Tehachapi Hospital Update - RaymondHino's Blog - Tehachapi News

Letter to TVHD Board of Directors Candidates Who Appeared at the Apple Shed on Wednesday Night

November 2, 2006

Dear Candidates for Hospital Board Who Appeared at the Apple Shed Restaurant:

First of all I would like to thank all of you that took the time on a weeknight to attend a public forum so that the public can hear your views on the hospital issues. And thank you to the Apple Shed restaurant for hosting the evening. Unfortunately, the whole experience was very frustrating for me. As I listened to the questions and the answers given, I felt like I wanted to give a hospital perspective on the questions. Of course, I was unable to do that because this was a night for the candidates. I do, however, want to give all of the candidates who attended last night the benefit of a hospital perspective on the questions and some of the statements that were made.

First of all, I would like to say for the benefit of all candidates that the Hospitalist program at TVHD is primarily concerned about providing better quality care for our patients. Some of the candidates last night said that the program was for the purpose of increasing revenue. From my perspective, that is not the primary purpose. The purpose is to provide care locally for patients who would otherwise be sent away from our community. Transfers away from our facility can cause delays in receiving care and hardships on family members who have to travel outside our community to visit loved ones.

Here are some additional observations:

Dr. Hall stated that the physicians are supportive of having a Hospitalist function at Tehachapi Hospital.

Additional inputs: This does not match with the fact that TVHD medical staff has rejected 2 prior proposals from Hospital Administration to implement a Hospitalist program. The first proposal was for an ER MD group to provide the service. The second proposal was to use the new CA law allowing hospitals to employ physicians. A proposal was made to the medical staff to employ a Hospitalist physician. The proposal was rejected.

Dr. Olsen stated that he was running for the Hospital Board so that he can receive the same financial reports that the Board of Directors receives

Additional inputs: Number one, the financials for TVHD are public record and are available to anyone that requests to receive them. However, it is particularly disturbing when Dr. Olsen says that he wants to receive the Board financial reports, since he has been receiving the exact same financial reports that the Board receives for the past 2 years. In his capacity as Chief of the Medical Staff, Dr. Olsen receives the exact same Board packet that the Board members receive.

All 3 physician candidates stated that they had been excluded from the planning process for the new hospital.

Additional inputs: I find this statement to be baffling since the new hospital plans were presented at, at least 2 medical staff meetings and due to the fact that there were several Building Committee meetings held in which Dr. Olsen was the medical staff representative. But what is particularly disturbing is that community citizen, John Hicks rose and introduced himself and stated that he, as a private citizen, had requested to borrow the new hospital plans and to make recommendations. In fact he convened a meeting of his friends and associates, which included at least 1 doctor and 1 nurse. They submitted a list of recommendations back to the hospital board which then turned the recommendations over to the hospital architect. Many of the changes recommended by Mr. Hicks group were, indeed, incorporated into the new hospital plans. What struck me from this report, is that wouldn’t it make sense that if the TVHD medical staff had taken the same interest in reviewing the plans and in making recommendations for changes that they would have, at least, received the same courtesy as Mr. Hicks? The answer is yes. Of course they would have.

Dr. Olsen stated that he favors contracts with all health plans, including Kaiser.

Additional inputs: Dr. Olsen added that he would not accept an insurance plan in which the “reimbursement is less than the cost to provide the services." He left me with the distinct impression that Kaiser is going to be held to a higher standard than other health plans because he has already made up his mind that TVHD is inflating its charges when it comes to the GEMCare contract negotiations.

Dr. Hall stated that she recalled an early conversation with Ray Hino in which she questioned "why don't we have a Kaiser contract?" I was quoted as having said that we tried but that Kaiser would not contract with us.

Additional inputs: I recall a more recent conversation with Dr. Hall in which I told her of our hopes for a Kaiser contract. That time her response to me was "you don't want a Kaiser contract, do you?" I understood her comment to mean that she feared TVHD having a Kaiser contract. I have also heard from Dr. Horowitz that he is not supportive of TVHD having a Kaiser contract.

All of the physicians stated that they would support TVHD contracting with all health plans.

Additional inputs: As Dr. Horowitz correctly stated last night, if Kaiser were to come to Tehachapi then they would insist that they have their own physician in the community. It would be commendable if the physician candidates for the Board put the community ahead of their own personal interests and persisted to bring a Kaiser contract here. By doing so, they would be inviting a competitor into our community that would, likely, not be welcomed by local Tehachapi physicians or by GEMCare (and by the way, that would constitute a conflict of interest because the TVHD MD Board members would actually be voting to bring a competitor into the community).

Dr. Horowitz stated last night that relations between the Administration and the Medical Staff have worsened in the past 4 years.

