1/9/2012 Board Meeting

1.  Nothing to really report regarding the enormous loss in November.  It may or may not be an accounting glitch.  At the next Finance meeting a presentation on revenue recognition and the calculation of reimbursement rates will be made.  What is clear is that something is going on that Management needs to investigate.  If you look at pages 35-37 of the Board packet, there are several inconsistencies that just jump right out.
a.  The combined acute care MCal reimbursement is listed as 2.8% of gross charges.  MCal may be a lousy payer, but that seems unlikely.
b.  This MCal number becomes even more confusing when the inpatient acute reimbursement is 10.5% and the outpatient is 4.1%.  Clearly, the combined being lower than the individual elements is a mistake or something that needs further explanation.
c.  On page 37, the 0.0% reimbursement rates listed for MCal/HMO are incorrect or need further explanation.
d.  If you add up the inpatient monthly mix of payers for inpatient SNF on page 37, the number is less than 100%.
e.  If you add up the mix for inpatient SNF for YTD payer mix then the number is over 100%. 

Clearly these graphs are not able to be used in this form to analyze what is going on.  Hopefully, next month will yield explanations for November AND better reporting.

2.  The month of December may or may not be good enough to bring the current asset ratio to greater than 1..0.  The 12/31/11 balance sheet is a test point for the Bank of Alameda loans.  Kerry Easthope had discussions with the Bank of Alameda regarding this and will be in contact with them as soon as December closes (which I believe is happening this week on an accelerated basis).  At that point, discussion as to what may happen will be easier with a clear understanding of what the financials are.  It seems unlikely that December results could yield a current ratio > 1.0 since that would require net income of over a quarter of a million dollars.  If the current ratio is indeed >1.0, then it is likely because the November unaudited results are grossly wrong.  I am pretty sure that is what management is hoping for.

(As an aside, it is a dangerous situation when your best hope of averting a crisis is that your financial reporting is so messed up that you have a hundreds of thousands of dollars variance between your actual results and reported results that you cannot identify immediately!)

3.  New guidelines were adopted for self pay and community care on the consent agenda.  Some may think that the discounts offered cash customers are overly generous.  My belief is that they are not generous enough.  When no commerical or government payer is ever charged anywhere close to 100% of gross, I think it is fundamentally unfair to bill 100% of gross to ANYONE regardless of their ability to pay.

4.  Rossi Builders was the low bidder for construction of the Wound Care Center.  Award of contract will depend on financing.

5.  Board officers are the same as last year.

6.  I was appointed to the Finance Committee replacing Director Deutsch.   Director Battani was appointed to Quality replacing me.  All other assignments remain unchanged from last year.

7.  ACHD Standing committees are part of a reorganization of the ACHD.  This is the trade organization for California Health Districts.  Originally we were going to stop being members, but it turns out that their workman’s compensation fund is the best deal available and membership is required to participate.  I believe I will be applying and it sounds like other Board members may also be interested in volunteering.

8.  In the CEO report, there is now a preliminary written version in the packet which I compliment Ms Stebbins on providing.  I was surprised on the relatively low number for last year’s IGT and this year’s.  I requested that Management check that the monthly accruals are matching up with the actual, final number.

9.  Apparently the Hospital has been busy in the first week of 2012.  I don’t believe, based on past experience, that any conclusion can be drawn from that.

10.  There was some analysis from Management of 2 Board referrals from December.  Also, I pointed out that a practice that the District has been following already is now law.  According to AB1344, if an agency maintains a website, then public notices must be posted simultaneously with any paper copies in order to meet Brown Act requirements.

11.  The wound care center is going along.  The next big step is award of contract (pending financing).  The Waters Edge transition is also moving forward.  Of course I was staunchly opposed to this initiative and the November results with the attendant uncertainty surrounding them hardly make me more comfortable with this project.  I still feel like the District is going to end up holding a mult-million dollar bag.

Thank you Irene Dieter for attending and commenting.  I wish more Alamedans took an interest. 

About egorelick

Gadfly. Former City of Alameda Healthcare District Board member.
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