MCDH Board meeting reveals past errors as well as new plans and progress
Terrence Vaughn & Marianne McGee
The Mendocino Coast District Hospital (MCDH) Board of Directors meeting on February 23rd was again well managed and directed by President Steve Lund. This board, operating under his guidance, gives us hope that old problems will be addressed and rectified along with new issues being more forthcoming and transparent. This leadership is critical to rebuilding community trust and enabling our critical access hospital to survive and thrive.
There was positive financial news as the patient census was up in December and MCDH broke a record with over 10 million dollars in charges, although it resulted in less than a $9,000 profit. CFO Wade Sturgeon explained the very complicated reimbursement matrix, which results in the hospital receiving different compensation for the same services, depending on who is paying the bill. And while Medicare reimburses costs at 99%, Medicaid (California has the lowest repayment rate in the US) and insurance companies pay at much lower rates. The good news is that very few people receive uninsured care and do seem to pay their bills. And, for the year to date, MCDH is operating in the red but the gap is much smaller than projected in the budget. This is why it is difficult to budget and explains the constant battle to break even.
Another financial issue discussed and made public was in response to the allegations of billing errors and potential fraud referred to in the widely distributed email which resulted in Dr. Peter Glusker’s censure. Responding to those assertions, Attorney John Ruprecht initiated a medical record and billing compliance review by an independent auditing firm specializing in these matters. As a result of the Affordable Care Act (ACA) and computerization, records and billing codes have multiplied and are extremely complex. This company found no evidence of huge errors or fraud in the samples tested, although there were instances of mistakes and some repayments need to be made. It did indicate procedures and policies that need to be updated as well as staff training. The Board unanimously voted to contract with this company to provide ongoing oversight and assistance as well as making the entire report available to the public in the interests of transparency.
A Plant Services report was given by Steve Kobert, recently hired to supervise engineering and facilities. We are lucky to have him analyzing so many of the structural and equipment deficiencies in the facilities. He explained every project, its current status, the budget estimates and shortfalls and what problems exist today. His document outlines the extremely complex and detailed government oversights and their relationships to MCDH as well as their standards, codes and regulations as they pertain to construction and renovations. The report also outlines the extensive, multifaceted process every project must go through. Overall, in the last 2-5 years, these often long delayed projects were not accurately planned, engineered, budgeted or executed. Additionally, it appears that these government agencies were often mislead about project details, process and timelines which have eroded these powerful governments’ trust in MCDH. Steve is reviewing, reengineering and analyzing the current projects as well as future facility needs. He is communicating and collaborating with the state and federal agencies to rebuild their trust as he proceeds. His astute cost analysis will probably save MCDH millions of dollars in future planning by determining what to continue to service and maintain and what to replace on a realistic budget and schedule. His investment in this hospital is based on his professionalism and his true concern for doing a high-quality job as he has no stake in our original problems; he’s just here to solve them. It is refreshing to see this candid honesty.
The Board, after a healthy discussion, voted to accept the increased terms given in the Hospice Thrift Store lease at their Boatyard Shopping Center location. While the new 5 year lease has significant rent increases, the original agreement gave the store a $2,000 a month break for 5 years. Heidi Kraut has researched other options and this is still the best location for the organization, which has an average gross income of approximately $27,000 a month.
The Board also approved a contract amendment to their Partnership Health Plan MOU which will provide North Coast Family Health Center with additional financial incentives to assist with the difficult task of physician recruitment and retention.
In closed session the Board of Directors voted to hold a special closed session meeting on March 2 to confer with legal counsel regarding a personnel action pending against the district, which raises our curiosity. They also considered a petition to rescind the resolution censuring Dr. Glusker and voted 4-0 with 1 abstention to uphold it.
I personally was a bit surprised to hear Dr. Kevin Miller’s report on the Ad Hoc OB Committee which you can watch on the video clip. It is interesting to hear there will now be space for differing views in the final report, which is healthy as there have been distinctly differing viewpoints. I am not privy to what I imagine may be a flurry of emails among the official committee members as they work to complete a final report by their March 1 meeting.
Initially I was concerned the MCDH Board meetings, under President Lund, were so streamlined and speedy that issues were glossed over with decisions already made. This meeting did delve into issues with appropriate time for discussion and questions. It is very perplexing that given the talk about MCDH, there have been virtually no public comments or feedback, with the exception of comments regarding obstetrics. Although there are still many issues to be addressed, including rebuilding the trust, respect and support of the coastal community, it is heartening to see positive movement.