Additional inputs: Just last May Dr. Horowitz and I shared a stage at a National Rural Convention and talked about the marvelous spirit of collaboration in Tehachapi in which the Administration and medical staff are working together. Also, Dr. Horowitz has been present at hospital planning meetings during the past 2 years in which we discussed alternatives to the GEMCare contract. Dr. Horowitz has been in favor of creating a Tehachapi Independent Practice Association (IPA) as a competitor to GEMCare. I think that a more correct statement by Dr. Horowitz last night would have been to say that relations between Administration and the Medical Staff have worsened in the past 5 months.

Dr. Horowitz stated that TVHD’s costs are too high. He further stated that instead of selling donuts for $1,000 each that TVHD should sell donuts for $10 each (or was it $100 each) and sell more donuts. He went on to say that TVHD inflates its charges in order to maximize Medicare reimbursement.

Additional inputs: Dr. Horowitz’s explanation of how Medicare reimburses critical access hospitals is just plain wrong. If TVHD were to sell donuts for $100 each, when it costs $1,000 each to produce them, then they would be subsidizing the health plan that is only paying a tenth of the cost of the product. Should TVHD subsidize a big company like GEMCare? And, as every accountant knows, you can’t turn a loss into a profit by increasing sales of products sold at less than cost. Dr. Horowitz’s statement that TVHD is gaming the government by inflating charges in order to maximize reimbursement from Medicare is also wrong. Medicare pays TVHD on the basis of cost (that is what we pay to produce a product – not what we ask the consumer to pay for that product). In fact Medicare doesn’t care what we charge to other commercial insurers (just so long as we don’t undercut our charge master to other payors).

Dr. Horowitz also stated that he recommends that a financial audit of TVHD be conducted, as recommended by the Grand Jury.

Additional inputs: Just like Dr. Horowitz’s statements last night to Pete Sturn, demanding that Pete show the doctors “where it says in the June med staff letter that the doctors want the hospital construction project delayed,” I would challenge Dr. Horowitz to show me where in the Grand Jury report it says “TVHD should do a financial audit.” It doesn’t. But that really doesn’t make any difference because TVHD does an independent financial audit every year anyway. The 2006 audit will be presented to the Board and to the community on November 29, 2006.

At the closing, Dr. Horowitz stated that Tehachapi Hospital only has a 1.7% market share which is indicative of the need for the hospital to be made available to the entire community.

Additional inputs: Dr. Horowitz uses that number to prove that Tehachapi Hospital is not used by the entire community. What he neglects to mention is the physicians role in keeping market share low in Tehachapi. As a small rural hospital, of course, it is understood that we will never get close to achieving 100% market share. The universe of hospitalizations that occur for Tehachapi residents includes secondary and tertiary care services that are likely to never be available here. However, we can do much better. Physicians admit patients to hospitals. Hospitals do not admit patients to hospitals. With our recent upswing in hospital admissions our percentage of market share has certainly improved in the past 4-5 months. I believe that we could have been serving that improved market share, for many years.

My hope for the outcome from last night’s meeting is that, regardless of who may be elected to the Hospital Board, at least the following commitments can be carried through from the campaign into actual implementation:

1. Continue the Hospitalist program at TVHD. It is serving a need that has been missing at TVHD.

2. Make continued financial viability of TVHD a priority.

3. Become educated on what constitutes the true cost of operating a hospital. Don’t make assumptions that TVHD can allow “low balling” in some areas of the hospital in order to make it up in other areas. This doesn’t work. When we tried it before, we found that the HMO plans took full advantage of discounts in the ER without referring business to other areas of the hospital (inpatient and rehab, to name 2).

4. Treat all managed care plans equally. Don’t give favoritism to 1 plan over other plans.

5. Move to expedite the approval of the new hospital plans and the construction of the new hospital.

Additionally, I highly recommend that the TVHD Board not follow through with the medical staff recommendation to eliminate the rural health clinic from the new hospital plans. Downsize it, if necessary. But ripping a profitable service from a marginal facility, which, as the physicians admit, will struggle for sustainability, makes no sense at all. I have no problem with maintaining a rural health clinic in the downtown area. I even encourage it. However, by housing a rural health clinic and an emergency department side by side, TVHD can use the rural health clinic as a fast track clinic and will be able to (1) lessen the load on the emergency department and (2) take advantage of higher Medi-Cal reimbursement when patients are appropriately referred from the ED to the RHC.

Thank you all again for your interest in serving the community of Tehachapi and its surrounding areas. This is an exciting time and I am going to be very sorry to miss it.

Sincerely,

Raymond T. Hino

Response to Questions

There has been discussion in the community and comments made on this site regarding my decision to leave Tehachapi and concern raised about the timing of my decision to leave Tehachapi Hospital. I would like for all who care to know that I remain very loyal to Tehachapi Hospital and to this community. My decision is not due to disdain for TVHD and our community. In fact, quite the opposite is true. It is actually made due to love for our hospital and our community and my desire to do what is best for all of you.

