It's time again for the KVHD "Finance Commit me" meeting, Wed. Aug. 26

It's time once again to look over the financial condition of the Kern Valley Healthcare District. We remember from last month that our pharmacy is on COD with the vendors and we are all to call first if we require any "unusual" medicine.

Strangely, though, Rite Aid pharmacy and the Drug Store in Kernville are able to make ends meat with their drug dispensaries, in fact, Rite Aid says the pharmacy carries the whole store.

What's the matter with our pharmacy, who is milking that cash cow?

So, I'm thinking tonight about how to cut the budget at the hospital and not short staff ourselves.

I've come up with a few ideas which could bring in a little dough.

Number one: Does a small hospital such as ours really need to have a full time chief financial officer?

We currently pay our CFO, Mr. Beedle, full time salary at or about 115,000. He also gets housing paid as he lives out of town. What if he goes Part time? There's almost $50K right there.

Then we have another potential money saver, why don't we change our contract with our hospital surgeon where he is paid per surgery or procedure or some other modification? He's a great surgeon, I admit, but can we really afford to pay him the money he's been getting? And the surgical nurses, can we cut back there too? Maybe put them on a Per Diem basis?

How can we get back on track with the pharmacy? At the last board meeting we were told in no uncertain terms there was nothing we could do about our pharmacy situation. Maybe we should ask the other pharmacies how they do it. Knowledge is power.

Mr. Beedle said we began losing money when the government made changes to Medicare Part D. Without elaboration, I asked Rite Aide if that was a problem for them, and they said no. I'll have to ask more about this at the meeting.

And certainly any of you with questions about the pharmacy or other financial issues should remember to stop by at the meeting, Wednesday, Aug. 26, at 9 am, in the trailer.

Since our surgery department is less a department and more of a loser at this point, why not gut the staff there until the time comes that the surgery actually does surgeries and not just endoscopy's.

Now there was this creation of a cardiac department where billing from pulmonary, who does EKG's, is moved into the cardiac department. I'm not sure exactly why this is, so yes, I will ask.

I spoke with Sharon Brucker, about a quality issue earlier this year, where there were used syringes on the ground, one was stepped on by someone with me at the hospital. I asked Mrs. Brucker what title she holds at the hospital now that she is no longer the Chief Nursing Officer.

Some of your commentary sounds like Administrative concerns but included in my title is as follows: Utilization Review(Case Management), Quality Improvement and Cardiology. My role as Quality Improvement centers around Quality Indicators set up for departments in the hospital. Each department decides on areas they will work on annually, of this could include quality assurance items (maintaining) or areas of improvement. I assist departments in collecting data and making sure reports are timely and sent to the appropriate committees. Administration has recently selected a Risk Manager, (I'll have to find out who that is too) who falls under Sherry Deppermann. Quality is everyone's responsibility.
There is no alotted time for a report coming from Quality in normal Board meetings. I can tell you that quality issues go to the Board through the meeting called the Med Quality committee. Two board members sit at this meeting.
Often I find myself as a facilitator for concerns. I certainly do not have any power to change policy but am able to make suggestions for change.
I also oversee the very small area -Cardiology. Currently we do echocardiograms and an occasional Stress Test. We currently only have a Cardiologist available on certain days, making it difficult to expand. But we do provide a service for the community. Cardiology does provide a positive cash flow for the District.
Sharon Brucker RN
QI
Now, I'm still not sure what Mrs. Brucker does, and what experience she has in this type of area, but it sounds like maybe we could do more of this melding of personnel.

At the last board meeting, new CCO, chief clinical officer, Cynthia Burciaga, told us that they were looking for "flexible" staff who could work in several areas as needed.

So, first we begin cutting, and I'm hoping that we have gone over all the contracts currently with the hospital to see if we can renegotiate or cancel anything that may not suit us anymore. Remember we paid $60K to a public relations firm, and I would like someone to quantify for me how that contract helped us.
(I'm going to hang out around outside the hospital, because money keeps getting thrown out the window, I could make a good living just on the waste from the hospital.)

Once we make the cuts, the choicest ones come from the top layer, cutting CNA or phlebotomy is pennies, we need to cut dollars.

And finally, how can we make money like they do at the darn thrift store? They're rolling in it.
I've never seen a hospital which relies so heavily on an auxiliary thrift store and not a pharmacy. But I guess using volunteers to make money is cheaper than paying for employees.

