More Misinformation on Palm Drive regarding No Wait ER
In yet another shot at the Open Our Hospital campaign, Jim Horn and Rollie have teamed up here:
https://www.sonomawest.com/sonoma_we...3b4f1cc04.html
Here is my response:
Sadly, Jim Horn continues his history of disinformation in this piece and Rollie aids and abets by printing what he knows to be false without presenting the true facts.
Let’s look at Horn’s statements and compare to the facts:
Horn: ‘Forty percent of SWMC’s projected new income comes from a “No Wait Emergency Room” similar to one developed at St. Helena Hospital in 2009.’
Fact: The plan for SMWC identified a number of opportunities for increasing revenue and is not dependent on any one of these to come to full fruition. What was identified was a range of growth opportunities of which, 1/3 might come to fruition. No Wait ER, was one of these opportunities.
The plan anticipates even more opportunities to be identified and developed as the business unfolds. Since it was written, A Geriatrician, a Breast Cancer Specialist, a Plastic Surgeon who specializes in wound care, a pain management physician and an additional General Surgeon have all been identified and shown interest in joining SWMC. None of these are listed in the plan yet half have already committed.
Horn: ‘However, there was no 50 percent increase in No Wait ER visits at St. Helena. State records show that ER visits increased by an average of about 3 percent a year from 2005 through 2014, with no appreciable difference in long-term trends before or after introduction of the No Wait in 2009. In terms of increasing visits, the success of the No Wait ER is a myth.’
Fact: Here is the information provided by the St. Helena ER physician group: ‘In the first quarter of 2009 the average [of ER visits] was about 14 daily visits and still falling. As we introduced the "No Wait" program the volume picked up. The early results were not as robust as later when the plan matured and we learned to optimize our promotional methods. By 2010 we did have some months averaging 21 daily visits… In just the last six months, according to the physician data, the SH ER visits have not dropped below 21 daily as an average and monthly average has been as high as 25 daily visits. Keep in mind this is in a community of 5,000, an area of 20,000, and over a half hour from next city, Napa, with only 100,000 people in that city. Thus, the geographic reach needed to pull in no wait patients is great.’
Horn’s own statement also rebuts his message that ‘the success of the No Wait ER is a myth’ when he states: ‘But state records do show a startling increase at St. Helena in inpatient admissions from the ER during this period. From 2008 to 2009, the rate of admissions more than doubled in the most severe category of ER patients. The rate of admissions increased yet again in 2010 and has remained high ever since. For the next most severe category of ER patients, the rate of inpatient admissions tripled between 2008 and 2010. Given St. Helena’s average net revenue per admission, this jump would have increased profits by nearly $10 million in just two years.’
To get around this obvious improvement in financial results at the time a No Wait ER was put into place, Horn wants us to believe that there was something fishy about this improvement and uses unproven allegations as his ammunition as follows:
Horn: ‘And a whistleblower lawsuit, recently settled by St. Helena’s parent company, Adventist Health, may shed light on this change. Terry Newmyer was the only individual defendant named in the suit among a host of corporate entities.’
Fact: Actually, the suit as filed named 28 John Does in addition to corporate entities and Terry Newmyer. It is standard practice to name the CEO in a lawsuit with any organization and to try to attribute blame to the actions of the CEO in order to pierce the corporate veil.
After listing some of the unproven allegations of the complaint, Horn adds: ‘Adventist Health did agree last month to pay $2.25 million to settle the complaint.’
Fact: Horn conveniently fails to inform the reader of any of the following: a) The settlement had nothing to do with the allegations of the original complaint. b) The settlement found no wrong doing by Terry Newmyer c) The settlement was for matters that had nothing to do with admissions from the Emergency Room d) The settlement was for practices started 18 months BEFORE Terry Newmyer was hired and e) The settlement acknowledged no wrong doing by any individual. Yet Horn still claims: ‘Given all this, it’s unlikely that a rebranded ER at SWMC will produce any significant new income.’
Horn: ‘On the expense side, the Foundation plans to reduce expenses by, among other things, cutting employee salary and benefits down to “industry averages”…In this case, the Foundation plans to cut labor costs to only 52 percent of patient revenues.’
Fact: The Sonoma West Medical Center calls for salaries and benefits to be 55% of net patient revenue, only 2% below 2010 when the hospital was last profitable. The SWMC plan anticipates outsourcing a number of services and creating efficiencies in middle management to accomplish this goal. The plan calls for only 3 less employees than were working for Palm Drive in early 2014 once full revenue has been reached. This plan has been very carefully worked out by experienced hospital administrators and CFOs.
