The following responds to the North Valley hospital nurse/CEO comments last week. I apologize for its length, but there is a lot to address. At the outset, I want to say that I greatly respect good hospital administrators, and that hospital boards have one of the most challenging jobs in the country. That’s why many hospitals send their directors to training sessions for nonprofit boards – there’s a lot involved in overseeing the operations of a healthcare system. That said, our healthcare system seems to have lost its way, judging from the level of dissatisfaction in the community.
First, it is never a disservice to the community to bring forward information that is not being provided to us by the people charged with responsibility for our hospital. Nothing I said in my prior letter was inaccurate, much less “disinformation.” The same cannot be said for your letter, at least by its omission of relevant information.
If you are going to say urban hospitals have an advantage over rural hospitals, then you should also tell us that rural hospitals already get extra money, regardless of critical access hospital status, that is intended to address that urban advantage.
And, when you reference an OIG report about critical access hospitals, you should tell people that no changes were recommended. The report said that up to 8 out of ten critical access hospitals may be too close to other hospitals, some as little as two blocks apart (with certain exceptions, hospitals are supposed to be 35 miles apart to qualify as critical access).
If a critical access hospital is two blocks from another hospital, how “critical” is that hospital? Critical access hospitals are paid more than their cost of providing care, and the OIG report said we may be spending too much money on those non-qualifying hospitals. All true.
Understand, when you only tell us part of the facts, to some it appears that you intended to hide the information that doesn’t support your position.
Second, “honoring history” is more than hanging a picture and talking about history. Honoring history is providing the care we paid to build and serving as good stewards of the money we give you.
For example, you might keep the assisted living center open and buy a standard boiler that would last another 35 years, instead of closing a critical service, adding office space for yourselves, and obligating way, way too much money for a geothermal heating system that will probably outlast the building by 60 years. That does not look like honoring our history, and it does not look like good stewardship.
Next, “transparency” does not only mean publishing a newsletter and having a reporter attend meetings, although both are good beginning steps. Transparency means giving the people who pay your salary full and free access to all the information relevant to their decisions about the hospital. For example, publish your annual budget in the Gazette-Tribune, then follow up with monthly budget variance reports. It would be good for us to see exactly why you continue to lose money, despite closing down services.
By the way, “revising” the budget for changes you anticipate during the year is not “budgeting,” it’s “fudging.” You’re supposed to anticipate changes and budget for them up front, not put the numbers together to show a razor thin profit at the public meeting, then revise it later when you can’t stick to the budget. Revising the budget is an emergency measure to address unanticipated changes. If you anticipate the change, put it in the budget now. Show us the money!
Finally, having certified ER physicians is good, though I personally believe we had better ER care when the physicians who know us treated us in the ER. Why are we paying to contract these services? Don’t the medical staff bylaws require hospital physicians to take call? How much do we pay? Why don’t they treat us with compassion and respect? Good ER care is very much about caring for your community, and that means more than paying someone from outside our community because they have a certificate.
It seems clear that this community needs you to do more to earn our trust. Holding an open dialogue is part of that. While it is probably uncomfortable for you to see these questions in the paper, the point is that we have questions, and that they need answers. Maybe you’re doing a good job, and we just don’t have enough information to know that. Give us full information, especially when you’re looking at tough choices. We can’t trust you if we don’t know what you’re doing.