There may be many in the community that do not remember what occurred in Tehachapi 9 years ago when there was a major power struggle between the Hospital Administration, Hospital Board and medical community. That controversy nearly destroyed this hospital. I was not here at that time. I arrived shortly after the controversy but I heard all about it. The Hospital Administrator at the time was the center of the storm. Perhaps if that Administrator had chosen to walk away at that time then maybe this hospital and the community would not have experienced the pain and agony that it went through for many years afterward. I am choosing to walk away at this time because I am beginning to see some of the same signs. The first sign is the negative campaigning that is occurring during the current Hospital Board election. Some on this website have said that only 1 faction is engaging in negative campaigning. That is certainly not true as 2 other factions have engaging in negative campaigning by attacking me. The election of Board members should not involve me. Every voter in this District should make their decisions on who they think will be the best Hospital Board members not whether they like or dislike me.

I am very proud of my record at TVHD. During the past 8 years, we as a facility have gone from the brink of closure in 1999 to becoming a model facility that dozens of hospitals in this State and others, are trying to emulate. We are known for being 1 of the first critical access hospitals in California and for our successful Measure J Bond election in 2004. We are known for being the pilot project of the Rural Health Design Network which brought over $100,000 in grant money to Tehachapi for the planning of our new hospital. And we are known for a remarkable financial turnaround. For those of you that remain unconvinced about the financial viability of TVHD I invite you to attend the next TVHD Board of Directors meeting on November 29, 2006 starting at 6:00 p.m. At that meeting our Independent Financial Auditor will be on hand to present the findings of this year’s audit for the most recent completed fiscal year which ended on July 31. I am very confident that the auditor will be presenting his findings that we have achieved a 5^th consecutive year of profitability. Please come and ask him any questions that you may have about our write-off policy or ask him about our managed care strategy. This auditing firm does a lot of hospital audits and they will be able to tell the public how TVHD compares to other hospitals.

And concerns have been raised regarding employee relations at TVHD. Is every employee at TVHD happy? No. However, I think that anyone that is around TVHD on a consistent basis would recognize that the majority of the staff is very happy with their employment here. I was overjoyed earlier this week when 1 of our nurses told me that she was coming back to work at TVHD after 1 year at CCI. Sure they pay better at CCI but the working conditions are much better here.

The success of our District has not gone unnoticed and I have received attention from Hospital recruiters for years. I have always had the belief in the past that I was needed here in Tehachapi. I no longer feel that way. I feel that it is now time to turn over the “reigns” of TVHD to a new Board of Directors that will be able to make their mark on our facility. So when Mendocino called, I was open this time, to hear about new opportunities.

Finally, I want people in this community to know that I am still very much committed to the construction of a new hospital in Tehachapi. We are so close to the construction phase of this project. Within days we will be making our second submission of hospital plans to the State of California. Most hospitals report that it has taken them years to get to the same point. Sure, some of this has to do with the fact that we are a small facility. But a lot of it has to do with the preparation and attention to detail that our architects have shown on this project. I implore the entire community of Tehachapi. Do not let up on the pressure. Make sure that your Board of Directors and administrators continue to push this project forward. I will be willing to stay involved to whatever degree is valuable to make sure that we get our new hospital in Tehachapi.

And thank you to all of you that have made supportive comments about me. I cannot tell you enough how important that is. Hospital administration can be very thankless work. Thank you for your kindness.

Thank you Carol Holmes and Good luck

I was really sorry to hear that Carol Holmes has left the Tehachapi News. She will be missed not only by me, but by the entire community. One thing that I will always appreciate about Carol was her passion to get a new Resource Center established in Tehachapi in order to aide children and families. A couple of years ago Carol escorted several of us to the Resource Center in Lamont which is doing great things. I hope that one day we will be able to build a similar center so that Carol's passion and efforts will not be in vain. The Tehachapi Collaborative, a new organization in the community with representatives from Public Health, School District, Kern County Human Services, Sheriffs Advisory Committee, CERT, hospital, Head Start and many more very important agencies in our community. The Collaborative held a fundraising yard sale last weekend at the home of Ernest Lopez which was very successful. Thank you to Ernest and Rose Lopez for the use of your beautiful home in Golden Hills. The Collaborative will also be joining with the Tehachapi Valley Healthcare District on Saturday, October 7 to present the this years Health Fair. We hope to see you all there.

Happy Mountain Festival Weekend

Hi Everyone;

I am the Administrator of the Tehachapi Hospital. I know that there are many questions in the community about the status and progress of the new hospital that is planned for Tehachapi. I am hoping to use this opportunity through the Tehachapi News to inform people and to answer questions. In brief, the plans for the new hospital have been submitted to the State of California for approval and they are currently undergoing plan checks by the State. If all goes well, we are hoping for approval from the State by the end of this year so that we can begin construction in early 2007. If you would like to see what the plans look like be sure and check out our hospital website at www.tvhd.org and click on the link for the new hospital plans. And if you have any questions please let me know. I can be reached at ceo@tvhd.org and I will check back frequently on this blog. Have a great Mountain Festival weekend!