The unfortunate truth is that Jim Horn is well aware of the information I have provided here since it was sent to him some time back. I leave it to the readers to understand his motives for trying to keep our hospital closed, I certainly do not.
Dan Smith
No Wait ER Is a GREAT policy who among us would not prefer this? More Jim Horn deception
The intellectual dishonesty of Jim Horn, like the Sonoma West and Ernie Carpenter, speaks to me of the absence of rational counter-arguments to reopening. As well as the moral bankruptcy of so-called leaders of West county's political establishment.
So it seems that Jim Horn is still playing his deceive-the-public hand.
First, he wants the public to believe that a no-wait ER will not help the hospital's finances. Because admissions did not pick up so much at St Helena's. Then he provides what seems to be a bogus 3% per year figure, which contradicts the 2009 to 2010 numbers you cite showing a 50% increase.
Moreover, your point is well taken. St Helena's is 30 minutes from Napa City, while Sebastopol's hospital will be just five to fifteen minutes further from Santa Rosa (and Rohnert Park) then the Santa Rosa hospitals.
I have heard of wait times at Memorial Hospital's ER of seven to ten hours, for friends whose kids had painful but not life threatening emergencies.
Who among us, when faced with the choice of a wait like this at Memorial, or a "no-wait" system at a new Sonoma West Medical Center, would not head straightway to the Sonoma West Medical Center?
To me, this is part of the economic promise of the new hospital. It takes a major Palm Drive weakness: proximity to a city with large hospitals, and makes it a big plus: proximity to 200,000 people.
Then Horn goes on to write that they while in patient admissions did increase dramatically, this was built upon unnecessary admissions. And it had nothing to do with Terry Newmeyer, whose reputation Horn was irresponsibly willing to malign in order to advance Horn's own obstructive agenda. As evidenced, Horn suggests, by a lawsuit settlement. Yet you point out that this is yet another example of Jim Horn's deliberate campaign of deception to undermine public confidence in reopening the hospital.
As you reveal, that lawsuit settlement "was for matters that had nothing to do with admissions from the Emergency Room d) The settlement was for practices started 18 months BEFORE Terry Newmyer was hired and e) The suit
that was settled, had nothing to do with excessive admissions."
This calls to mind Horn's repeated assertion that the hospital has lost more than $60 million during the past 15 years. A number that used 14 years of tax revenues earmarked for a hospital as losses.
When it comes to fact checking and presenting accurate reporting about the largest public health crisis to face our community in generations, Rollie Atkinson, and his Sonoma West, would be good candidates for a no-wait journalism ER.
Quote:
Posted in reply to the post by farmerdan:
In yet another shot at the open our hospital campaign, Jim Horn and Rollie have teamed up here:
https://www.sonomawest.com/sonoma_we...3b4f1cc04.html
Here is my response:
Sadly, Jim Horn continues his history of disinformation in this piece and Rollie aids and abets by printing what he knows to be false without presenting the true facts.
Let’s look at Horn’s statements and compare to the facts:...
No Wait ER and Other Myths
Regarding my recent commentary that appeared in Sonoma West, Dan Smith writes the following: "Sadly, Jim Horn continues his history of disinformation in this piece and Rollie aids and abets by printing what he knows to be false without presenting the true facts."
For the record, everything I have written or said about Palm Drive Hospital and the proposal to reopen it is correct to the best of my knowledge. Despite Smith's claims, this commentary is no exception.
Regarding Smith's specific comments: He disputes my statement that 40% of SWMC's projected new income will come from the Emergency Room (ER).
Fact: This number comes verbatim from a document titled “Sonoma West Medical Center Financial Projections,” prepared by SWMC's own consultants and presented at its board of directors meeting on 12/16/2014. Here’s a link to the relevant pages.
And, on closer inspection, it appears that SWMC's reliance on new income from the ER is now even higher than before. This latest document estimates that 30% of overall income will come from new sources, of which 40% will come from the ER. Given SWMC's “idealized” first year income of almost $34 million, SWMC now expects roughly $4 million in new income from the ER—more than double the previous $1.7 million estimate. This heavy reliance makes a careful analysis of the ER even more important.
Smith disputes my assertion that state records do not support the claim of a 50% increase in patient visits at St. Helena’s “No Wait ER.”
