SIHD Board and staff take questions at Measure J forum

By Deb Murphy

The Independence Civic Club hosted a forum on the Southern Inyo Healthcare District’s April ballot measure for a parcel tax. Two things were obvious: the district board has explored every avenue to resolve its bankruptcy and give the hospital a chance to survive. And, the atmosphere Monday evening was markedly different from the contentious meetings more than two years ago as the district was sliding out of financial control.

Since then, the district has survived two years of mismanagement with Healthcare Conglomerate Associates and appears to be on the right track under the management of new CEO Brian Cotter. The question for district voters: will the $215 parcel tax be enough to get the district to the point of sustainability?

Board member Dick Fedchenko brought the audience up to date on operations—the Skilled Nursing Facility is near capacity at 27, up from 15 when SIH was shut down in January 2016; all departments are near historic levels and the district receives $750,000 annually from the PRIME program through the rural healthcare clinic.

As for the bankruptcy process, the district filed its revised plan in mid-January. The judge opted to hold off until a May 30 hearing, after the election. The estimate on the scope of money owed ranges from $2 million for allowed claims to a potential $5 million. The difference depends on the outcome of future rulings on a loan through Optum, HCCA’s unpaid management fees and additional monies to a HCCA financial affiliate.

Measure J would levy a $215 tax on all parcels within the district, generating more than $602,000 a year until it sunsets in 15 years. The one new wrinkle: adjacent parcels could be combined to reduce the tax impact on the owner. The parcel tax was the only available vehicle to cover the cost of repaying debt.

If Measure J fails, Fedchenko anticipates the bankruptcy would be dismissed opening up the district for legal action by creditors and the strong possibility that creditors would go after the hospital’s collateral assets.

Additional information was provided during the course of the Q&A session.

Cotter responded to the question of the hospital’s chances of surviving once the bankruptcy is settled. His answer “there’s almost enough business to stay open.” The gaps right now are lower numbers at the clinic, a static potential for use of the Emergency Room and the SNF operating below its capacity of 33. The solutions: provide additional services through the clinic, continue to recruit staffing for the SNF to bring it up to capacity.

Cotter’s current focus is increasing the efficiency of the billing process. Right now, he explained, the income represents half of the billing—a pretty good ratio in the weird world of health care—up from less than 30-percent under HCCA. Once the revenue cycle is improved, the district can begin to provide additional services.

An additional source of income is Intergovernmental Transfers, another healthcare oddity involving the state matching funds from the district. According to Fedchenko, the district can “do a better job with IGTs” than HCCA.

Innovative approaches to health care, like free-standing ERs, are currently not available due to existing laws and regulations. According to Cotter, the free-standing concept would be an easier sell for rural hospitals. SIH is currently working with Ridgecrest and Northern Inyo Hospital to bring specialists to all three hospitals.

The rural health clinic requires the availability of an ER in order to stay open. In other words, the district can’t close the hospital and continue to provide care through the clinic.

District 5 Supervisor Matt Kingsley responded to the possibility of increasing income by adding to the district’s sales taxes, putting some of the burden on the tourist trade. The sales tax increase would have to be too high to have a real impact, Kingsley said. Another alternative the district could look at later is to increase the Transient Occupancy Tax, levied through area motels for a potential income between $50,000 and $200,000 annually.

Downgrading the hospital from an acute care facility to an urgent care facility would negatively impact reimbursements, according to Cotter.

The impact on the district’s ambulance services if the hospital closes would be significant with drive times doubling or tripling, according to board member and Lone Pine Volunteer Fire Department Chief Chuck Carson.

The district opted for a special election, April 10, rather than wait for the June primary election cycle. Fedchenko explained the judge in the district’s bankruptcy case has been patient, but the issues have to be resolved soon. “With the bankruptcy going on for two years, putting off until June or November just wasn’t viable,” he said.

 

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12 Responses to SIHD Board and staff take questions at Measure J forum

  1. Karen March 7, 2018 at 5:35 pm #

    Why doesn’t Southern Inyo Hospital employ a qualified accountant? Too much fraud in Inyo County.

     
  2. Lawrence Kraus March 8, 2018 at 8:31 am #

    After reading this article you would never know that there’s serious opposition to Measure J…or why those opposed thought as they did. That’s called biased reporting.

     
  3. Lawrence Kraus March 8, 2018 at 9:35 am #

    Measure J is a difficult and complex subject to cover. I thought of an analogy which will make it easier to understand.

    You own an older Mercedes Benz which you like but can’t afford. You have to borrow money to keep it running. Finally you reach the point where you can’t make the payments and your creditors take you to Court. You tell the Judge “I think I can get my relatives to help me pay so let me keep the Mercedes”. But your wife steps in and says “That won’t do. We’ll just force our relatives into bankruptcy a few years later. Let’s sell the Mercedes and buy a newer Toyota which will be almost as good and we can afford”. You reply “The Toyota is a beater. I don’t like it and the world will know we’re poor”.
    That’s where we are now.
    The Judge has several choices.
    He can say
    “Ok, keep the Mercedes but be sure you make the payments or you’ll lose it”
    or
    “Sell the Mercedes and buy the Toyota…but you still have to pay the creditors something”
    or
    “It’s too late for the Toyota. It’s the Mercedes or a beater to end all beaters”
    There is another option but its highly unlikely.
    You are allowed by the Court to keep the Mercedes if you make the payments…but…you later change your mind and sell it and buy the Toyota

    The owner is the Board, the wife is those opposed to J, the Court is the Court.

