Columbia Aventura (Fla.) Hospital and Medical Center stands like a white bunker in north Dade County, just blocks from the Broward County line. From its upper floors you can see new condominium towers rising against the ocean front. At $250,000 to $400,000 per unit, their target market is South and Central Americans who need a pied-a-terre in North America.
They're also Cecilia Franco's clientele. Franco, a critical-care nurse born in Cali, Colombia, runs Columbia Aventura's year-old international program.
A typical case for Franco: She receives a phone call from a patient in Honduras. The husband wants to see a cardiologist; the wife, an endocrinologist and gynecologist. Franco finds out what language they speak and arranges for them to meet with a doctor who speaks that language. She sets up appointments and makes discount deals with nearby hotels if they don't have a place to go. Her clinical background allows her to explain to patients their diagnosis and courses of treatment.
"Coming from another country, being sick, and not speaking the language-those three things, it's a hard proposition," she says.
As hospitals go, Columbia Aventura is nothing special. Licensed for 407 beds, it has 1,300 employees and 800 physicians on staff. It has excellent orthopedics, diabetes and oncology, but lacks cardiac surgery, transplant capability and a burn center. It has no academic pretensions or tertiary care.
But Columbia Aventura shows how creative thinking can pull in patients who otherwise wouldn't be there.
The hospital already had two things going for it: a good location with favorable demographic trends and a medical staff with long-distance connections that was already bringing in similar patients on an ad hoc basis.
The hospital builds on a couple of unusual niches. The Jewish population of Miami has moved northward in the past 10 years, and many resettled in Aventura, a new municipality. Numerous Jewish physicians, both American and foreign-born, have joined the staff. About 50 or 60 of the non-natives came from Latin America but trained in the U.S. They retain their ties to their country of origin and take referrals from physicians there.
The hospital draws from the Jewish professional and merchant class in Central and South America, "a sophisticated group of people," Franco says. Franco, who is Jewish, advertises the hospital in Entre Nosotros, a magazine that circulates to that population.
The other niche is French Canadians, snowbirds who flock to the seashore of south Broward County from November to April. They have a completely different profile: Mostly blue-collar retirees, they come for the sun and don't spend much money. To pay for U.S. healthcare, they buy supplemental insurance policies. They insist on French-speaking nurses and signs.
To keep them coming, the hospital advertises in French in local publications and on local radio. It also sponsors a monthly health chat known in French as a Jaser Sante. On a sunny afternoon in March, Diego Mazzone, M.D., a
native of Montreal, is carrying on a rambling Jaser Sante holding a plastic backbone.
Tanned, gray-haired and sun-hatted, about 50 French Canadians in the audience eat a free lunch, sip soft drinks and pick up marketing materials stamped with the ubiquitous Columbia/HCA Healthcare Corp. logo.
"Si vous avez un disc hernie, c'est que l'espace entre les vertebres . . . " intones the doctor, a non-native speaker of French. Some women in the back row shout out the words he can't remember.
Upstairs in the hospital, Alfredo Hasbum's wife has just been operated on. The surgeon steps into the hall to brief him on the procedure. The Salvadoran spots Franco and grasps her hand to tell her how much he and his wife appreciate her care and concern.
Franco, who has lived in Florida since coming there to nursing school at 18, understands intimately the cultural expectations of Latin Americans. She projects the warmth and attentiveness that Latins seek but seldom find in the bustling and impersonal U.S. healthcare business.
"My program is based on word of mouth and patient satisfaction," Franco says. This is the Hasbums' second visit to the hospital. "Last time they came with five family members and stayed 21/2 weeks," Franco recalls. They took a hotel room, shopped, rented a car, filled prescriptions and ate in restaurants. This time they are staying four weeks. "So the whole area benefits from this."
Downstairs in the cafeteria, ophthalmologist Moshe Yalon, M.D., from Tel Aviv thanks Franco for bringing him a new patient who had surgery that morning.
The hospital treated 565 foreign patients in 1996, including those who came through the emergency room and outpatient services. Of the 565 patients, 176 were recruited through the new international outreach program. Forty-two were outpatients, the rest inpatients. The average bill of an international patient is $7,000 to $9,000, not including physicians' charges.
The economics are irresistible. A foreign patient who had a radical prostatectomy paid $13,000 to $17,000 for a five-day stay. "From an HMO or Medicare, you would have gotten about $3,500," Franco says. "You need four of those patients to equal one international patient."
And there are no pre-authorization hassles, no utilization management and no peer-review second-guessing.