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Updated 4:46pm - Sep 16, 2014

Home arrow Opinion arrow Columns arrow Coastal Voices: Regionalization, critical access: setting the record straight

Coastal Voices: Regionalization, critical access: setting the record straight

Spending time at a recent two-by-two meeting of the Board of Supervisors and the Del Norte Health Care District Board gives me the opportunity to address concerns I heard.

The public seems eager to get the facts and we want to offer them. As a reminder, we are in the midst of the Strategic Options Study with The Camden Group because of very real financial issues. Our No. 1 goal is to ensure this community has access to health care.

The first misconception continues to be that regionalization/centralization equals Critical Access Hospital (CAH) designation. This is not true. Regionalization is strictly a governance structure. Sutter Coast Hospital will continue to have a local administrative team and input into governance matters and a local advisory board.

The regional bylaws require that the Board be representative of the communities it serves. The current West Bay Board has individuals from each of the four counties in which it has facilities. If Sutter Coast becomes part of the West Bay, I have every reason to believe there would be at least one individual from Del Norte County.

Some have speculated that if we regionalize, we impose CAH designation. We have not made that statement, or that decision. In fact, The Camden Group, as discussed in my last “Coastal Voices,” has been enlisted to guide us through the process of analysis about the best options to ensure that the hospital can meet the health care needs of our community now and in the future.

A significant focus of The Camden Group is patient safety, quality of care and the financial impact to access that care. This study is currently under way and we look forward to the evidence-based interactive process. The Steering Committee plays an active role.    

In the meantime, we have made a commitment to the community to wait for the completion of the study before deciding what options for the future may exist and whether regionalization or critical access hospital designation might be worth considering and pursuing. This language was placed in the legal settlement with the Health Care District, at our request, to reaffirm publicly our commitment to the process.

CAH inaccuracies continue to cause fear and much emotion from the community, therefore I would like to address the concerns I heard voiced in the meeting.

“We will be shipped out if there are more than 25 patients at the hospital.”

Fact:  CAHs are limited to 25 staffed/available beds that can include any combination of acute inpatient or swing bed services. However, they can also operate a distinct part such as rehab or mental health units of up to 10 beds each. Note that labor/delivery rooms can be taken out of the count under certain circumstances and observation beds are excluded from the 25-bed count.

Our average daily census has declined significantly in the past five years: 2008, 25 patients; 2009, 22; 2010, 22; 2011, 21; 2012, 19.

Not only are all of those numbers at or below 25, they do include our labor/delivery census. While we have days that have been over 25, especially in the winter; you can see that our overall census stays well within the requirements. Last week we had a day with 11 patients, one with 13 and one with 14.

From a business perspective, we cannot afford to operate a 49-bed hospital with 11 patients.

“We will be shipped out and it will cost thousands of dollars,” and “We will be shipped to fellow Sutter hospitals in the Bay area.”

Fact:  Sutter Coast Hospital regularly transfers patients requiring a higher level of care, including trauma. They are always transported to the closest hospital that has a bed available for their specific diagnosis.

Dr. David Wilson, co-director of the Sutter Coast Hospital Hospitalist Program shared, “If we are ever presented with the need to send a patient elsewhere due to census, this will be evaluated on an individual basis and could include sending out a non-critical patient over a critical person.”

The average costs one can expect for air and/or ground transportation are very high and can range well into the thousands. However, both of our local EMS providers — Cal-Ore Life Flight and Del Norte Ambulance — offer annual memberships for as little as $20 per year full family, which could eliminate or offset what your insurance does not cover, based on your personal coverage. Further, should there be changes in services or available beds, we would definitely look to additional funding sources — internal and external — to help subsidize patients who may be transported out.

“If I need to stay longer than four days, they will ship me out.”  

Fact:  No. The total average length of stay for the entire year cannot exceed 96 hours, which is calculated considering all patients in the facility. This means one patient might stay one day and another may stay for a week. 

Like our average daily census declination, our average length of stay has also declined in the past five years: 2008, 3.67 days (88 hours); 2009, 3.21 days; 2010, 3.30 days; 2011, 3.36 days; 2012, 3.15 days (75.6 hours). 

“The ER would not be fully staffed or open 24/7.”

Fact: Many CAHs are 100 percent staffed with ER physicians 24/7.

“Our Emergency Department has more than 22,000 visits each year, which averages to a patient every 20 minutes,” shared Sandy Saunders, M.D., Medical Director, Valley Emergency Physicians, the organization which staffs Sutter Coast Hospital Emergency Department.  

“There would be no change in this service. You will see the same doctors for the same service. Critical Access will mean the same services, just fewer inpatient beds. Further, we transport patients out of here nearly every day due to acute conditions that would be better served elsewhere.  We are good at this, it won’t be a new practice.”

I encourage you to do your own research.  Also, I ask you to wait with us for the results of The Camden Group study.  Please complete the survey that will arrive in some of your mailboxes over the next couple of weeks. The Camden Group has enlisted a third party mail vendor to distributed and analyze the surveys, which will be sent to 4000 random households in our service area, giving voice to thousands of community members who want to share their perspectives about health care.

Linda Horn is the interim chief executive officer at Sutter Coast Hospital.

 


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