The auxiliary and the hospital foundation, have purchased equipment and many things to upgrade the hospital. Without them, I don't think this hospital would still be up and running (running is an exaggeration, let's say crawling).

We need an overhaul here. I still think a forensic audit is in order. And an audit committee would be a good start.

The CFO told me during one finance meeting that they don't need an audit committee because they have the finance committee meeting. If you haven't attended one of these you need to come and see for yourself. There's little or no open talk about solutions to problems, and it seems to be just more of a report.

Come on we need to bring in the public and talk about these problems. One member of the audience at last month's meeting said, we need to bring back the hospital breakfasts inviting "the movers and shakers" from the valley. I agree.

Finance commit me meeting, Aug., without KVHD CFO/pharmacy/staffing/cutting/

I’m beginning to get a complex here, everywhere I seem to go people stop showing up who were expected to show up. I was so looking forward to chatting, with Chet Beedle, our Chief Financial Officer, at the kern valley healthcare district today at the monthly “finance commit me meeting,” but he wasn’t there. I even brought my cameraman for the occasion.

Bob Jamison was at finance commit me today, but he wasn’t at the “town hall, debate, confusion as to the title,” healthcare reform meeting this past Monday. There was some sort of debate between Jamison and Dr. Gross, DO, which a lot of people thought would take place.

I asked him why he didn’t show up.

For the first time in years, an utterance was heard out of Jamison directed at me, which didn’t include kicking my skinny ass.

He said he didn’t even know about it. He even asked, “What meeting are you talking about?”

I told him, his radio brethren, “smooth news” told me that Jamison said he wasn’t invited.

Jamison, looked perplexed. Then he said, I don’t know where he got that from.

I said, he said, you, said it. Then I let him off the hook as he began telling me he had heard about a “flyer” or something, but didn’t know, blah blah, it was beginning to sound way too much like the skilled nursing facility and staffing from 2007. (I wonder what he would be like under oath in court?)

But, then our new CEO, Tim McGlew arrived, eyeing my cameraman and I like we might be “up to something.” (Not us.)

I wanted to get on film the actual nature of these financial meetings to show the public. As I previously described, the meetings usually consisted of the “Fed Ex” description of the finances by, Chet Beedle, whose explanations have always been on the rather skimpy side as well as getting the feeling we are playing the shell game: which one is it under.

Since, Beedle, wasn’t there I didn’t ask my glowing red ember question, “is it the policy of the hospital to take the $200 burial fee from the people who have passed on in the skilled nursing facility, rather than giving it to the families for it’s intended purpose?” I guess that will have to wait.

Controller, Barbara Figeuroa, was at the helm today, to guide us through the monthly numbers game. I'm hoping to win at KVHD Bingo someday.



I found her to be much more interesting and forthcoming than Mr. Beedle, and I could actually understand her even when there was a little mumbling.

QUESTION NUMBER ONE:

Why can’t our pharmacy make money?

Tim McGlew began to tell us what we already knew, that the pharmacy is on COD, (cash first, product second), because we didn’t want to pay certain bills for a while, our wholesaler, is a pain, and we have no credit.
Then, however, Mr. McGlew showed that when he is asked directly he will offer more of an explanation.

I said, Rite Aid and The Drug Store are making money, why can’t we? McGlew caught the first ball in his mitt immediately. Yes, Rite Aid is a big corporation who gets the big breaks on prices. (I imagine they also pay the wholesaler on time too).

He said they have not given up on the situation and are working with the wholesaler as we speak to reduce prices and also look at other options. He said there are only three wholesalers, which makes things a bit difficult.

More to come on that story…as prescriptions filled at Mt. Mesa Clinical Pharmacy fell sharply this last month.

I stopped by on my way out of the hospital meeting to ask the pharmacy if by some miracle, they had my rare these days, thyroid medication. You’re right, it was stupid, and they didn’t have it, and even told me again it’s not being manufactured anymore.

I don’t know who’s right or wrong there, as I contacted the manufacturer who has a recording explaining they are behind on the production of the drug, but should be caught up by the end of August.

To be fair, Rite aid and the Drug Store in Kernville, both do not have the drug in the dosage I need. And Walgreens, a great big chain, found only 30 to give to me.

One last thing on that subject, when prescribing medicine which is required daily, and not a week or two later when the pharmacy is stocked up again, or the doctor is back from vacation, is a serious responsibility. I continue to stress trying to get my three medications which need to be filled on time or I could seizure, die or go insane. (I mean, more insane) So, doctors, pharmacists and hospitals, realize we are not angry customers, we’re scared…okay?