Fact: Here is a link to a graph of annual ER visits at St. Helena Hospital from 2005 to 2013. The numbers are taken directly from state (OSHPD) records. The No Wait ER was created in the 2009 calendar year. Except for two jumps, in 2006 and 2010, the graph is essentially flat. Smith and his consultant, Terry Newmyer, claim that the jump in 2010 was a direct result of the No Wait ER-—but then, how explain the even larger jump in 2006, three years before No Wait was introduced? And where is the alleged 50% increase in ER visits?
Unfortunately, Smith and Newmyer confuse the noise (monthly ups-and-downs in the data) with the signal (annual data and long-term trends). He wants us to compare the very worst months before the change with the very best months afterwards. But that’s no more valid than comparing the best months before against the worst months after. Only the long term numbers have meaning for the future, and they don’t support SWMC’s claims at all.
Smith completely mangles my observations on the remarkable and otherwise unexplained increase in ER admissions at St. Helena during this period.
Fact: From 2008 to 2009, the number of ER visits at St. Helena in the most severe category (the so-called “Level 5”) actually declined by 24%, while the number of patients admitted to the hospital from the ER shot up by 56%. As a result, the rate of admissions more than doubled in just one year. The following year, the number of visits declined but the number of admissions increased once again. This obviously doesn’t support Smith and Newmyer's claim that the No Wait ER increased visits by 50%, but it does point to a disturbing change in the hospital's criteria for admitting patients.
Which leads us to the whistleblower lawsuit settled recently by St. Helena Hospital. Smith maintains that Newmyer was named in the suit simply because he was the CEO. But one only has to read the suit (especially beginning on page 14) to understand Newmyer's central role in the allegations.
Smith further maintains that the settlement had nothing to do with St. Helena's ER.
Fact: Again, just read the lawsuit. It contains multiple allegations of fraud directly related to the dramatic increase in ER admissions at St. Helena—allegations clearly supported by the state records cited previously. Smith does not provide evidence for his assertion, but he may rely on a brief press release issued by the U.S. Attorney's office. Given the brevity of the release, it understandably concentrates on the most egregious allegations—unnecessary surgeries that threatened the life and health of patients. In comparison, the alleged ER violations are merely fraudulent. But there’s nothing in the press release, or in any other document I've seen, to indicate that the U.S. Attorney dismissed or discounted the other allegations in the suit. That’s simply Smith’s opinion, and if it's supported by evidence, I hope he will produce it.
Finally, Smith disputes my statement that the Foundation's business plan relies in part on cutting employee salary and expenses down to only 52% of patient revenues.
Fact: The latest “Sonoma West Medical Center Business Plan” uses the 52% labor cost estimate in two separate charts (here and here). This number is remarkably optimistic because it’s less than any other hospital in the area except Memorial. When combined with unrealistic assumptions about income from the No Wait ER, it casts doubt on the long-term viability of SWMC.
So let's recap: Smith claims I provided “disinformation” by accurately reporting state records, court documents and SWMC's own plans and projections, then reaching logical conclusions based on that data. He confuses disinformation with facts and analysis he doesn't like or doesn't want the public to hear. That is truly sad.
Quote:
Posted in reply to the post by farmerdan:
In yet another shot at the Open Our Hospital campaign, Jim Horn and Rollie have teamed up here:
https://www.sonomawest.com/sonoma_we...3b4f1cc04.html
Here is my response:
Sadly, Jim Horn continues his history of disinformation in this piece and Rollie aids and abets by printing what he knows to be false without presenting the true facts.
Let’s look at Horn’s statements and compare to the facts:...
Re: No Wait ER and Other Myths
Jim,
In college, statistics was a required course and one of the texts was 'How to Lie With Statistics.'
One of the things you learn from this little book is that how you select and display the data has everything to do with the interpretation of it and that with skill, pretty much any set of data can be shown to prove its opposite if you control what data you work with and ignore the data that you don't like. I must admit you seem to have mastered these skills!
Here are just a few examples:
You claim that the SWMC business plan is suspect because it calls for salary and benefits to be 52% of Net Patient Revenue and that Palm Drive, Sonoma Valley, and Healdsburg all showed higher percentages.
