Jackson Health Trust

Fitch Affirms Miami-Dade County, FL GOs at 'AA'; Outlook Negative

Fitch Ratings has affirmed Miami-Dade County, FL's $1 billion in general obligations at 'AA'. The Rating Outlook remains Negative. In addition Fitch affirms other tax-supported ratings with a Negative Outlook for the county, as follows:

--$151 million public service tax revenue bonds (UMSA public improvements) at 'AA';

--$29 million special obligation bonds (courthouse center project) at 'AA-';

--$368 million public facilities revenue bonds (Jackson Health System) at 'AA-'; and

--$319 million professional sports franchise facilities tax revenue bonds at 'A+'.

Fitch also affirms the following ratings with a Stable Rating Outlook:

--$73 million special obligation bonds (convention development tax) at 'A+'; and

--$550 million subordinate special obligation bonds (convention development tax) at 'A+'.

SECURITY

General obligation bonds are supported by the county's full faith and credit pledge and payable from ad valorem taxes unlimited as to rate or amount.

Special obligation bonds (courthouse center project) are payable from a $15 traffic surcharge and, if necessary, from a county covenant to annually budget and appropriate from legally available non-ad valorem revenues.

Public facilities revenue bonds (Jackson Health System) are secured by the gross revenues of the Public Health Trust (PHT), an agency and instrumentality of the county, and the county's covenant to budget and appropriation non-ad valorem revenues to replenish any draws from the debt service reserve fund on an ongoing basis which serves as the basis for the Fitch rating.

Public service tax revenue bonds are secured by a pledge of the public service tax (PST) levied by the county in the unincorporated areas of the county on the sale of electricity, gas, coal, fuel oil, water service and telecommunications (CST).

Professional sports franchise facilities tax revenue bonds are secured by a 1% professional sports franchise facilities tax (PSFFT) and a 2% tourist development tax (TDT), both on the rental of facilities such as hotels, motels and apartments countywide (except in Miami Beach, Bal Harbour and Surfside). In addition, if the county determines that the PSFT and TDT are not sufficient to pay debt service on any payment date or if there is a deficiency in the DSRF, the county has covenanted to budget and appropriate non-ad valorem revenues to cure such deficiency. The county can be released from the covenant to budget and appropriate non-ad valorem revenues if the PSFT and TDT in each of the preceding two fiscal periods equaled at least 150% of MADS. The ABT requires sum-sufficient coverage from pledged taxes so long as the covenant to budget and appropriation non-ad valorem revenues is in effect.

Electronic Medical Records and Going For Broke: Jackson Health ...

I have written on numerous occasions that health IT in its present form, often poorly designed and implemented under current IT leadership structures, is often a waste of precious healthcare resources. The resources might be better spent on essentials such as patient care for the poor or improved human staffing, until this experimental technology is perfected.

As at my site on health IT difficulties and mismanagement I observed: mismanagement of the technology . Mismanagement of HIT is largely due to false assumptions and naïveté concerning the challenges presented by this still-experimental technology, and underestimations of the expertise essential to achieve the potential benefits of HIT. This results in mission-hostile HIT design, and HIT leaders and stakeholders operating outside (often far outside) the boundaries of their professional competencies.

“Cerner is pleased to partner with Jackson Memorial Hospital, an institution continually ranked as one of the best hospitals in America,” said Trace Devanny, Cerner — president. “JMH’s decision to implement a solution-oriented information technology system reinforces its vision to improve healthcare communitywide. Cerner worked together with JMH to implement multiple Cerner Millennium solutions specifically designed for various roles, venues and conditions that will ultimately improve the patient experience.”

The bad news came at PHT committee hearings late Tuesday afternoon. “Very drastic measures need to happen” to stem the growing losses, said Chief Executive Eneida Roldan. She said the losses were likely to increase, because considerable funding for poor patients comes from Tallahassee, and the Legislature is expected to cut back on healthcare funding programs as it deals with its own budget crisis.

“We’re making very drastic decisions that no hospital wants to do,” Roldan told the board,

If that was the case (and I note the “may have”, implying the organization is not even certain of this explanation), why was this discrepancy not noted before or during the transition? Who, exactly, was managing this project? This would be a stunning example of IT mismanagement making what happened at Yale some years ago look like a cakewalk, and on par with the mismanagement at another Miami hospital, Mt. Sinai, as I posted here .

Looking forward and back, Jackson Health System’s grim financial picture just keeps getting worse.

Governance for whom and for what, principles to guide health policy in Miami-Dade County

Evaluation of Community Voices Miami, affecting health policy for the uninsured

Organizational behavior, theory, and design in health care

Healthcare financial management, journal of the Healthcare Financial Management Association

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