By Deb Murphy
Everyone agrees on a few health care truisms: it’s complicated, sustainability is an issue and rural hospitals are both necessary and struggling. But, in the Eastern Sierra nobody seems to agree on a solution.
Inyo County Planning Director and Executive Officer for the Local Agency Formation Commission Josh Hart presented his report on the challenges and constraints on pursuing regional health care, stretching from Mono County to Southern Inyo and even looking into including Tonopah, Nevada and Ridgecrest.
The report was well received by LAFCO members at Monday’s meeting. Members directed Hart to draft a letter to the healthcare districts in Inyo and Mono counties requesting a meeting to discuss the possibilities.
Issues faced by Northern Inyo, Southern Inyo and Mammoth Lakes hospitals are similar: dealing with changes in requirements and funding as a result of the Affordable Care Act while providing comprehensive health care to a small population spread out over a large area. In an over-simplified nutshell, the healthier a hospital can keep its population, the better off it will be financially.
While hospitals are shifting their emphasis and complying with reporting requirements, it’s going to be tough to balance budgets.
Grant funding is available to bridge the gap between health care paradigms, Hart reported.
And, some of that grant funding encourages a regional approach to reduce overhead while still providing a broad spectrum of health care. One case study in the report focused on the Northern California Health Care Authority.
Working through a Joint Powers Agreement, five area hospitals “coordinate human resource functions, share procurement and medical practitioners and operate a telemedicine program.”
Under “constraints”, the report included “individual personality frictions, cultural differences between the organizations and competition amongst the providers.”
To illustrate these constraints, Mono LAFCO Executive Officer Scott Burns’ e-mail response to Hart’s report was “a regionalization study should not occur until the current legal proceedings have ceased.”
Northern Inyo Hospital did not respond.
The two districts are in the middle of a lawsuit over Mammoth’s orthopedic clinic in downtown Bishop, a move NIH alleges is a violation of district boundaries since the clinic is operating without the consent of NIH.
To help bridge this particular gap, Inyo County Counsel Marshall Rudolph volunteered to help draft a letter to lure Mammoth Hospital into the discussion. “This is just an information gathering meeting,” he said. “It would have no impact on litigation.”
Southern Inyo Hospital’s Chief Restructuring Officer Alan Germany was the one positive response. His e-mail encouraged eliminating duplicative services, starting with administrative.
Germany also suggested involving his employer Health Care Conglomerate Associates in the process. HCCA has a management contract with SIH, a district that had its license pulled, lost its CEO and board. The hospital re-opened last February.
HCCA’s head Dr. Benny Benzeevi attended Monday’s meeting, supporting the concept of regionalization. “Efficiencies don’t help,” he said. “There are new programs available to help hospitals bridge the gap. But you have to know where to find and access them. You almost need a PhD in health care to navigate the terrain.”
Interestingly, Mono LAFCO’s Municipal Service Review and Sphere of Influence Recommendations report from 2009 strongly urged a regional approach to health care with Northern Inyo Hospital, citing a single administrative entity for healthcare in the Eastern Sierra.