I wonder if other rural hospitals are having a tough time with their pharmacies. If so, could we not initiate some sort of coalition with other hospitals and get our pharmaceuticals together, like chain drug stores do?

Would you like a little off the top?

Questions came and went about how the hospital plans on cutting back and then on making money. It seemed only I, and committee chairwoman, Mrs. Kathryn Knight asked questions though and that is my point about bringing on an audit committee as an adjunct to this mystery financial theatre.

I put it straightforward, as usual, are you cutting from the top or the bottom? I explained that I meant there were more cost savings from the top layer than there is with the lesser paid.

It was announced with a soothing tone, that registry and traveling nursing costs are now at the lowest in years, but the hospital has been hiring which drove up the costs of actual employees. (We’re all good with adequate staffing and not from overpriced temp agencies)

There is not a shortage of good people, you just have to attract good people, by having, good and fair hiring and firing practices. As well as being good and fair in general. Human resources, the title speaks for itself. But problems have been there at KVHD for a long time, and the baton (some have been hit with) may have been passed along in 2007.

A Psychiatrist in the house: Is that for me?

But then I was told about the new psychiatrist, who is being utilized in the skilled nursing facility to provide consultation about psychotropic drugs, which we all have learned are part of the arsenal of pharmaceuticals used for geriatric problems.

Unfortunately, this contract came way too late to avoid the indictments from the office of Medical Fraud and Elder abuse, under the auspices of the Department of Justice.


Former, CEO, Pam Ott, said she had a few psychiatrists consult in 2007, when the state was breathing down her neck. She even said these psychiatrists agreed with the treatment and medications residents of the skilled nursing facility received in the "dark years." Her doctors said the residents needed even more of the medications in some cases.

But we must be at least somewhat relieved that the district is now taking this quite seriously and consulting with another shrink on a contract basis.

McGlew reported that the new psychiatrist will also be consulting with the emergency room, as the ER director, was said to have an interest in utilizing the specialist as well.

As I have previously mentioned, I am bi-polar, along with the whole of my family along with many friends, and it is a concern to me how people with this disorder and other mental health challenges are treated at the hospital and within the district.

The history regarding these issues is rather “crazy” really, and I will begin to advocate for those like me, or those who don’t like me, or whatever, us different folks. People all across America are eating up anti-depressants, as the economy and social change, have people worried and “bummed out.”

I am not making fun of depression as it kills people every day. Bi-polars head the list of those offing themselves regularly, and not just this hospital, but every hospital and medical provider needs to understand this unpleasant reality. (In fact, my brother was let go from the KVHD ER twice while he was suicidal, cut to the bone, leaving a bloody hopeless trail and nobody from mental health ever showed up.)

Since we have little in the way of treatments for depression, the pharmaceutical companies and Budweiser head the list of antidotes people choose most often, I would like to see a more natural approach, one of understanding and compassion.

Hugs not drugs KVHD. Also staff, not half, too. Nurses kept too busy cannot tend to the little things that make life livable, like a letter from a friend, a neck rub, reading a book aloud, a good conversation, a funny movie. (if these were your last years, months, days, what would you want for you or your family?)

The psychiatrist will not provide those things, but the often brow beaten and overlooked nurses, can: Most especially the underpaid CNA’s.

Bravo, a psychiatrist, I hope we utilize him well and learn, especially for those in the skilled nursing facility.

McGlew also reported that the state has frozen the expected 3% increase in payments to the skilled nursing center and will have an impact.

Just what we need less money for our SNF. Well, not less, but the same as last year, so it could be worse.

But it shows again, the lack of concern for the elderly and disabled by the state government. Stop it up there in Sacramento. This is sounding a lot the point of a certain woman at the town hall meeting about euthanasia.

In Conclusion, there is still a hospital that needs the public’s attention, but we seem to have obtained a dedicated, CEO in Mr. McGlew, and an equally attentive new Chairwoman of the board of directors in Mrs. Knight.

They are the “portrait of dedication,” or something syrupy like that. (Oh, I’m starting to use platitudes; I must stop reading the local newspaper. Aren’t newspapers written at a fifth grade level? Or is that blogs?)














I still have so many questions, like the bond payment, the pharmacy Medicare Part D issue, and that audit committee stuck in my mind. Of course, I still want to speak to Chet Beedle. All in good time…