Palm Drive-Too Few Patients, Too Many Expenses
Palm Drive, a small hospital, went into bankruptcy, for the second time, because it could not make enough money (including the parcel tax). Over the years, it used borrowed money and tax receipts to stay open. But expenses kept rising, income kept falling, and the debt kept growing until it was forced to close.You can pretend it was mismanaged, but in reality, over the years, the board tried many different approaches to increase profits. Multiple CEO's, management companies, shared ventures, new physicians, new services, and cutting staff were all tried. Nothing made enough profit to cover the rising costs.
Let's just say there was a small restaurant with a lot of local competition and few tables. It did not have enough customers (income) to cover the wages, insurance, utilities, taxes, mortgage, and suppliers. Eventually the debt grew so large that it was forced to close its doors. The local customers missed the restaurant. They felt very comfortable having their morning coffee in that sunny booth, and they wanted it to reopen. The customers formed a committee and had fundraisers to reopen the little restaurant. It reopened with great fanfare, but over time the debt kept growing and once again it was forced to close. After all, nothing could change the facts. It was too small and expenses were too high.
What will happen to Palm Drive in the future? I too, miss that sunny booth. But can anyone really change the facts--too few patients, too many expenses?
Re: Palm Drive-Too Few Patients, Too Many Expenses
Hi, there.
Have you read the most recent version of the foundation's proposal? In case not, here's a link:
https://pdhcf.org/
This version strikes me as thorough, solid, and do-able. You may see it differently, of course. But if you haven't read this version yet, perhaps it will also strike you as do-able.
treasure
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What will happen to Palm Drive in the future? I too, miss that sunny booth. But can anyone really change the facts--too few patients, too many expenses?
Re: Palm Drive-Too Few Patients, Too Many Expenses
Re: Palm Drive-Too Few Patients, Too Many Expenses
It's a good article, not good news....I'm just hoping that we can survive anyway, because we have such creative, good thinkers in this area. We've come up against some huge problems already, with corporations, plus we've been the FIRST in many ways--i.e.the first Green city council in the u.s....if memory serves me. We've got to think way outside the box, be original, and prudent....I believe we can do it...
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Posted in reply to the post by Sara S:
Re: Palm Drive-Too Few Patients, Too Many Expenses
As a physician going through this transition I can say this is what the public voted for. This is the affordable care act. There will no longer be community hospitals or local, independent physicians. In order to mass distribute care, resources have to be centralized. Think Kaiser. This type of socialized medicine (which this still isn't, it's still a highly corporate medical system with a government seal of approval) can't meet both the needs of the larger group and still be at every street corner.
Physicians stood up and told the public and congress that our patients would lose their doctor, their hospital, and no one listened. We could not be heard behind the private health insurance lobbyists.
My only hope is that this is a bridge to single payer. Cutting out all the fat and adopting a single electronic medical record will save the medical system. But no one wants to listen to doctors...
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Posted in reply to the post by Sara S:
Re: Palm Drive-Too Few Patients, Too Many Expenses
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Posted in reply to the post by treasure:
Have you read the most recent version of the foundation's proposal? In case not, here's a link:
https://pdhcf.org/
This version strikes me as thorough, solid, and do-able. You may see it differently, of course. But if you haven't read this version yet, perhaps it will also strike you as do-able.
Dear Treasure,
I have reread the foundation proposal hoping to find some new ideas that I thought could make a financial difference to a future full service hospital at Palm Drive. I have listed the pros and cons as I see it.
PRO: Using the existing facility, using former employees to staff the new hospital and a major emphasis on marketing which includes a no wait ER are great. Philanthropy (gifts to the hospital) to the tune of 1-3 million a year would help, as the hospital was losing 4 1/2 million a year. Alliances with larger medical entities is a must have idea. Palm Drive had an alliance with Sonoma Valley and Marin General. We shared CFO, billing, EMR system cost and pharmacy operations.
CON: A 13 member board seems too large and unwieldy.
The EMR systems cannot be free. It requires hiring personnel who can write the code on an ongoing basis as each hospital department needs their own interface which must be frequently updated. The staff must be educated and monitored.
Is rebranding a doctor's practice as an "institute" and marketing it as such, going to increase business? The doctors listed on page 21 practiced at Palm Drive except for Dr.'s Hulkower, Field, and Finley. We did have a psychiatrist and a cardiologist who consulted when necessary. Palm Drive had an active outpatient surgery, as well as inpatient orthopedic, general, urological and spinal surgery department. In addition, we had inpatient beds, ER, lab, radiology, wound care, and outpatient physical therapy.
The problem was not in the services we offered, but in the reimbursement for those services. As a doctor once said, "It doesn't matter how famous the doctor doing your surgery is, the hospital will only get paid what Medicare, etc., has allotted for that procedure."
The foundation has quite a challenge facing them. I do wish they appended an economic disclosure to their proposal since many involved with the foundation have strong financial incentives to opening a full service hospital rather than looking at all the options.
Re: Palm Drive-Too Few Patients, Too Many Expenses
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Posted in reply to the post by trixie01:
As a physician going through this transition I can say this is what the public voted for. This is the affordable care act. There will no longer be community hospitals or local, independent physicians...
