Nothing Will Change

“They were careless people, Tom and Daisy- they smashed up things and creatures and then retreated back into their money or their vast carelessness or whatever it was that kept them together, and let other people clean up the mess they had made.”

No posts because nothing really changes.   Consistently wrong is the mantra of the Board and Management.  Political connections trumps facts.  Perception trumps reality.  The Hospital will just go on losing money and killing people no matter how many predictions of profitability prove false or no matter how many fines, surveys, or statistics suggest that people would be better off receiving their care elsewhere.

 

 

2/6 – Choosing a New Board Member UPDATE: CHOSEN + Embarassingly wrong about City Council

We will be interviewing and voting tonight (after an abrupt cancellation of the 1/28 special meeting).  I fully expect we will be able to come to an agreement.  As to the assertion that the City Council would choose if there was some kind of deadlock (Lauren Do’s blog); well, as with most things she writes about the Hospital, she is wrong (as far as I know and I have studied the governing laws and documents more thoroughly than she I would guess).

UPDATE:  Indeed the City Council is responsible if 60 days go by without the vacancy being filled whether due to gridlock or any other reason.  Apologies to Lauren Do.

Congratulations to Tracy Jensen the newest Board Trustee.

Happy New Year (Post more resolution edition)

Random notes:

1.  From the Board meeting:

a.  The process of referring an item to the agenda for Board consideration was clarifies although I found the earlier dual process without conflict.  The basic outline is more formal than I desire, but still preserves the prerogative of 2 Board members to add an item that the Board President opposes.

b.  The District lost only $18000 last month.  The accrual reversal was 96,000 so, without that reversal, the loss would have been about what I had previously estimated.  113,000 remains of accruals that could be reversed at Management’s discretion.

c.  The District appears to have had a strong November.  I am skeptical that this will mean a positive bottom line although it is certainly possible – it’s only one month.  Clearly the Water’s Edge acquisition offers a positive contribution, but since it comes with multiple albatrosses, not the least of which, is a requirement to keep the acute care hospital open (or it loses the “distinct part” benefit), it was the wrong direction to go.

2.  The Ninth Circuit lifted the AB97 injunction which I had anticipated to be more likely than not.  The District reserve quite a bit for this circumstance (based on what the auditor reported).  Management will report at the next Board meeting how much additional has to be reserved for this change.  The California legislature is now controlled by Democrats with a super-majority so maybe legislative relief is possible – ask Rob Bonta.

3.  The application process for the Board seat vacated by Stewart Chen is ongoing.  Thursday, January 3 is the last day to apply so, if you were considering it, you may have to scramble.  Unfortunately, there is little chance that the Board majority would allow someone with the idea of closing the Hospital on, but perhaps you enjoy quixotic efforts.   Several times I have referred to the previous application process where the odious Williams was chosen where it was ridiculously obvious that she was the designated choice.   Unless you have been solicited to apply by one of the Board majority, don’t count on having a chance of actually serving.

Nov. 7 Review of Board Meeting

1.  Minutes from last month approved.  The open session was less than 1/2 hour long.  I don’t think that’s a good thing.  Perhaps I can nitpick, but fine toothed combs are preferable to rubber stamps when you have to delouse something.

2/3 Consent for changes to the pension plan and the SEIU-UHW West MOU.

4.  The Alameda Hospital Foundation is designated as the sole fundraising/charitable donation vehicle for the District.  The Foundation, just like the rest of the Board, is way too Hospital centric, but after a minor change to the MOU, the vote to approve was unanimous.

5.  September 2012 financials.  What can you say?  Management is always upbeat even when losing tens/hundreds of thousands of dollars.  The loss this month was 190k.  This does not bode well for the year.  The total loss so far this year is 672,229.  We can take a guess as to whether October will turn around this trend. 

First, add back in the Accucare fee of 16,000 and add another 14,000 just to be generous so that Wound Care in October would help make that number a loss of 160k.

Second, let’s add in the additional net census for Waters Edge + subacute (simplifying things here).  That works out to about 4.  We will assume that adds 50k to the bottom line by multiplying $400/day X 31 and assuming no net increase in expense (rounding up).  The loss is now at 110k.

Third, the acute care census was down but the case mix index was up.  Also surgeries were up so I will just assume that the September to October delta of dollars of this segment is flat.

