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Tuesday, Jul 08 2014 01:26 PM

Healthcare district CEOs talk past, future

After presiding over the Tehachapi Valley Healthcare District for six months, one chief executive officer is heading on to another challenge while a new one takes the reigns locally.

Evan Rayner, outgoing Interim CEO for the healthcare district, has taken a position as the new president/CEO for Madera County Hospital in Madera County. While serving in the Tehachapi position for less than a year, he noted the conflict he felt with the decision to leave.

"I do it with emotion because I'm very fond of the Tehachapi area and its folks, and I've become very pleased with the working relationship I've had with the board of directors, the employees," Rayner said in a June 24 interview that included incoming Interim CEO Eugene Suksi.

The district board was preparing to offer Rayner the permanent job when he took the job in Madera; Suksi replaces him as interim.

However, Rayner said he believes Suksi will be able to handle new developments at the healthcare district.

During his brief tenure, Rayner presided over some development of the new hospital and kickstarted new programs at the hospital, including a telemedicine stroke program partnership with Bakersfield Memorial Hospital.

Rayner commended the healthcare district board of directors for an easy working relationship.

"They're smart, they're savvy, ask the right questions and have the best interests of the community and best interests of healthcare for the community in mind," Rayner said.

Rayner noted during his time as CEO that a lot has been accomplished by the healthcare district staff and board of directors.

"We've been able to stabilize the financial viability of the institution, we are actively recruiting new physicians, the stroke program will be a great opportunity and continue to build our clinics and relationships with physicians," Rayner said. "That will allow us to be able to strengthen our bench for specialists."

Rayner added that the healthcare district continues to look at "value engineering" to save money on the costs of the new hospital being constructed on Capital Hills Way.

Those methods include both hard capital costs and ways to save on purchasing equipment for the new facility.

Of course, there have been challenges, especially with some employees. During a June 23 healthcare district board meeting, three employees voiced their concerns over staffing cuts and other impacts to service at Tehachapi Hospital.

Rayner noted that communication plays a key part in the healthcare district, with updates provided through manager updates and at quarterly staff meetings.

Some talk of collective bargaining at the June 23 meeting had hints of possibly unionizing, something Rayner said he does not know about.

"I have no idea if they want to unionize," Rayner said. "This is a union-free facility and we don't see any need for any unions here."

As of June 24, he said, 12 layoffs had taken placeout of a workforce that employs 200 full and part time people.

"These changes are continuously communicated through our managers, which is expected, but also (through) employee forums," Rayner said. He added the staff reductions are done on an industry standard based on patient volume. When more patients come in, staff is added. When patient levels ebb, the district staffing is reduced.

"We don't do this with joy and is something we regret and do as a last resort to modify our staffing," Rayner said. "But there had been no productivity measures in place when I got here and it is an important piece in being responsible for the organization."

Suksi, whose career included management positions in many healthcare institutions, said that flexing the staff levels tends to be a two-way street.

"If volumes go up, employment goes up," Suksi said. "If we are successful with some of the initiatives to incrementally increase (patient) volume, we'll incrementally increase staff to go with that."

Rayner said that the healthcare district has seen an increase in volume at its rural health clinics in Mojave and California City since Covered California, the state version of the Affordable Healthcare Act, went into effect.

With the new law mandating that everyone hold some type of healthcare insurance, Rayner said he has seen the health dynamic shift.

"Now that people have health insurance, they are more apt to go to provider than wait to the last second," Rayner said. "You'll find that those without healthcare insurance wait until the last second and land in the ER with their health significantly more compromised that could potentially kill them."

Suksi, the new interim CEO, agreed.

"If you can do more preventative care in an outpatient setting, it's lower cost and better quality for the patient," Suksi said. "They don't have to wait until they show up in the emergency room, which is the most expensive place to seek care."

He added that it could prove more financially viable in the long term.

"It has both positive financial impact for what it costs you for healthcare nationally and it has better outcomes for patients if they can access healthcare early on in a prevention basis," Suksi said.

New CEO at the helm

With the passing of the rod from one interim CEO to another, some things remain the same, including the continued building of the healthcare district's new hospital.

Suksi said that while he has never been involved in "green field" development, or building from scratch, he has seen his fair share of development.

"I've been involved in a number of large scale construction projects, though this one would frankly be one of the largest in terms of total dollar value," Suksi said.

His career included almost five years as CEO of Sutter Coast Hospital in Crescent City, four years as chief operating officer at Cascade Medical Center in Leavenworth, Wash., as a consultant and as a vice president of clinical services at three different hospitals.

The new Tehachapi Hospital project is being funded in large part by a $65 million bond that property owners will pay through their tax bills for years to come.

"Some of the facilities I've been involved with, their construction in the early '90s were larger but certainly cost less because of the price escalation over 27 years," Suksi said.

However, he is looking forward to the challenge of running the healthcare district in the interim.

"Healthcare in general is a challenge," Suksi said. "Virtually every healthcare organization has those, and hospitals in particular, because the role of hospitals has changed and the healthcare continuum is different than it was 20 years ago."

However, he called it a good challenge.

"What you're looking at doing is build a replacement facility and expand services," Suksi said. "It is very complex, there will be some bumps in the road, but it is a very worthwhile endeavor. It is something worth your efforts to achieve."

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