Sutter Coast plans to apply for conversion to Critical Access while preserving its local Board
In what Sutter Coast Hospital's CEO called a "sincere effort to find a middle of the road" solution, the hospital Board of Directors voted Thursday to pursue Critical Access Hospital designation while maintaining a local governing board.
"What we wanted to do was have the local board in effect during the time it takes to turn around the financial well-being of the hospital," said Ken Hall, chairman of the hospital's board of directors, by phone Friday.
He acknowledged the continuation of a local Board could be temporary.
Hall said that the resolution supporting a local board "says very clearly to Sutter Health that if we're going to regionalize, the local hospital needs to be assured that there will be representation on that board."
Just over a year ago, the board decided to focus more
attention on the Critical Access issue than regionalization, since that
was "the spark that ignited the community," Hall said.
for Critical Access designation, a federal program that alows rural
hospitals to receive cost-based reimbursements for Medicare patients, is
expected to significantly boost revenue at Sutter Coast, where more
than half of the patients are insured by Medicare.
the hospital's proposal for a Critical Access facility have said that
one of the program's restrictions, a maximum of 25 acute care beds, will
cause many additional patients to be flown to other hospitals due to
lack of space. Sutter Coast currently has 49 acute care beds.
a great program when you're not downsizing to fit it," said Dr. Greg
Duncan, the hospital's chief of medical staff and the only hospital
board member to vote against Critical Access on Thursday.
said that when Sutter Lakeside Hospital in Lakeport switched to Critical
Access in 2008, the hospital's emergency transfers jumped from 257
patients in 2007 to 1,064 patients in 2009.
Duncan said one Lakeside doctor told him that the transition to Critical Access there has been "amazingly problematic."
public health officer of Lake County has said that increased emergency
transfers from small hospitals to specialized centers for services like
cardiology or stroke care is a common industry trend and that the
Critical Access transition at Lakeside did not stay controversial for
Sutter Coast executives and the hospital board chairman
have pointed to a consistently falling daily census rate at the
hospital, which averaged below 20 patients through 2013, as a reason to
not fear the 25-bed cap. Additionally, they said that utilizing
different classifications of beds that do not count toward the 25-bed
cap is a way that the hospital can avoid a spike in emergency transfers.
said the hospital will have procedures in place so that if the
facility is close to the 25-bed cap and there is an influx of patients
requiring acute care "you have a plan in place for triage - who's going
to be transferred and how are the transfers going to be made."
Horn, Sutter Coast's interim CEO, said that the designation of a
particular part of the hospital for "observation beds," which do not
count toward the 25-bed cap, is a certainty under Critical Access.
patient may be in an observation status even though the CAH furnishes
the patient overnight accommodation, food, and nursing care," according
to federal guidelines for Critical Access Hospitals.
next eight to 18 months while the hospital jumps through the hoops
necessary to become a Critical Access facility, Horn said it will
simultaneously research and evaluate what other types of units with beds
that don't count toward the 25-cap should be implemented at Sutter
Horn said the hospital could create a distinct sub-acute
care area where patients could receive treatment like IV therapy and
pain management until they are ready to be discharged. In this area,
patients could legally stay longer than 96 hours, she said. Along with
the 25-bed cap, Critical Access Hospitals are required to have an
average length of stay of less than 96 hours, on an annual basis.
sub-acute care areas would not compete with local convalescent homes or
replace acute care functions, but "fill a niche in the middle where
patients spend a few days when they aren't quite ready" to be
discharged, Horn said.
By looking at the unique diseases and
common ailments in the community, the hospital will also evaluate the
wisdom and necessity of creating distinct psychiatric and rehabilitation
units, which also would not count toward the 25-bed cap, Horn said.
Coast will continue to be a full-service hospital, Horn emphasized,
with a 24/7 emergency room. Critical Access Hospitals are actually
required to maintain a 24/7 emergency room that has a registered nurse
on-site and that has an on-call doctor who can be at the hospital within
The first step in applying for Critical Access
designation is completing a financial feasibility analysis to determine
if the program would be beneficial to the hospital. Sutter Coast
completed this in both 2008 and 2012, and Horn said the facility should
have no problem qualifying for CAH status.
The chairman of the
board is convinced that Critical Access is "not the impending disaster
that some people have made it out to be."
Horn said that the stability that comes with Thursday's votes should also help with recruiting new physicians.
"Clearly defining our future helps us not only recruit but retain talent," Horn said.
CAH not a panacea
additional revenue that will come with CAH designation is not expected
to be enough to bring Sutter Coast into the black, Horn said.
"Revenue won't cover our expense unless we're prudent," Horn said.
hospital could continue to eliminate some positions through attrition
and continue to encourage "flexing people off," having employees
voluntarily take time off when the patient census is low, Horn said.
"At the end of the day, when we see what our volume is we may not be able to maintain every job," Horn said.
possible, the hospital has cross-trained existing employees working in
an overstaffed department to fill a need in another part of the
operation, Horn said.
To cut costs, the hospital will also
evaluate what non-patient clinical services could be completed more
efficiently outside of the area.
"Centralization will be part of
our future," Horn said, adding that this will not be applied to patient
care services, since "we are already at a level of basic services."
Some centralization that has already occurred, like billing, received criticism for being inefficient.
Horn said that the new billing system was not fully implemented at first, but it "has improved significantly."
Horn said improved pre-planning will make any further centralization actions smoother.
Medical staff support
the wake of a $170,000 "strategic options study" commissioned by Sutter
Health and conducted by its consultant, the Camden Group, the rhetoric
in the community seems to have softened.
Thirty-six members of the
Sutter Coast Hospital medical staff signed a letter that ran in the
Dec. 5 edition of the Triplicate that thanked the community members who
served on the steering committee.
"We look forward to a strong partnership between the medical Staff and the Hospital moving forward," the letter states.
success is dependent on a close working relationship with our medical
community and that support will make the difference in planning the
future of our hospital," Horn said.
Two members of the steering committee accepted a request from Sutter Coast to record radio spots about their experience.
Mentink, who works in the diagnostic imaging department of Sutter Coast
and was asked to participate as the 2012 employee of the year, said
this in her radio spot: "I grew up in a small community with two
hospitals - both of which were critical access. The community didn't
know the difference. We just knew when we needed care we had it. I
know that the fear of the unknown scares our community, but trust me:
fewer beds does not equal less care."
Clarke Moore, who
participated on the steering committee as an individual, also recorded a
radio spot: "I wanted to know if Sutter was guilty of profiteering ...
What I confirmed is that Sutter Coast Hospital and Sutter Health appear
to be making necessary business choices to ensure a viable hospital.
They are strong partners with this community - not profiteers."
said that the hospital tried to listen to the concerns of the community
over possible loss of local control and downsizing that have been
voiced over the past two years. More recently, the hospital received
less than 10 comments on the hotline and email address that were set up
since the completion of the study.
"People said no
regionalization; we're not regionalizing. People said keep a local
board; we're keeping a local board," Horn said.
Duncan said the resolution supporting a local board does not mean much since it could be changed at any time.
"In what concrete, binding way did that change anything?" he said.
said the steering committee agreed to be available as the hospital
undertakes the changes and that community input will continue to be an
"We'll try to listen to any avenue that gives us feedback," Horn said.
See "Sutter Coast statement on Critical Access" in Triplicate.com's Local News section for the hospital's press release on the vote to pursue Critical Access Hospital designation.
Reach Adam Spencer at firstname.lastname@example.org .