repair, including a new air conditioning chiller, Love said.

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“There’s beds, there’s medical equipment, there’s diagnostics,” said Jodi Laurence, a vice president and general counsel for Nicklaus Children’s, adding that the hospital could boost the number of beds to 150 to 200.

Love emphasized that no decision has been made yet on how the hospital might be deployed in response to the pandemic. But that decision will likely be made with the advice of the Miami-Dade consortium members.

“It would be a community resource,” he said, “and not necessarily for one particular group or another.”

Love said Nicklaus has also offered to provide nurses to staff drive-thru sites, and that in recent weeks the hospitals in the consortium began to share information on their supply chains.

One thing that members of the consortium are finding is that their hospitals have lots of empty beds now after the governor issued an executive order canceling elective and non-emergency surgeries and many patients are trying to avoid hospitals for fear of the virus.

Migoya said Jackson’s patient census is “the lowest it’s been in many, many years,” and he said he’s heard the same thing from others in the consortium. “Therefore, do we have available beds? We have plenty of available ICU beds.”

Like other hospitals in the group, Jackson Health is preparing for a worst-case scenario even if they don’t know exactly how many people with COVID-19 will need to be hospitalized. In that scenario, Migoya said, administrators have worked to make as many of the more than 1,400 beds at Jackson Memorial capable of caring for patients struggling to breathe.

“We’ve acquired additional ventilators to be able to provide between 50 and 75 percent of all our beds with ventilators on them,” he said. “You don’t need a full ICU. You need the patients to have ventilators. Those are the kinds of conversations that we have created this coalition for — to understand where each one is and how we can help each other.”

Hospitals in the consortium also have worked to make sharing patient information easier, even across software systems that aren’t designed to communicate easily.

This kind of information-sharing between Miami’s major hospitals is critical during a pandemic response, said Justin Senior, president of the Safety Net Hospital Alliance of Florida.

“There has to be a lot of communication, particularly making sure everyone is getting information into the emergency management and public health officials about bed capacity, resource status in terms of equipment and supplies, and give them the opportunity to work with the hospitals to potentially move resources around,” he said. “Everyone really sticks together in this situation.”

There is no equivalent group in Broward County, said Jaime Caldwell, president of the South Florida Hospital and Healthcare Association. But the hospitals there are cooperating, just like they would after a hurricane or other crisis.

“They are working through their local healthcare coalitions, departments of health in each county, and each county’s emergency managers,” Caldwell said in an email. “There are daily meetings to talk about supply availability and operational issues.”

The emphasis on collaboration during the coronavirus pandemic has been particularly helpful for patient care, Migoya said, and he likes having a sounding board of fellow hospital executives who can help him gauge whether what’s happening at Jackson Health is unique or a shared experience.

Will the cooperation last once the crisis has passed? South Florida hospitals will be in dire financial shape once the pandemic has ended — because so many surgeries and procedures have been canceled or postponed — and then it’s likely back to business as usual.

“The problem we’re going to have when this virus is over … is that obviously we’re all going to have huge financial challenges,” Migoya said, “and everybody is going to go back to their corner to try to figure out how to make up for the losses.”

Ben Conarck is a reporter covering healthcare at the Miami Herald, which he joined in August 2019. He was previously an investigative reporter covering criminal justice at The Florida Times-Union. In 2018, he and reporter Topher Sanders received Columbia University’s Paul Tobenkin award for outstanding reporting on race and the University of Colorado’s Al Nakkula award for outstanding police reporting for their multi-part investigation “Walking While Black.” Conarck has also extensively covered the Florida prison system.
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