Font ResizeSpeaking for the Finance Committee, board member Gary Wellborn said the district had “a pretty decent month” but added that the big issue for the district will be the cost report from Medicare. One of the peculiarities of Medicare funding is the ability of that program to take back money it has paid hospitals for services rendered.
”The big question,” Wellborn said, “is what we have to pay back.”
Knowing that it's a given they will be required to return a portion of their reimbursements, the district has set aside what they estimate will be required. Wellborn said they have reserved $1.91 million. If the cost report is for less than that, they will have some money to spend, but certain projects are on hold until the cost report comes in.
Operations manager Kent Scown presented the board with information on a proposal to repair and replace the heating system and ducting in the clinic/administration side of the facility. He said that the system is old and inadequate. The distribution system leaves some rooms too cold and some without any heat at all. While the board supported the improvements, they decided to hold off on spending the money until after the cost report comes in.
In his report district administrator Harry Jasper said that the hospital's bed census was higher than last year. They are averaging about three acute patients a day, he said, and the average stay is 3.2 days.
Jasper said also that he had “taken to heart” comments made at the previous meeting on improving communication with staff. He said he planned to engage employees in discussing “what that might look like” and include staff in developing a communication plan.
Progress is also being made on the efforts to attract doctors to the community and the hospital. Two doctors, currently engaged in family practice residency, are candidates for joining the district medical staff. One has a tentative start date of September, 2012. Both are agreeable to doing an ER rotation as well as working in the hospital and clinic. Dr. Doug Pleatman would continue as medical director.
Jasper said also that Dr. Wendi Joiner, medical director at Redwoods Rural Health Center, has been given admitting privileges at the hospital and that both medical institutions desire to work together.
Currently, a team of eight doctors is working the ER and the clinic.
Dr. Pleatman was at the meeting briefly to give his report. He said that the radiology group that is currently reading x-rays for the hospital is a “little improved” but he is continuing to search for another group to work with.
Dr. Pleatman also discussed protocols for heart attacks. St. Joseph Hospital has sent the district a new protocol for heart attacks that show up on an EKG. He said the situation in Garberville is unique, “not just because we're rural but because everything is so far away.”
He weighed the risks and benefits of the administration of clot buster drugs when the patient is facing a one-hour ride to St. Joseph and the cardiologist. He had discussed the issue with different cardiologists and got different feedback from each, but there is general agreement on the 30-minute window for administering the drugs, which should be available in the ambulance. He said also that the ER can take blood tests and fax the results to St. Joseph's so they will be there when the patient arrives.
Dr. Pleatman announced that two new tests have been added to the number available at the hospital laboratory. One test is for ammonia levels in liver disease patients and the other is for acetaminophen (Tylenol) levels in overdose cases.
Dr. Pleatman said that there hadn't been a “unified group” working in the ER for years, as doctors didn't stay very long. That has changed. He said that for the past two years there has been a solid, cohesive group working together in the ER and he thanked the board for supporting his suggestions and additions to hospital staff and procedures.
Jasper and the board discussed improved technological capability at the hospital. He wants to install the same telemedicine capability at the hospital as exists at Redwoods Rural Health Center. The goal is to have three units in the clinic and the hospital with high definition capability so they can be used for dermatology and orthopedic consultations.
Board member Mary Krissie Branzei expressed support for the idea, saying it would be a great tool for the physicians.
Jasper is also working on getting CT diagnostic service at the hospital. Currently patients have to be sent north for a CT scan. Jasper estimated that if CT could be available at the hospital, it would serve 20 to 30 patients a month.
The district has yet to make the switch to electronic health records. Jasper said he prefers they use Next Gen, the same system in use at Redwoods Rural. The problem with that, he said, is that St. Joseph uses another system. This lack of conformity in systems is “one of the broken problems in our health care system.”
Jasper proposed bringing in a team of experts to develop an in-house accounting system. The district accounting firm has merged with another firm and he suggested this was an opportunity to make improvements. Board member Branzei wanted assurance that no one would be laid off if Jasper brought in “people from outside.” Jasper said that he had “no intent to terminate anyone.” His plan is to educate current employees in a new system.
The board reminded Jasper that he would need their approval to proceed with the idea, but this and some of the other improvements would have to wait until the cost report from Medicare is received. A special meeting will be called when the cost report arrives and some of these proposals may be discussed again at that meeting.
In the public comment portion of the meeting, complaints were made about the quality of health care available and about Jasper's salary increase. One community member defended the board against the criticisms of another community member who decried the board's determination to observe the Brown Act. A question was raised as to whether or not the board would allow the staff to form a union. This item will be placed on a future agenda.
Board member Barbara Truitt praised the staff for their latest monthly newsletter, “Vitals.” She said she hoped the board would get to contribute to the newsletter.
Board president Nancy Wilson said she wanted the board to hold a staff appreciation party and asked it be put on the next agenda. She also asked that Scown take the board on a tour now that the retrofit project is finished.