Overall, the District still faces a deficit of 110k for October is my best guess.  The Orthopedic program opened October 22 and almost certainly lost money for that initial time period.  We can safely assume that October will be a negative result. 

We can furthermore assume that there is, at most, another 50k of monthly margin that can be squeezed out of Waters Edge and maybe another 20k out of the wound care.  This would still mean a baseline loss per month of 40k (and I think I am being somewhat optimistic here).  I think it would be unlikely for the new surgeons to hit their stride prior to January 1 with the holidays coming up.  So let’s assume that the cumulative loss as of December 31 is 670k (1st quarter) + 110k (October) + 80k (November + December).  That is a total of 860 thousand.  The Bank of Alameda is not going to be very happy about that unless the Orthopedic program is starting to show signs of generating large amounts of cash; it would have to generate over 210 thousand a month for the District to generate $1 of net income for the year.  I don’t recall the budget numbers for the ortho program, but that sounds high to me. 

So 2012/2013 is like every other year, unless a miracle occurs, the District loses money over and above the subsidy provided by the parcel tax.  And let’s not forget the non-economic cost the District incurs in the form of poor health outcomes.

6.  2011/2012 fiscal year audit.  The auditor would have to be hit over the head with a hammer to give anything but a “clear” opinion.  They know who butters their bread.  The major change was after a series of minor adjustments which made little difference in net income, grants and donations were reclassified to an income statement account rather than being driven directly to the balance sheet.  This made the loss less for the year, but did not change the underlying numbers or dynamic.

7.  Metrics plan was approved.  I think there may be some small chance of the participants getting the 25% for the seismic part of this plan, but I don’t see much chance of them reaching the thresholds for the other pieces.

8.  Election results remain the same as the previous post.  There will be an appointed Board seat available shortly. 

9-xx.  Not much more interesting to report.  Board packet and video available on the web.

 

Random thoughts on the election and other stuff

1.  THANK YOU Leland Traiman for running.  It’s not easy to openly express an unpopular view.  And I will reiterate, “Because besides the fact that the District spends 5.7 million dollars of Alamedan’s (should be “Alamedans’ — embarassed that Heather Wood had to add a “sic” to that over at the The Alamedan) tax money every year (plus losses that erode the balance sheet); the Hospital ends up causing death and illness that would not occur if we closed it down.

2.  To people who dispute the above statement on the basis that I can’t possibly know that care at Alameda Hospital results in poorer outcomes, I point you to all those who were willing to attack Nate Silver for having the temerity to suggest that Obama would win the election.  You may not believe you are in synch with Karl Rove, but, in this small (?) way, you are very much related.
3.  XKCD has the best take on Nate Silver’s and Sam Wang’s war with the pundits:  MATH.

4.  Thank you Tracy Jensen for running.  It’s not clear to me why you ran, but, if it was to take a seat in case Stewart Chen moved to the City Council then I would say your relatively strong showing puts you in the lead for that seat should you apply.

5.  Congratulations to Stewart Chen who appears to be likely to move to the City Council taking the seat that is likely to be vacated by Rob Bonta of good resume, friendly demeanor, and good looks.

6.  Congratulations to Rob Bonta.  I didn’t vote for you because of your District Board service, but I think you are definitely worthy of the State Assembly.  I think you will do a fine job and my vote was a close call.  Take a stand once in a while.  Stand up to your backers or the conventional wisdom.  Don’t always take the easy route; I don’t think Cesar Chavez was trying to win any popularity contests.  Combine all the assets you have especially your gentle nature, your intelligence, your good looks with some courage and you will not only go far (which seems predestined), but you will have something to show for it.

7.    Congratulations to Jordan Battani and Michael McCormick.   Could someone explain the 3000 vote difference in you tallies?  I certainly know that you are different people who don’t always think alike, but I saw nothing in your campaigns that would distinguish you two to that degree.  Maybe your ballot statements?

8.  Thank your favorite higher power that Mary Hayashi went down to defeat.  Having a convicted thief replace an addict on the Alameda County Board of Supervisors would have been shameful.

9.  Disappointed that Swalwell defeated Pete Stark, the only atheist in Congress.  Yes, Pete was the lesser of two evils and should have stepped aside this cycle, but now I fear that we will be stuck with the slimy Swalwell for multiple terms.  Of course, I was proud to cast my vote for Barbara Lee.