Here is what is wrong with your analysis of this point:
a) You ignore that the most recent versions of the business plan call for 55%, not 52%.
b) You ignore the fact that the plan calls for outsourcing a number of services, lowering the employee count considerably (and reducing the % of labor.)
c) In 2010, when Palm Drive was last profitable, salary and benefit costs were 57%, very close to 55% being proposed. The hospital became unprofitable when this percentage grew dramatically in 2013. Palm Drive failed precisely because salary and benefit costs were out of control as we pointed out in the plan.
d) Sonoma and Healdsburg both operate Skilled Nursing Facilities, which have higher labor cost to revenue than acute care facilities. Comparing them to SWMC is apples to oranges. Also Healdsburg is a critical access hospital, which will support higher wage costs because they are cost reimbursed.
e) Sonoma and Healdsburg are both in trouble for the very reason that their cost of labor is too high and would likely suffer a similar fate if they continued. Healdsburg did major staff reductions last year for exactly that reason.
f) We need to run a profitable business and should not build a model on unprofitable ones.
g) The staffing plan has been developed from the ground up with every position identified and every salary range set at market rates. This is the only way to budget accurately for labor costs.
h) The plan calls for only 3 positions less than Palm Drive had after layoffs early last year. This is approximately the same staffing model that Healdsburg currently has for its acute care services after they right sized.
If you take all of these into consideration, likely you will arrive at an even lower number than 55%.
Let's look at another topic:
You make a variety of claims that the complaint against St. Helena somehow demonstrates that the SWMC plan is not credible. In doing so, you claim there were fraudulent activities in ER admissions at St. Helena.
a) This has nothing to do with SWMC in any way whatsoever in spite of your attempts to claim otherwise. Terry Newmyer did not write a single line of the business plan, has not been working with our physicians, and Raymond Hino, a highly respected hospital administrator is the CEO of SWMC.
b) A complaint is not a finding of fact, but a listing of unproven allegations. Your statements attribute the status of 'fact' to allegations. No court of law has ruled that these were true. No investigation has established their veracity and the settlement does not find fault with any party. From everything I can find, the opposite is true, the settlement did not cite the original allegations.
c) No blame was assigned to Terry Newmyer in the settlement. In fact no blame was assigned to any individual or Adventist health in the settlement.
d) The settlement was not based on allegations in the original complaint, but on other practices not listed in the complaint (angioplasties that were performed from 2008 to 2011.)
e) The settlement had to do with practices that started 18 months before Terry Newmyer was hired and ceased shortly after. If anything, this would indicate good management on his part, not culpability.
f) Doctors make decisions to admit patients and perform services, not CEOs. Dr. Powers made very clear at a recent meeting that our doctors would never admit patients who were not appropriate and our plan does not depend on doing so.
g) Medicare sets very high standards for admissions and physicians are careful not to exceed or upcode for fear of the strong penalties for doing so. If anything is true today, some people are not admitted who should be because of this.
Your attempt to cast aspersions on Terry, SWMC, and a 'No Wait' ER have no basis in fact. They are simple mud slinging.
One thing I know about life is that it is very hard to build something new and wonderful and it is very easy to criticize it, tear it down and attack the people who are giving their heart and soul to it. You have chosen the easy path.
For the hundreds of people who are engaged in the difficult job of building Sonoma West Medical Center, we should all give thanks. For the few detractors, we can wish for a more enlightened discussion in the future.
Something Wonderful is Happening
Sonoma West Medical Center
Dan
Re: No Wait ER and Other Myths
Quote:
Posted in reply to the post by JimHorn:
Regarding my recent commentary that appeared in
Sonoma West, .
Jim,
I understood and appreciated your critical analysis of Palm Drive's situation and prospects during the campaign and election for the Palm Drive Health Care District.
But why are you still doggedly trying to shoot down Dan's plan now?
Barry
Re: No Wait ER and Other Myths
>>>But why are you still doggedly trying to shoot down Dan's plan now?
This is the question in many minds, I think, and not just in my own. It emerges again in the latest Sonoma West coverage, quoting the doubts of the dissenters on the District Board — headlining it "More Questions Surround Hospital Takeover," as if it were a coup d'etat — with no response whatever from Foundation plan proponents.
The District election results were not a rejection of Jim Horn's expertise but of what appeared to be a choice between permanent closure of Palm Drive and the possibility of salvaging some of its services. If there was an actual, detailed "reopening" plan in competition with what's now being savaged, it was not public knowledge. Instead, we got the equivalent of the Republicans' critique of Affordable Care: it's terrible, it won't work, get rid of it and we'll craft a realistic alternative. Yeh, sure.
The naysayers may be quite correct, for all I know, but what are the likely results of saying nay? Will failure of the proposed plan save the ratepayers money? Will it clear the way for a better plan? One can't help imagining there must be some hidden agenda, other than people just wanting to feel righteous, in the campaign against the plan — and I for one sure as hell don't want to believe that of my fellow townspeople. I would happily be won over by a clearly articulated alternative plan — other than making it a parking lot or a Walmart.
Sonoma West has a whole buncha pages to publish proposed amendments or alternatives to the "takeover" and still have room for its sports coverage.