Dear Trixie,
So much pain in this process. As a consultant once said, "We (meaning a small hospital) was supposed to fail."
Re: Palm Drive-Too Few Patients, Too Many Expenses
Just a note to explain the Palm Drive Health Care Foundation's proposal to reopen our hospital.
The plan document, available on this site, is the work of many months of research and development.
The reasons Palm Drive failed have been carefully analyzed by the foundation and many financial experts.
We have been working closely with hospital administration and the district board to prepare a business plan that will work.
As the situation remains dynamic, financials are being prepared for presentation to compliment the business plan outlined in our document.
We will open your hospital and work tirelessly to keep it financially sustainable. Without question.
Thanks for your attention.
Re: Palm Drive-Too Few Patients, Too Many Expenses
Many have put their heart, soul, and pocketbook into our hospital. I hope a working solution can be found that works despite the decreased reimbursement of the affordable care act. I wonder if the financial plans involve creating an ACO to take advantage of the government subsidies offered to places like Sutter, Kaiser, and other large corporate systems.
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Posted in reply to the post by droffeld:
...We have been working closely with hospital administration and the district board to prepare a business plan that will work.
As the situation remains dynamic, financials are being prepared for presentation to compliment the business plan outlined in our document...
Re: Palm Drive-Too Few Patients, Too Many Expenses
Yes - Single Payer
Insurance companies are the problem, a large part of the waste in the system, and getting worse.
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Posted in reply to the post by trixie01:
...My only hope is that this is a bridge to single payer. Cutting out all the fat and adopting a single electronic medical record will save the medical system. But no one wants to listen to doctors...
Re: Palm Drive-Too Few Patients, Too Many Expenses
Thank you Brightwhite for your thoughts and time to read and evaluate the proposal. For clarity's sake, I guess specifically mine, I have a few questions about some of your comments.
In regard to the EMR platform, are you saying that to provide the software and support at no charge for 5 years is not exactly a free system because the daily operation will require trained hospital staff to operate and update that system? Further are you suggesting that perhaps the costs associated with the training and operation of a new EMR system may well be greater than implementing an EMR platform that staff has had prior experience with as well as the potential cost offset if sharing a currently in place system with Sonoma Valley and Marin General? Thank you to help me better understand these elements.
Finally, I noticed that in the proposal it was stated that “one of the primary drivers of Palm Drive's financial failure” was the EMR platform that was being used. What do you, or anyone else, know about the facts of that analysis?
I can't agree with you more about alternative options and the personal incentives driving the current Foundation's proposal. I would like to see more folks raising an eyebrow rather than a quick nod of the head.........
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Posted in reply to the post by Brightwhite:
Dear Treasure,
I have reread the foundation proposal hoping to find some new ideas that I thought could make a financial difference to a future full service hospital at Palm Drive. I have listed the pros and cons as I see it.
PRO: Using the existing facility, using former employees to staff the new hospital and a major emphasis on marketing which includes a no wait ER are great. Philanthropy (gifts to the hospital) to the tune of 1-3 million a year would help, as the hospital was losing 4 1/2 million a year. Alliances with larger medical entities is a must have idea. Palm Drive had an alliance with Sonoma Valley and Marin General. We shared CFO, billing, EMR system cost and pharmacy operations.
CON: A 13 member board seems too large and unwieldy.
The EMR systems cannot be free. It requires hiring personnel who can write the code on an ongoing basis as each hospital department needs their own interface which must be frequently updated. The staff must be educated and monitored...
Re: Palm Drive-Too Few Patients, Too Many Expenses
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Posted in reply to the post by Rustie:
...In regard to the EMR platform, are you saying that to provide the software and support at no charge for 5 years is not exactly a free system because the daily operation will require trained hospital staff to operate and update that system? Further are you suggesting that perhaps the costs associated with the training and operation of a new EMR system may well be greater than implementing an EMR platform that staff has had prior experience with as well as the potential cost offset if sharing a currently in place system with Sonoma Valley and Marin General? ...
Dear Rustie,
Palm Drive was losing about 4 and one-half million a year before we started using an Electronic Medical Records (EMR) system. Any additional expense for the hospital was going to be a problem. Getting an EMR system up and running was definitely an additional expense, but not the reason Palm Drive went into bankruptcy for the second time. In fact, the hospital received over a million dollars in reimbursement for meaningful use of the EMR. Harmony MD will not be eligible for meaningful use monies, according to their recent proposal.
An EMR system (a group of computer programs that talk to each other) is expensive, and that expense is very hard on small hospitals. All hospitals are forced to get an EMR system, or they will be punished by receiving smaller payments from Medicare. At Palm Drive, most patients were in the Medicare, Medi-Cal and uninsured group.
I can not say what the relative costs are between adopting HarmonyMD versus staying with Paragon, but I get the sense that HarmonyMD has a lot of work ahead of then to develop the programs necessary for the nursing, physical therapy, discharge planning, pharmacy, medicine dispensing, lab and radiology departments. Difficult to believe that all the programming, training and monitoring necessary will be free.
When Palm Drive had to pick an EMR system, they looked at HarmonyMD. At that time, it was not certified to be used in a hospital setting. Palm Drive was also creating a collaboration with Sonoma Valley and Marin General, and they use Paragon.
I hope my response helps with the understanding of the issues.
