Directors with the Del Norte Healthcare District expressed disappointment Tuesday in a letter they received from Sutter Coast Hospital CEO Mitch Hanna refusing to provide information about the criteria the hospital uses in its billing practices.

In his Nov. 16 letter, Hanna stated the hospital has no intention of providing that information to the healthcare district board, “as we are concerned that it might be misinterpreted and somehow used to besmirch our reputation in the community as has so frequently been done in the past.”

Hanna pointed out that the hospital already has mechanisms for its patients to obtain information about charges they have incurred or may incur for services. He also stated he wouldn’t want the community to “somehow think that the Healthcare District is the governing body of Sutter Coast Hospital or the intermediary between them and the hospital.”

According to healthcare district Chairman Dr. Greg Duncan, he and his colleagues have been discussing Sutter Coast Hospital and emergency room billing and billing codes for the last several meetings. Duncan noted that a number of patients have approached the healthcare district after having already gone to hospital staff with concerns about their emergency room bills.

“There are five levels of service the hospital assigns to a bill when the hospital goes to the emergency room for treatment,” Duncan said. “From 1, which is the least expensive, to 5, which is the most expensive. One of the apparent patterns that we saw was the use of a level 4 charge, and — we’ve discussed this at other meetings — what we wanted to know is how these coders who work for the hospital determine what’s a level 1 and what’s a level 5 and everything in between.”

Duncan said the charges hospital patients have approached him with concerns about have been in the thousands of dollars. The healthcare district has established that Sutter Coast has criteria it uses to establish its billing codes, but were directed to Hanna when it asked to see what that criteria is.

Duncan, on behalf of the healthcare district, sent a letter to Hanna requesting the criteria it uses to determine its billing codes on Oct. 25. In his letter, Duncan stated the information would help the healthcare district and the public better understand “how hospital charges are derived.”

Duncan also took issue with Hanna’s concern that any information Sutter Coast Hospital provides the healthcare district about its billing practices may be used to besmirch its reputation. Duncan encouraged hospital board members David Gibbs and Ron Sandler, hospital board chairman Ken Hall and Ellie Popadic, Sutter Coast’s director of ancillary services and business development, to let the healthcare district board know if it has besmirched the hospital’s reputation unfairly.

“What we do is provide facts,” Duncan said. “And if we’re wrong, then tell us we’re wrong and we will gladly retract what we say, but I’d love to see Mr. Hanna’s examples of frequent besmirching by this district.”

Duncan’s colleague on the healthcare district board, Dr. Kevin Caldwell also expressed disappointment, noting this is the fourth month the healthcare district has discussed one case “after the patient had already been through all the hospital committees and gotten everything they were going to tell her and was still not satisfied.”

According to Caldwell, hospital staff’s response when the healthcare district board began asking questions was that it wouldn’t discuss a specific case.

“So we said OK, let’s make up a case,” Caldwell said. “It took three meetings and (they) finally said there’s apparently some book with a criteria and that’s what the coders use and we’re like great let’s see that. That’s what precipitated the letter to Mr. Hanna, but his reasoning as Greg just said that he has no intention of giving it because we’re going to misuse it to besmirch the hospital board... that’s kind of like no good way to get along in the community and we still don’t know how these enormous bills are arrived at.”

Following Caldwell’s statement, healthcare district director Terry McNamara, whose final meeting is next month, asked the Sutter Coast Hospital board members if they discussed Hanna’s letter before it was sent to the healthcare district board.

Hall said the Sutter Coast Hospital Board of Directors received Hanna’s letter as well as the Oct. 25 letter from Duncan, but hadn’t discussed them.

Gibbs said the hospital board hasn’t met since Oct. 25, the date of Duncan’s letter, but will meet in early December and encouraged Hall to place discussion of the letter on the agenda, although he wasn’t sure if Hanna’s position on disclosing the hospital’s billing code criteria would change.

“I think Mr. Hanna has responded for the hospital and I think there would be discussion of the letter at the meeting, but I wouldn’t expect to hear anything unless the board chooses to change Mr. Hanna’s position,” Gibbs said.

Duncan encouraged Gibbs to get back to the healthcare district board even if the answer to the district’s request is no.

“We’ll persist because we feel like it’s the right thing that (if) the patient receives a bill for thousands of dollars they have the right to know how it was derived,” he said. “We hope we get a different response; at least a response in either direction would be helpful for us going forward.”

In other matters, the healthcare district board indicated that it would prepare a bid for the expansion of the Del Norte Wellness Center for its next scheduled meeting on Dec. 18.

The healthcare district board also welcomed its incoming directors, Dohn Henion, Michael Young and Elizabeth Austen. Henion and Young ran unopposed for two of three seats on the Healthcare District board. the Del Norte County Board of Supervisors recently approved Austen’s appointment to fill the third vacant seat on the healthcare district board.

Henion, Young and Austen will be sworn in at the Healthcare District’s Dec. 18 meeting and will replace McNamara, Dwayne Reichlin and Shellie Babich.

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