Adam Spencer, The Triplicate

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.

Opponents of

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.

During the

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

30 minutes.

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

important component.

"We'll try to listen to any avenue that gives us feedback," Horn said.

See "Sutter Coast statement on Critical Access" in's Local News section for the hospital's press release on the vote to pursue Critical Access Hospital designation.

Reach Adam Spencer at