MCDH Board Meeting August 27th 2015

MCDH: voting minority of two continues to impede progress

By Marianne McGee

Much of the Mendocino Coast District Hospital Board of Directors August 27 meeting’s focus was on physician contracts and financial issues, which are interrelated. While 2 people spoke to protest the manner in which Dr. Diane Harris’s contract was handled (she now has an extension through December), this issue sparked discussion during several agenda items. It culminated in the confession by President Sean Hogan that the 2-0 motion passed by Dr Rohr & Dr. Glousker at the August 17 Special Session, which extended Dr. Harris’s contract, was probably a violation of the Brown Act. While Dr. Rohr roared about how his primary concern is for patients safety, insinuating he didn’t care about the consequences of the legal violation, Dr. Kirkman, as Acting Medical Director of North Coast Family Health Center (NCFHC), had spent all weekend reviewing Dr. Harris’s files and x-rays as well as scheduling her patients with the new NCFHC internist, Pankaj Karan, MD, who was introduced at the beginning of the meeting. Dr. Kirkman appeared offended at Rohr having inferred that patients were left hanging without safe care. Director Birdsell was upset this matter was added unexpectedly to the agenda when he was not present and would have changed his schedule to have been there. Mr. Hogan also pointed out that people, who were not happy with Dr. Harris, didn’t have an equal opportunity to express their concerns.

Dr.’s Rohr and Glusker led the march to undermine new CEO Bob Edwards by insinuating that he is now incapable of handling the Harris contract negotiations, although he stated, at the start of the discussion, that if they were unable to work together, he would engage the new CFO, Wade Sturgeon, in the process. Instead, a motion eventually passed allowing a paid mediator to be engaged, if necessary, to negotiate the contract. This action, combined with the fear expressed over having another angry mob appear at a board meeting, opens the floodgates for every physician to conduct themselves in the same manner, which is expensive and undermines the authority of the CEO.

As Dr. Rohr continually points out, there are limited ways to bring MCDH into economic balance. One is to raise revenues, the other to decrease expenses. Given the limits of increasing revenue, especially with the new Howard Memorial Hospital opening, the only logical place is to cut expenses is with the biggest line item, being personnel. Given that physician salaries must be costly and may not be consistent, it is time to bring them into line. These physicians are no longer responsible for all the expensive elements of operating their own practices incurred, including malpractice insurance, which is what drove their rates up decades ago. If they truly care about the health of their patients and community they ought to be willing to tighten their belts, like the rest of the MCDH staff has done.

It seems disingenuous that Dr Rohr, given that he came here on a sweetheart deal and when his initial contractual responsibilities were completed, would only see patients that had his preferred insurance reimbursements, (not including Blue Cross Anthem, the leading provider in this area) and also now refuses to do emergency coverage. This has resulted, when Dr. Bella is unavailable, in patients with broken bones driving to Willits, giving more business to the Adventist Health Care System, our primary competitor. Now that Dr. Rohr is leaving his practice soon, his primarily elderly patients, who have been informed that the other local surgeon’s hip replacement procedure is dangerous, will likely go to the new state of the art hospital in Willits. So, while Dr. Rohr kept insisting he would not sign this new physician contract, reflecting his overall lack of concern for the health of this hospital and community, he would never practice at NCFHC anyway.

It appears that the need for a new boilerplate primary care physician contract is born out of financial issues and particularly conforming to the Stark Law. When Mendocino Medical Associates (MMA) merged into MCDH, rumor has it there were some very sweet deals that benefited the doctors financially, working short hours with generous pay, perhaps contributing to NCFHD failure to meet its financial goals. Now that most of them have retired, it is a good time to review the contract boilerplate.

The elephant in the room, bearing further study, is the impact and circumstances of the Stark Law (http://starklaw.org/) violation, which resulted in MCDH paying a $400,000 fine that was potentially 2 million dollars. While it is a complex law and the violation has barely been mentioned in MCDH board meetings, it appears the breach occurred in conjunction with the physician contracts. The Stark Law is federal legislation that was essentially designed to protect consumers. It prohibits physicians or their families from financially benefiting from direct or indirect ownership or investment interest in the hospital through equity, debt or other means, or a direct or indirect compensation arrangement with it. Their website advises that contracts between hospitals and physicians need to be carefully negotiated and perused as to not incur violations. It is applicable to all hospitals receiving Medicare & Medicaid reimbursements, which appears to have impacted MCDH when it became a Critical Access Hospital in 2006. Another potential issue that bears further investigation is the speculation that some physicians were investors in the Mendocino Coast Medical Plaza, the leased building that houses NCFHC.

A primary financial consideration is the role of insurance company reimbursements, which often pay less than half of what procedures or visits, cost. These costs have skyrocketed just because the insurance companies keep strangling hospitals with their reimbursement rates. It leaves, as Dr. Bella pointed out during a short discussion about raising costs, any increases will just fall back on poor people and those insured, with high deductibles, which are paying directly out of their own pockets. Remember that insurance companies are generally profit making corporations now, thanks to deregulation, and are the primary beneficiaries of the entire health care system, including Obamacare!

As MCDH struggles for financial viability, I am puzzled by the fact that Dr.’s Rohr and Glusker appear to oppose bringing Summit Pain Alliance physicians to the NCFHC staff. While this addition is proceeding without their support, it is hard to understand why, with roughly 2000 chronic pain patients on the coast, they wouldn’t support it as a resolution to some of the funding issues as well as bringing much needed humane care to the community. Those of us who suffer must drive at least to Santa Rosa, or further, to take advantage of new compassionate modalities that may assist patients in reducing chronic and acute pain as well as the harmful effects of long term opioid use.

And why are MCDH physicians on the Board of Directors anyway?