     
    • Watchedthewholething March 16, 2018 at 11:49 am #

      Lawrence please read the article and declaration from Hickman about the current state of the Hospital. Visit http://www.ourvalleyvoice.com

       
  4. John Rothgeb March 8, 2018 at 11:24 am #

    The SIHD Board has singularly focused on keeping the SIH open and the have put together the most optimistic numbers to show that the SIH could stay open if Measure J passes. The Board admitted that their financial analysis shows that the possibility of the SIH staying open without debt financing is marginal at best. There just aren’t enough people in the SIHD to support a hospital. The SIH is a dinosaur on life support. If you keep doing the same thing over and expect different results, you are crazy. I say: pay off the debt, start with a clean slate, and come up with a new plan in line with changes in rural heath care taking place across the country. We are lucky that we have a high speed fiber connection in the valley, many rural communities lack this necessity. “You need to have an urgent care facility linked by telemedicine to a larger medical center. That is your best hope.” This was the response from Dr. Emanuel in a recent email exchange. Please read his Feb 25, 2018 NY Times editorial “Are Hospitals Becoming Obsolete”.

     
  5. John Rothgeb March 8, 2018 at 12:20 pm #

    There just aren’t enough people in the SIHD to support a hospital. If you keep doing the same thing over and expect different results, you are crazy. I say: pay off the debt, start with a clean slate, and come up with a new plan in line with changes in rural heath care taking place across the country. We are lucky that we have a high speed fiber connection in the valley, many rural communities lack this necessity. “You need to have an urgent care facility linked by telemedicine to a larger medical center. That is your best hope.” This was the response from Dr. Emanuel in a recent email exchange. Please read his Feb 25, 2018 NY Times editorial “Are Hospitals Becoming Obsolete”.

     
  6. Kathy G March 8, 2018 at 1:47 pm #

    The Q&A format of this meeting provided little opportunity to evaluate the attitudes pro or con of those present. Is this the way the Board received the impression of an “overwhelming sentiment” in favor of keeping the Hospital open? A forum should afford the opportunity for debate, not just cherry-picked questions.

     
  7. John Rothgeb March 8, 2018 at 1:52 pm #

    The SIHD Board has singularly focused on keeping the hospital open, using the most optimistic numbers to show that it can survive if Measure J passes. Still, they admitted that the likelihood of keeping the hospital open without debt financing is marginal at best. Southern Inyo Hospital is a dinosaur on life support. If you keep doing the same thing over and over and expect different results, you are crazy. I say: If Measure J passes, pay off the debt, start with a clean slate, and come up with a new plan in line with changes in rural heath care taking place across the country. We are lucky to have a high speed fiberoptic connection in the valley; many rural communities lack this necessity. “You need to have an urgent care facility linked by telemedicine to a larger medical center. That is your best hope.” So wrote Dr. Ezekiel Emanuel in a recent email exchange. Please read his Feb 25, 2018 NY Times editorial, “Are Hospitals Becoming Obsole

     
  8. Beth March 8, 2018 at 2:10 pm #

    For years SIHD has had serious financial and management problems. It’s time to face the fact that the area does not have enough population to support a hospital. The debt that has been allowed to accumulate is unsustainable and, as interest accumulates, will never be re-payed. This proposed tax is a lien on every property owner in the district, many of whom are on a fixed income. Homes could be lost in the future due to nonpayment of property taxes. They will always be asking for more and for what??? A “hospital” that has had no patients in years??

     
  9. Sandy March 8, 2018 at 2:51 pm #

    Indeed, you would think SIHD would hire a qualified person to come in and clean up the billing office and perhaps train the billing office? Also, what about a professional (licensed medical) to audit charts with that? In 2009 they had outside people in there recovering money and working in the billing office. One understands the money was flying out of there as fast as it was coming in “a black hole” so to speak. No on measure J !!!!!!!!

     
  10. John Rothgeb March 8, 2018 at 4:08 pm #

    There just aren’t enough people in the SIHD to support a hospital. I say: pay off the debt, start with a clean slate, and come up with a new plan in line with changes in rural heath care taking place across the country. We are lucky that we have a high speed fiber connection in the valley, many rural communities lack this necessity. “You need to have an urgent care facility linked by telemedicine to a larger medical center. That is your best hope.” This was the response from Dr. Emanuel in a recent email exchange. Please read his Feb 25, 2018 NY Times editorial “Are Hospitals Becoming Obsolete”.

     
  11. John Rothgeb March 8, 2018 at 5:10 pm #

    There just aren’t enough people in the SIHD to support a hospital. I say: pay off the debt, start with a clean slate, and come up with a new plan in line with changes in rural heath care taking place across the country. We are lucky that we have a high speed fiber connection in the valley, many rural communities lack this necessity. “You need to have an urgent care facility linked by telemedicine to a larger medical center. That is your best hope.” This was the response from Dr. Emanuel in a recent email exchange.

     

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