Southern Humboldt's new community-based doctor, Dr. Marcin Matuszkiewics, is now seeing patients five days a week at the Garberville clinic, administrator Harry Jasper told the Southern Humboldt Community Healthcare District at their board meeting last Thursday, Sept. 27.
The collaboration between Dr. Matuszkiewics, Dr. Peter Nash, and the contract emergency room doctors who are helping out in the clinic has been “great,” Jasper said. He noted there has been an increase in male patients since Dr. Matuszkiewics came on board.
Board vice chair Barbara Truitt said she had personally received several positive comments about Dr. Matuszkiewics, as well as the contract doctors.
SHCHD has also hired a new patient financial services (PFS) manager, Sue Adams, who has over 30 years experience in PFS management. “We've never had someone with this caliber of experience,” Jasper said.
Adams is already hard at work reviewing the multiple aspects of the district's PFS, including compliance with regulations and contract negotiations with insurers. Jasper was particularly impressed with her negotiation skills and insistence on getting at least an 80 percent reimbursement agreement from insurance companies.
St. Joseph and RMH
At the August board meeting, Jasper asked the board for approval to discuss informal affiliation with St. Joseph's Health Systems, which operates the nearest “receiving hospitals,” Redwood Memorial in Fortuna and St. Joseph's in Eureka.
While board members were interested in the benefits of affiliation, they were concerned about whether SHCHD would retain its autonomy.
Last Thursday Jasper reported that he met with his counterparts at both hospitals and found them eager to work more closely with SHCHD without waiting for actual affiliation.
An SHCHD team including director of nursing Sarah Beach and clinic nurse manager Julie Moore as well as Jasper and others are continuing to meet with “all players,” including City Ambulance, to develop a protocol for transfers between the three hospitals.
This means not only transferring local patients north for specialized diagnostics and care but also transferring local patients back from Fortuna or Eureka to Garberville when appropriate, especially for rehabilitation after surgery.
Jasper noted that the other hospitals are particularly willing to work on this program because Medicare will soon begin reducing payment to hospitals that re-admit patients with the same diagnosis.
Most importantly, patients benefit from recovering in their local community, in familiar surroundings and close to family and friends.
Additionally, collaborating more closely with St. Joe's and Redwood Memorial will make it easier to implement telemedicine services so that treating physicians from all three hospitals can consult in real time while examining a patient at one of the facilities.
Along those lines, a team consisting of Dr. Matuszkiewics, Beach, and operations manager Kent Scown made “significant contacts” with other providers to implement both telemedicine and electronic health records.
The team met with their counterparts from the Open Door Clinics in Eureka and Arcata to talk about connecting to their telemedicine system. Dr. Matuszkiewics also contacted one of his mentors at the University of California at Davis who is a specialist in telemedicine for guidance.
The board discussed the outcome of July's strategic planning workshop, which was attended by about 30 members of the public in a “World Cafe.” Public input was condensed to a little over five pages of notes, mostly lists of “likes,” concerns, factors critical to success, and additional ideas.
Board members admitted they found it difficult to reduce this much information into specific recommendations for revisions to the current strategic plan, and to respond to every point made, as promised when the workshop was announced.
Board chair Nancy Wilson suggested appointing an ad hoc committee made up of two board members and two members of the public to review the comments and organize them not only by which strategic plan goal the comment relates to but also by possible methods to address the comment.
For example, many of the items relate to staff shortages, Truitt pointed out.
The board readily agreed to Wilson's proposal and appointed a committee made up of board members Truitt and Gary Wellborn, with Beth Bennett-Allen and David Ordonez as the public members.
Ordonez and Bennett-Allen are candidates for the two four-year board seats in the November election and were both present at Thursday's meeting. Judi Gonzales, a candidate for the two-year seat, was also in attendance.
Human resources director Linda Feretto presented a new chart showing the results of the employee satisfaction survey that contrasted last year's responses to this year's responses to help the board identify problem areas.
Employees responded to 30 statements, indicating how much they agreed or disagreed with the statement, with 5 being the highest level of agreement. The averages for each statement this year were compared with last year's averages to see whether agreement had risen or fallen, and by how much.
Several of the items that showed markedly less agreement now than in 2011 concerned employees' relationships with their managers. Feretto pointed out that several departments, including health information management, patient financial services, the laboratory, and radiology, did not have managers during much of 2012, which would account for disagreement with statements like “My department manager is helpful and supportive.”
Since managers have been hired in these departments, these conditions should improve.
The statement that received the least amount of agreement, by a wide margin, continued to be, “The community has confidence in the healthcare services we provide,” with an average of 2.54, up slightly from 2.78 in 2011.
This reflects comments gathered at the strategic planning meeting, Truitt said.
”There's a lot of opportunity here for improvement,” Jasper added.
Feretto observed that some of the results opened up areas that need further study. For example, although there was generally high agreement with the statement, “My work environment is safe,” she wondered why anyone disagreed with that. Employees should be questioned to find out why they feel unsafe so that problems can be addressed.
Jasper told the board that results of the patient satisfaction survey are not yet available but he expects to present them to the board at the October meeting.
Turning to the financial report, Jasper said that accounts receivable - the money owed to the district for patient services - had increased significantly since last year, indicating potential increases in future revenue.
A/R tends to spike at SHCHD in October, then declines over the winter, and starts to rise again in the spring.
He also explained that A/R reflects the amount billed by the district but because insurers, Medicare, and Medi-Cal routinely allow only a portion of the billed amount for payment, net revenue will always be less than A/R.
Additionally, Medicare and Medi-Cal pay SHCHD based not on what the district bills but on its actual overall cost of providing service, a method called “cost-based reimbursement.”
At the October board meeting, the board and interested members of the public will be able to hear a presentation about cost-based reimbursement from Dr. Ralph Llewellyn, director of critical access hospitals for Eide Bailly, SHCHD's financial consultants.
”Overall we're within our budget for our net revenues,” Jasper continued. The district currently has net income - that is, what's left after expenses - of $829,000, but because the district's cost report for fiscal year 2011-12 has not yet been compiled and reviewed, that figure may be too high.
Once Medicare and Medi-Cal have reviewed the cost report, they can ask for return of overpayments and reduce payments for current services. Jasper is preparing for a negative adjustment of up to $400,000 for last fiscal year, but added that the district will still be in such good financial condition and that it will not need to draw on its line of credit.
”We'll know in a month,” Jasper said. “There's always this period of uncertainty.”
Next month's board meeting is scheduled for Thursday, Oct. 25, with open session beginning at 1 p.m. Board meetings are held in the Dimmick meeting room at the Garberville hospital.
For more details about the district's financial condition, the public also may attend monthly meetings of the finance committee. The next finance committee meeting is scheduled for Tuesday, Oct. 23 at 1 p.m. in the Dimmick meeting room.