10.  I’m happy that Obama won a second term and that the Senate was retained for the Democrats, but I expected that result.

11.  I am THRILLED that the State Assembly and State Senate have supermajorities.  Please don’t give away the store to the prison guards.  Please do raise taxes.  Please fund higher education, healthcare for all, schools, environmental regulation, etc., etc.

Enough.  Board Meeting tonight.  I will try to get back to regular summaries, but no promises.  Come visit us if you plan on applying for the open seat.

 

The 47% really annoy me? (navel gazing)

I’m talking about the people who are going to vote for Mitt Romney.  How can they tolerate a liar who will just tell them what they want to hear?  But that’s the mystery I face at every Board meeting when I face 4 people all who I believe are “nicer” than me in the conventional sense and certainly claim to believe in civility more than I do (although there is that nasty words vs. deeds conflict).

Because besides the fact that the District spends 5.7 million dollars of Alamedan’s tax money every year (plus losses that erode the balance sheet); the Hospital ends up causing death and illness that would not occur if we closed it down.

This is especially galling to me, someone who believes government has a positive role to play and should be the primary provider of basic needs.  (YES MITT, I believe those 47% have it exactly right when they think they are entitled to things like healthcare, education, subsistence food and shelter needs, etc.  100% are entitled to that, at a minimum, whether they pay taxes or not.)  When government wastes money, I don’t see it as a reason to shut government down because there is waste everywhere.  But we shouldn’t turn a blind eye to waste especially when it is hurting people and our civic leaders should not be BS’ing people about safety or financial responsibility.

“Nationally recognized experts” for one should be offering truth and leadership and not myths and conventional wisdom.  That’s what is so disappointing to me; that people who at least pay lip service to the same philosophy of government I believe in are willing to lie in order to protect the status quo.  I expect that of Republicans (whether they call themselves Tea Partiers, Liberterians, or traditional GOP), but I hope for better from Democrats.
P.S.  To end on a positive note, the Alameda Community Health Fair is this weekend and well worth it.  (Just don’t get your follow-up care at the Hospital if it involves any acute services.)

Transport Time Overrated in Public’s Mind

Everything I know about public health leads me to the conclusion that the existence of Alameda Hospital causes harms to Alamedans.  One of the candidates for Director wants to emphasize how close the Alameda Hospital ER is (although I think he uses the wrong numbers and the actual difference is less than 10 minutes and more likely an average around 5 to 8 minutes).

Nonetheless, I thought that perhaps this was just my bias against the Hospital so I went to PubMed and did a search on “transport”, “time”, and “mortality”.    1451 articles came up many of them having nothing to do with the subject I was interested in.  All of the ones that appeared to be relevant concluded that within a narrow range, that transport to resource rich hospitals bypassing local community hospitals either made no difference or resulted in better outcomes.  The one article abstract that said it best was on trauma (and, to be fair, EMS protocol, I believe already dictates that trauma patients NOT go to Alameda Hospital).  “Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer’s effect on mortality,” states in its conclusion, “Triaging severely injured patients to hospitals that are incapable of providing definitive care is associated with increased mortality.”  Without getting into specific details of all the studies (Lauren Do can go try to cherry pick or misunderstand those irrelevant, not-really-a-study sources available that contradicts the overwhelming evidence, but I’ll refrain from debating her.), the conclusion I come to is:

1.  Reducing transport time has a powerful conventional wisdom logic to it that is pretty much contradicted by the actual evidence.

2.  In most cases, the determinative timing factors are initial call to EMS (witnessed events), beginning of BLS (AEF’s, bystander assistance), and the start of ACLS (the arrival of the ambulance).  Again, transport time is a non-factor in the ranges we are talking about.

3.  Bypassing the local hospital for a more resourced, higher level of care alternative leads to better outcomes.

4.  Stops at local hospitals caused delay in treatment, introduced error, and resulted in increased mortality.

The results appear to be generalizable with specific studies showing this general result for cardio and trauma.

Now I don’t know whether this is related and demographics vary greatly but here are available the latest raw mortality numbers for each hospital in California.  The % for the latest period reported (7/1/11 to 12/31/11) is 3.7% for Alameda Hospital which seems considerably higher than other facilities in Alameda County that I spot-checked.