Cheers—
Conrad
Re: No Wait ER and Other Myths
Good question, Barry, and one I've been wondering about, myself. It just plumb evades me! :hmmm:
Rev. BE :heart:
Quote:
Posted in reply to the post by Barry:
...But why are you still doggedly trying to shoot down Dan's plan now?...
Re: No Wait ER and Other Myths
Some sunshine would be nice!:waccosun:
Farmer Dan
Quote:
Posted in reply to the post by Barry:
...But why are you still doggedly trying to shoot down Dan's plan now?...
Re: Everybody Just Shut Up?
You and Rollie seem to be the only ones still voicing "serious questions" about the plan. Neither of you need to "shut up".
Re-opening the hospital as the Sonoma West Medical Center is now what the public has voted for and the current policy of the district board.
Rather than being supportive, even if by pointing out concerns or other helpful criticisms, it seems like your comments are still coming from a place to hobble support for the plan. Why is that? Why not get on board and be supportive and help pull off this minor miracle that the community desperately desires?
Do you hold a grudge against Dan Smith? Seems that there are many people who do. It's quite possible that he's not the angel that he appears.
Are you somehow supporting the former Palm Drive workers, including your wife?
Do you feel that the public interest is severely jeopardized by the possibility of the plan failing. If it does will we be worse off than we are now?
Do you think this self interest at play that abuses the public trust?
Are you trying to vindicate your position that re-opening the hospital is not viable?
As I've written, I have my doubts that SWMC will be successful, but while we have a shot at it, why not be supportive? Wouldn't it's success be a boon for the community?
Something is clearly motivating your "serious questions and concerns". So how about being clear about that now the election is over and there's no need for posturing.
Quote:
Posted in reply to the post by JimHorn:
So, Barry, should everyone who has serious questions and concerns about this plan shut up--or just me?
Just askin'...
Re: Everybody Just Shut Up?
It could be that no one else is voicing concerns because, when you do, you're immediately attacked in this forum and others for "disinformation," "deception" and all the rest of it...
And I don't understand your distinction between my writing and "pointing out concerns." This plan doesn't need more cheerleaders, but it still needs someone to take a hard look at the numbers. Some people treat the Foundation's proposal like Tinkerbell in Peter Pan--if we all don't clap for it, it will die. In my opinion, the potential income has been exaggerated and the expenses downplayed. As a result, I think the Foundation proposal is unlikely to succeed, and that will have serious consequences for our community.
So why do I care now, "after the election" as you put it.? In the first place, the version of the plan available before the election contained very little financial data and had big gaps in other areas. At the time I was a member of the District committee reviewing the plan, and we had to basically twiddle our thumbs the month of October waiting for more information. One week after the election, the Foundation provided a revised plan with additional, but still insufficient, data. Based on that revised plan, our review committee wrote a report (that I drafted) summarizing our review of the plan along with specific recommendations to improve it. Unfortunately, after receiving the report at the December 8 meeting, the full District board has never reviewed or discussed it. In fact, the full board has never reviewed and discussed the merits of the plan at all.
So why do I care? Other than a respect for facts, here's why:
- The District is in bankruptcy and owes unsecured creditors, including many former employees, more than $10 million. Adoption of the most recent version of the plan would leave little money to pay even a substantial fraction of those debts.
- Many former employees were friends of my wife, who was a staff nurse at Palm Drive for six years until she, like they, was laid off last April. Those folks abruptly lost their jobs because of short-term mismanagement but also long-term health care trends. Many have found work elsewhere but are considering applying for jobs at SWMC--where they could have the rug pulled out from under them yet again. I want them to have facts when making their decisions, not meaningless "supportive comments" or your vague misgivings.
- Rather than proposing a straightforward lease or transfer of the hospital building and licenses from the District to SWMC, the very latest Foundation plan would have the District renew the state licenses and pretend to "reopen" the hospital itself, with SWMC as the "manager." Unfortunately, the proposed agreement would leave all responsibility and liability for the hospital operation with the District (and we taxpayers) but all authority and control over hospital operations with SWMC. The agreement would last for up to 15 years, at the sole discretion of SWMC. The District would be required to give SWMC $1.5 million a year from parcel taxes and an additional $2 million the first year.
Sorry if I'm not blowin' sunshine up people's butts, Barry, but that's my take on things...
Quote:
Posted in reply to the post by Barry:
...Something is clearly motivating your "serious questions and concerns". So how about being clear about that now the election is over and there's no need for posturing.
Re: Everybody Just Shut Up?
