This is Uncivil?

I had some questions about the financial packets.  I just fired them off to the person I thought could best answer them.  The message below was viewed far and wide by Hospital staff as being rude and belittling.  If that is the case, then I need to recalibrate because although I would say it was short and direct, it was not meant to be rude or belittling, I was just trying to understand the fortunate turnaround in the trajectory of the Hospital’s income.  I can see some umbrage about the survival question, but since I am fiercely interested in public health policy and a hot topic of debate in that arena is the cost of futile end-of-life care, I just added it on  because I was curious and not with any agenda or underlying attitude.

So it looked like ICU days in those two months totaled somewhere around 100 days over budget.  Is that correct?  What was the contribution of those to the good results in those two months?  What is the unit contribution margin of an ICU day?  Is there any chance that the 3rd party payers (I assume that these were not private pay) may challenge the medical necessity of the ICU days or is that unheard of?  Qualitatively are we looking at a general surge in ICU usage or one or two patients who had extraordinarily long stays?  If it is the latter, I guess I have to ask if they survived?  How much variance, in general, is there in the ADC in the ICU.  Is this two month period the best (worst?) ADC for the ICU vs. budget in the last year, the last 5 years, the last 10 years?



About egorelick

Gadfly. Former City of Alameda Healthcare District Board member.
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1 Response to This is Uncivil?

  1. notoz says:

    Huh? <<< that has become my mantra of late. Your questions are fact-finding, that's all. There's nothing personal there at all. Given the unexpected aberrance in the ICU (100 days over budget), it's particularly important to find out why. The facts you ask for are normal types of facts--financial performance and quality of service--that those responsible for any unit or program should be aware of and able to provide to the Alameda Healthcare District Board. One would think those in charge of the ICU would be interested in being apprised of the answers in order best understand and manage their unit. Why would inquiring about these facts be cause for concern? Moreover, why would they be cause for an emotional reaction? Last week, a friend phoned me from the Alameda emergency department, asking for my help. She'd had what appeared to be a stroke, the ER doctor wanted to keep her overnight at Alameda Hospital but she asked to be transferred to a stroke center. Her request elicited inappropriate emotional (hostile) responses from the doctor which then put the nurses into an uncomfortable, even defensive, mode. Huh? Because my friend phoned me after 4 hours at the ER and asked for my help to getting the medical choices she felt she preferred but felt helpless to secure, I'll write about this experience soon on my blog (

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