Sonoma West Medical Center - Radical and reckless strategy

[luke32]

Following is a well written letter to Sonoma West Times concerning the medical center's arrangement to secure funding through a lab testing program. I certainly hope PDHCD Directors Thomas, Colthurst and Powers read this letter carefully and think long and hard about what they may be exposing the PDHCD voters to if they continue the lab testing program.

"Radical and reckless strategy
EDITOR: Reflecting on the Dec. 18 Palm Drive Health Care District board meeting I remain at a loss to understand why the board is so adamantly embracing a radical and reckless financial strategy. Considering Sonoma West Medical Center’s substantial operating losses since reopening the hospital, and the district’s $28 million in debt, the board clearly has a fiduciary responsibility to be cautious and prudent in their decisions.

The proposal for an ad hoc committee to draft a Request for Proposal (RFP) for the sale or lease of the hospital for the board to review and discuss in February or March is an example of prudence. There was no motion to require the board to ever issue the RFP; it was pointed out that if the RFP was ever issued the board would be under no obligation to accept an offer.

It was also pointed out that should an RFP be needed in the future the process would be drawn out, with a likely six to twelve month time frame (if not longer). Taking preliminary steps now could potentially save the district a significant amount of time and money should the need arise. And if the need does not arise, nothing has been lost – i.e., there’s no downside, but substantial upside. Any reasonable person would consider this to be sound business practice.
That this motion was rejected because directors Thomas, Colthurst and Powers have decided the hospital’s financial problems will be solved by the nascent toxicology testing partnership, so no contingency plans are necessary, is baffling.

In fact, no reasonable person, examining the known facts, would say that the toxicology testing program is better than a 50/50 bet to provide a sustainable revenue source to offset the hospital’s ongoing operating losses, though everyone, myself included, hopes this does happen. However, wishful thinking is not considered a sound business practice, and is not sufficient justification for abrogating a fiduciary responsibility.

The rejection of the motion to draft the RFP is another of many indications that directors Thomas, Colthurst and Powers will not entertain any discussions regarding any strategy other than their own – to blindly support a full service hospital, by any means, and at any cost.

Such behavior is disappointing in a publicly owned and funded health care district. But what makes this situation truly disturbing is the decision that future toxicology testing revenue precludes any need to consider alternative strategies, especially considering the decision to embrace toxicology testing was done without conducting due diligence. Directors Thomas, Colthurst and Powers have no factual reasons to believe the toxicology revenue will solve the hospital’s financial problems.

Concerns that have been directly expressed to the board, and dismissed, include:

• The toxicology business partner is newly formed and has no track record in the business;
• The toxicology business partner has no local involvement, no local staff and no actual investment in the hospital;
• The high profits involved are due to the arbitrage nature of the partnership – SWMC conducts tests for a business in Florida (capable of performing the tests itself), but uses SWMC to leverage SWMC’s higher rural hospital billing rates. Is this a business a publicly owned community hospital should be involved in?
• Is it ethical to charge $1,000 to $2,000 for tests that could be performed for a few hundred dollars? Does this conform to our community values?
• Should a community hospital’s primary focus be on toxicology testing for out of state patients?
• Is the business sustainable? Has PDHCD confirmed with the insurers that pay the SWMC bills that the hospital's contracts and reimbursement rates for drug testing will remain in effect if the hospital engages in high volume testing for patients who are not treated at this hospital, or even in the state?

There are multiple examples of similar business arrangements between rural hospitals and large volume toxicology testing companies ending very badly for the hospitals. How is our arrangement different?

If high volume toxicology testing triggers lower reimbursement rates for SWMC will our partner guarantee they will continue using SWMC?

If high volume toxicology testing triggers lower reimbursement rates could SWMC be held liable for paying back what insurers were overcharged (as has happened in multiple cases around the country)? Will our partner assume responsibility for all, or even some, of the forfeited revenue?

To engage in a business partnership without due diligence is itself a failure of fiduciary responsibility. To fail to employ basic sound business practices is a failure of fiduciary responsibility. To reject prudent business planning and then justify it with wishful thinking about a sketchy business arrangement is incredibly irresponsible and altogether is an egregious abrogation of fiduciary responsibility.

Michael Windsor
Sebastopol"

[Imagery]

I believe that one way to HELP (no, one item is NOT going to provide the complete solution) solve the issue is to bring billing back in-house. The day before Thanksgiving, in 2016, I tore my calf muscle at work (A Worker's Compensation insurance claim). The doctor at the urgent care clinic referred me to Sonoma West Medical Center for more thorough diagnosis and treatment.

Liberty Mutual was my WC insurance at the time, and I brought in the policy number, the claim number, the date of injury, the injury sustained (in laymen terms), and figured that they would simply bill the insurance company, and I could focus on healing.

It took nearly seven months to receive a bill for the ER visit. One from the doctor, one from the x-ray technician, a different one for the immobilizer boot that I wore, and yet another for the crutches that I *used one time*.

How about having a central (on-site) billing department? Having these charges billed to the insurance company? How about billing within 30 days of service? Possibly that would help.

[Hot Compost]

The operational 'community values' were made quite clear during the October wildfires.

Price gouging is OK in the "medical" community, and nowhere else.

• Is it ethical to charge $1,000 to $2,000 for tests that could be performed for a few hundred dollars? Does this conform to our community values?

>> no, one item is NOT going to provide the complete solution

Actually there is: simply enforce existing laws regarding anti-trust & RICO, and dozens of other laws on the books in most states.

The investigator I've found who does the best job tallying up the laws being broken by the American medical industry, is Karl Denninger at Market-Ticker.org // Karl is a semi-retired dot-com wealthy person with a very good mind for detail.

If you can get past his rants on many other subjects, he has done a thorough enough job that if he were made assistant FBI director tasked with cleaning up the American medical industry, we would be halfway back to the very functional medical care we had in the 1960's & 1970's.

His essays on the American pseudo-medical system are easy to find on his website, I think under health care.


My mother was a stay at home with 4 kids who occasionally needed to go to the ER. My father made $20K a year working in New York City. We lived in Connecticut. Though not rich, we were never bankrupted by any medical bill.

It's not too hard to resurrect social arrangements that were quite functional 50 years ago.

The Press Democrat made the Caste System that is in place in Sonoma County very obvious during the fires. In the articles about price gouging. I don't think I was the only person who pointed out the obvious 2 tiered system in place - price gouging is OK in medical establishments & prohibited everywhere else.

If censorship is a compliment, they paid me one. Within a week of the price-gouging article first coming out, they switched to a 'members only' commenting system - no more Facebook interface posts in the comment section at the end of articles.

"to protect the children" /sarc

[OldGranddad]

I went to the Sonoma West Med Ctr Emergency Room on April 13, last year. I was impressed with the care and the personnel and felt they did an excellent job.

At this time, I have not received a bill from the hospital, though I did get one from the doctor and for some tests. After about six months, I called and was told that Medicare turned down the charge. About a month ago, I dropped in and they checked the Medicare claim and discovered there was no reason given for turning the claim down. They said they would resubmit it, as they felt Medicare had made an error. So far, I've not heard a thing.

Aside from cheating or stealing, I can think of no worse thing a business can do, than to not bill for its services, especially one that is supported by the taxpayers.

It's time to rethink public financial support, or exert more control of the operation on behalf of the public.

Old Granddad