Jim,
Quote:
Sorry if I'm not blowin' sunshine up people's butts, Barry, but that's my take on things...
First let me say that some of your critiques have been valuable for improving the plan and have caused us to relook at assumptions we have made. Sometimes, our original thinking has been confirmed and sometime we have made adjustments. No one I know is expecting Timkerbell to clap, what we are hoping for is being open to the fact that something different than failure is actually possible. Not guaranteed, but possible.
To your three points:
1) The plan calls for $4-5M for creditors to be paid over time. You may note from my comments at the last meeting, I also believe that the Warn act money owed to employees is really current debt, not pre-filing, bankruptcy debt. I also believe that PTO owed in the last 90 days of employment should be treated as current debt. Therefore, employees would be paid 100% of this money.
I also believe that it is in the best interest of employees, creditors and bondholders to reopen the hospital with a sustainable business model. Joan and I are personally donating $3M to make this happen because we firmly believe that it will be successful, not because we are wishful. Not all employees have found suitable work and many have had to take traveling jobs to make ends meet so I believe we owe it to them to reopen if we can.
2) I would find it hard to imagine that employees would not be pretty aware of the risk of joining SWMC. That being said, the plan calls for a cash reserve of $2M+ so that we would not see a similar failure in the future. That so many want to come back is a testament to their commitment to the community, the quality of caring and each other. It does not reflect their naivete.
3) Opening under a management services contract is likely the only way that the hospital can reopen and is not anticipated to be a long term solution. Given that donors (including myself) are putting up more money than the district to reopen, seems like the district is getting a pretty damn good deal for its money.
Dan
Re: Everybody Just Shut Up?
Quote:
Posted in reply to the post by JimHorn:
So, Barry, should everyone who has serious questions and concerns about this plan shut up--or just me?
Just askin'...
Carl Jung observed that the more light you shine on something, the more shadow you create.
At Walt Disney studios in the fifties you could only critique if you had an alternative solution. I think Jim and Dan should switch roles. Then we'd have a workable plan.
Or yes please shut up so we can do the work required to open our hospital.
Re: Everybody Just Shut Up?
Quote:
Posted in reply to the post by MdocDave:
... I think Jim and Dan should switch roles. Then we'd have a workable plan.
...
I think you are on to something there, David!
I'd love to see a pair of posts by Jim and Dan taking some version of the other's point of view. That is for Dan to post a critical, perhaps even skeptical, piece about the SWMC plan to re-open the hospital, and for Jim to champion that plan and explain why it just may work and what a benefit that would be!
How about it, guys?
Re: Everybody Just Shut Up?
Brilliant!
Rev. BE :heart:
Quote:
Posted in reply to the post by Barry:
I think you are on to something there, David!
I'd love to see a pair of posts by Jim and Dan taking some version of the other's point of view. That is for Dan to post a critical, perhaps even skeptical, piece about the SWMC plan to re-open the hospital, and for Jim to champion that plan and explain why it just may work and what a benefit that would be!
How about it, guys?
Re: Everybody Just Shut Up?
Barry,
I have sent you a private email with the risks and weaknesses with the SWMC plan as I see them and suggest to Jim that he sends to you as well. Then, you can judge if each of us has made a serious attempt and publish both (or get back to us with a critique.) A lot of what I have sent is in the Weaknesses section of the plan already, but I have added more to the list.
If Jim does not respond, I would be ready to publish my list, but would want to include mitigating factors as well. I don't think anyone should believe that reopening a community hospital is easy or devoid of risk, otherwise everyone would do it. It is made especially difficult by the short time available and having vocal opposition.
That being said, it is well worth the effort in my view for we would never know the outcome without trying and the reward of succeeding will be life and health for a lot of our neighbors, family members and perhaps even our selves. The way I see this is that the payoff for the community is so big and enduring that the risks are outweighed.
Dan
Quote:
Posted in reply to the post by Barry:
...How about it, guys?
Re: Everybody Just Shut Up?
Farmer Dan, that may be the most sensible thing I've read throughout this whole episode we're all in! I feel it is a good plan and, at the very least, it shows your dedication and commitment to a monumental endeavor for which I and many others are grateful. Thank you!
Rev. BE :heart:
Quote:
Posted in reply to the post by farmerdan:
Barry,
I have sent you a private email with the risks and weaknesses with the SWMC plan as I see them and suggest to Jim that he sends to you as well. Then, you can judge if each of us has made a serious attempt and publish both (or get back to us with a critique.) A lot of what I have sent is in the Weaknesses section of the plan already, but I have added more to the list.
