It would be easy to get into a back and forth with people acting loathsomely, but fruitless.
The top things about the Hospital to keep in mind:
1. The Hospital is on tenuous legal ground. There was a January 1, 2002 deadline for certain seismic improvements that was never met. There has been no extension or waiver of that deadline. OSHPD has declined to enforce.
2. Care is subpar. What numbers are publicly available demonstrate this. I urge you to check them out. The difference between Alameda Hospital's stroke mortality and the currently stroke certified hospitals represents real lives. In general, volume = better quality in healthcare and Alameda is too small to generate enough volumes to provide anything other than subpar care.
3. The Hospital operates at a loss. Whether the level of that loss is above or below the parcel tax subsidy varies, but it loses money every month.
4. The Hospital cannot get financing for the state mandated improvements because of its financial position. In addition, the ability of the Hospital to finance any new service (such as wound care) or care initiative (such as PACS) is hampered by the terrible financial position.
So look past my personal issue with some people, who by their actions seem to me to be detestable, and examine whether the Hospital is accomplishing its mission since Alamedans are the owners of the Hospital and each parcel pays $298 per year to keep the doors open.
If I'm understanding the numbers correctly, and for strokes, Alta Bates hospital is around 8% mortality while Alameda is in double-digits, almost 13%. 8% seems to be the average best across hospitals with stroke centers? What's interesting about this, is Alameda Hospital reports 58 stroke victims for 2009. The projected cost/benefit of a stroke center at Alameda hospital, given a volume of 58 CVAs per year, must be abysmal. The other stroke centers---Alta Bates and Kaiser---have 300+ CVAs per year. Eden, in 2009, is in the 200s; and with their recent (August 2010) primary stroke center certification, that number will rise. So what about the strategy to become a stroke center makes sense?
ReplyDeleteStroke centers have to meet certain minimum requirements. They must monitor and maintain certain reporting parameters. In addition, they are the admitting hospital sets the course for recovery going forward which, for any stroke victim, is a process rather than a well-defined event. Stroke centers do a good job of making sure that the process gets off to a good start. So, all things being equal, it's a good thing that Alameda Hospital become a stroke center. But there's the rub, all things are not equal. For whatever reason (probably size and services) Alameda has a higher mortality rate. Also, these programs cost money and there are economies of scale both in terms of quality and cost. I was, unfortunately, not able to appropriately articulate my view that the trade-off here favors foregoing stroke certification at the Hospital. The County subscribes to the opposite view and wants every hospital to seek and obtain stroke certification. That does give me some comfort because I trust the County medical offices much more than anyone at Alameda Hospital and my exchanges with them have been logically, instead of emotionally, based. We have discussed data and not anecdotes. I remain unconvinced, but the conversation, at least, has been more illuminating then the ridiculous spectacle at the 1/10 meeting.
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