MCDH Budgeting process includes OB for Fiscal Year 2017/18
The most vital news from the Mendocino Coast District Hospital (MCDH) Finance Committee meeting on April 25, 2017 was that, although Director Kevin Miller, MD, had declared at the last Board meeting that Obstetrics (OB) should be closed, slashing that program is not a consideration in the draft 2017/18 MCDH Budget.
The 2017/18 Budget draft assumes the current level of services, accounts for a variety of changes impacting the current budget, still heavily relies on registry staffing (expensive travelers), adding 10 new staff positions and a basic 5% increase to most line items, it pencils out with an almost $800,000 deficit.
Member John Allison, referring to years of fiscal mismanagement, no additional new taxes and continuing OB care, asked what can be done to zero out the bottom line. In addition to the well known registry issue, CFO Wade Sturgeon said that if contract reimbursements could be increased by less than 1%, the deficit could be eliminated. He also expressed optimism regarding some of the new software including the package which will provide much more fiscal information by department, one that determines eligibility efficiently and one that will track improvements in early patient screening for vital diseases, earning MCDH cash quality bonuses.
If you want to understand the fine details of the budget, its process and the considerations taken to make the projections, watch the last 1 1/2 hours of the meeting.
The first portion of the meeting was an overview of the the clinical presentation by the Surgical Department, which covered many minute details. It was interesting to listen to Committee member’s questions, some of which are answered easily by reading the Monthly MCDH Financial & Statistics Report. This report shows services provided by patient numbers, the month’s actual & budgeted numbers, the prior year’s same month & year as well as year to date actual & budgeted numbers. While it sounds complicated, looking at the statistics page it is very easy to make comparisons and determine trends. This budget information, as well as the entire MCDH Board packet is available to the public through emailing Gayl Moon, who also brings many copies to the meeting.
The March Report indicates that generally, with the exception of Obstetrics, Infant Deliveries and Swing Beds (generally elderly patients needing additional care), the inpatient census and days hospitalized are below both currently budgeted and last fiscal year’s actual numbers. In surgical procedures, discussed in this meeting, inpatient surgical cases indicated that while general surgeries were down last month and off its budgeted target, the current budget target had projected an increase over last year’s actual numbers. Implant surgeries are significantly decreased from its budget, although it anticipated a greater increase with the hiring of Dr. Praveen Reddy than has materialized. While Mr. Sturgeon pointed out that Dr. Rohr previously had a lengthy practice with patients returning to MCDH from out of town, it is my recollection that Dr. Rohr had stopped performing surgery here several years ago because of safety concerns. The category out performing goals are the outpatient surgeries, primarily driven by the new pain clinic procedures now available at MCDH with Committee Chair Lucas Campos, MD/Phd. Some pain procedures cannot be performed at MCDH and are handled in Santa Rosa, as are patients who need oral sedation. The temporary OB/GYN physician Amy Tomlinson, who will be here until September, is starting to do some surgeries as well. While that’s an added bonus to coastal women, it appears she is not doing surgical abortions, which are not available in Mendocino County. Previously those abortions, which were available to low income patients too, were performed at MCDH by Dr.’s Abramson and Gutnick until the Adventist Hospital chain purchased their practice.
Dr. Peter Glusker asked two interesting questions during the presentation. Currently the surgical department operates on a 4 day a week regular schedule and he wondered if expenses could be shaved realistically by initiating a 3 day schedule. John Kermen, DO, discussed how surgical scheduling is handled and said it would be tight, especially given the small MCDH surgical staff. When surgical emergencies occur after hours and weekends, the same staff may work all night on a case and then have to work the entire next day without rest. His other question was whether or not the surgical department operated at a profit or at a loss, which brought a quick rebuke from CFO Sturgeon, who said that was not an appropriate question for this presentation. It appears to me that the profitability question is only relevant to staff when it comes to Obstetrics, although Mr. Sturgeon reiterated that closing Obstetrics is not a consideration.