If Jim does not respond, I would be ready to publish my list, but would want to include mitigating factors as well. I don't think anyone should believe that reopening a community hospital is easy or devoid of risk, otherwise everyone would do it. It is made especially difficult by the short time available and having vocal opposition.
That being said, it is well worth the effort in my view for we would never know the outcome without trying and the reward of succeeding will be life and health for a lot of our neighbors, family members and perhaps even our selves. The way I see this is that the payoff for the community is so big and enduring that the risks are outweighed.
Dan
Re: No Wait ER and Other Myths
Ugggh, grown men in the he said this, he said that argument.
I'm sorry to see that the SWMC is a thing of people trying to prove their credibility. Absolutely do want truth in the matter- we all want truth, transparency, clarity and yet we hold different points of views, difference of life experiences and values.
If the Medical Center is to be effective and thrive, perhaps there are voices that can be solicited to serve in the betterment. What I see missing from this conversation is the perspective of women, especially mother's and nurses as well as other hospital staff. Those in the lower tiers often have incredible problem solving powers without outlets for empowerment.
The he said this and he said that is tiresome and I can barely read it. Surely we can improve our communications and regards so the conversation isn't one of people trying to preserve their reputations in light of bickering. Good luck peoples.
Quote:
Posted in reply to the post by JimHorn:
Regarding my recent commentary that appeared in
Sonoma West, Dan Smith writes the following:
"Sadly, Jim Horn continues his history of disinformation ...
Re: No Wait ER and Other Myths
Quote:
Posted in reply to the post by Serendipity:
Ugggh, grown men in the he said this, he said that argument.
Serendipity,
I agree, way too much testosterone!
Fortunately for me at 68 my testosterone level is receding along with my hair.
Dan
Re: Everybody Just Shut Up?
Barry,
Since Jim has demurred from advocating for Sonoma West Medical Center, here is the email I sent you that lays out what I see as the major risks in reopening our hospital. While no one of these is likely to be a show stopper, combined, they present a challenging picture.
While I am personally confident that we can be successful, I accept that for some this seems unlikely and the only proof will be long term financial sustainability. I liken this to free climbing Half Dome, it takes stamina and determination beyond what most people would allow themselves to endure to overcome the challenges. I believe that as a community we possess these qualities or I would not be working so hard on this project. Also, when I meet with people like Dr. Richard Powers as I did today and who has devoted his entire life to the care of the community, I simply cannot walk away.
My own confidence also comes from 2007 when we turned the hospital around after it was losing $500K a month and made it profitable in 2010. In some ways, the current situation is an easier job because we can fix things before we start instead of in the middle of a failed hospital but there are still many challenges to the process and we should not underestimate them.
Having said that, here are the major risks in my mind:
- As a small hospital, SWMC will not have economies of scale that allow larger hospitals to spread costs over a larger number of patient visits. Being small also challenges the hospital to utilize outsourcing and other contractual relationships to mitigate costs but without a great deal of leverage in these negotiations.
- Because of the bankruptcy of the Palm Drive Health Care District, SWMC will likely have difficulty reaching commercial terms with vendors and obtaining other forms of credit going forward. This will likely require additional operating capital in startup and may hamper capital acquisition over time.
- SWMC may experience inadequate startup capital since it is depending on philanthropy as one of the main sources of operating capital. Additionally, there are people in the community, including former District board members who are actively discouraging people from making donations, which has already affected some donors decisions and may continue to be an obstacle to fund raising.
- SWMC will need to re-establish Medicare billing, which will be delayed for a number of months. This delay will require operating capital to be available until Medicare issues a new billing number.
- Additional downward pressure on reimbursement rates for hospital care in the future will affect SWMC’s ability to be profitable. Medicare will continue to place new restrictions on reimbursement in order to keep federal pending on healthcare under control. Changes in the presidency and congress can have a great effect on hospital reimbursement. With a Republican Congress setting its sights on the Affordable Care Act, the future of medical reimbursement is uncertain.
- Changes in the makeup of the Palm Drive Healthcare district board could adversely affect the full implementation of the business plan. Historically, elections, deaths and resignations from the board have caused large shifts in board policy and the district board tends to be influenced by small but vocal groups. This is less likely within the SWMC board since it is much larger and self appointing, but until a stable and long term relationship is established, changes on the district board could have negative impacts on the relationship between SWMC and the District.
- A number of the physicians that the plan depends on are advanced in years. SWMC may have difficulty replacing these physicians in the future and will need to recruit younger physicians, the cost of which could exceed the budgeted allowances.
- The plan depends on maintaining an enthusiastic SWMC board of directors who will guide policy and oversee financial performance and a competent administration over a long period of time. This has proven elusive in the past and may be difficult to maintain in the future as people drift away.
- The plan depends on reaching an agreement with bondholders prior to the final bankruptcy settlement, which has yet to be worked out and may prove difficult.
- The plan depends on a rapid ramp up of patient volumes over a 6 month period. If this does not occur, operations could continue to lose money and SWMC would have to find additional capital sources, which might prove difficult.
- Major failure of mechanical systems in the hospital could create the need for additional capital beyond budgeted amounts.
- Failure of SCAN and Western Health advantage to make headway in the county against Kaiser and continued market share for Kaiser would continue to make patient acquisition difficult.
- While Raymond Hino is clearly very competent to operate a successful hospital, the hospital has gone through a number of CEOs in the past and not had stable leadership during much of its tenure. If Mr. Hino leaves, SWMC may have difficulty recruiting a dynamic leader in a timely fashion and there would be a loss of confidence in the community.
Re: Everybody Just Shut Up?
I attended the presentation by SWMC CEO Raymond Hino at the Grange Tuesday evening, along with a full house of around 100 people. I was impressed by the plan that he presented for re-opening the hospital. As Grange president Jerry Allen pointed out in introducing the evening, the election is over and those who won are focusing on re-opening the hospital. They deserve our support in their attempt.
I appreciate Dan's honesty and forthrightness below in addressing the real difficulties. I attended the meeting with a nurse who works at Memorial. She indicated that there are also serious problems there. One of her favorite doctors is planning to work for SWMC, which is a good sign.
The larger picture within which Palm Drive and the new Sonoma West Medical Center exist is that health care has become increasingly corporate and thus greed based on making money. Memorial, for example was founded on religious principles, which no longer guide it. Since I am 70-years-old and was partly raised in rural Iowa, I remember when doctors even did house calls.
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Posted in reply to the post by farmerdan:
...
Having said that, here are the major risks in my mind:...
Re: Everybody Just Shut Up?
(above and beyond the call of duty for the Greater Good of this Community): That’s what I call a “Hero” in my book, Dan and Joan!
You have made this Report transparent and clear enough for me to comprehend these obstacles.
Thank you for your dedication and perseverance.
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Posted in reply to the post by farmerdan:
...Having said that, here are the major risks in my mind:...
Switched Roles /Thanks to Dan for playing devil"s advocate...
Thanks to Dan for playing Devil"s Advocate in this monumental effort to reopen our hospital. I love the mountain climbing metaphor. When Royal Robbins pioneered the use of hexagonal chocks instead of pitons on Half Dome noone knew or thought it could be done until he did it. Now it's been done many times with much less damage to the mountain.
We've studied the obstacles, assembled a world class team, mapped out a route, and raised money for the effort.
If anyone has thoughts about the concerns Dan has raised, please step up and join us. Otherwise, wish us luck:
we're headed to the top.
Dave Murphy PhD
Integrative Health Institute
Sonoma West Medical Center
Re: Switched Roles /Thanks to Dan for playing devil"s advocate...
NOTE FROM BARRY: Since there are so many posts over the last day on several threads, I have suppressed a few of the conversational posts from today's digests. The posts are still on the website and they have been sent to all the participants in the threads.
Quote:
Posted in reply to the post by MdocDave:
Thanks to Dan for playing Devil"s Advocate in this monumental effort to reopen our hospital. I love the mountain climbing metaphor. When Royal Robbins pioneered the use of hexagonal chocks instead of pitons on Half Dome noone knew or thought it could be done until he did it. Now it's been done many times with much less damage to the mountain.
We've studied the obstacles, assembled a world class team, mapped out a route, and raised money for the effort.
If anyone has thoughts about the concerns Dan has raised, please step up and join us. Otherwise, wish us luck:
we're headed to the top.
Dave Murphy PhD
Integrative Health Institute
Sonoma West Medical Center
When horseflies bite, they are an annoyance, but not life threatening. It is definitely time to ignore the nips and bites of naysayer horseflies to focus instead on the wonderful new hospital that's being born! an addition to Sebastpol that will surely not only save many lives, but will improve the lives of us here in West County plus many more outside this area. Me? I'm so excited and thrilled about this magical new center for health and healing I feel positively fizzy! You're right, Dave: we're headed to the top!
And every bit of positive imagery will help support the successful climb, plus the growth of the SWMC during it's first vital few years. Picture success, everyone! We need this hospital. It will happen and will succeed.
