Did not review the finance committee meeting on the blog even though I reviewed the material. The most interesting information is the February financials (which were poor) and the projections for the remainder of the year. The 1206(b) clinic review was hard for me to evaluate, but I don't know if that report will be brought forward to the Board meeting.
Check back Friday evening or Saturday morning for a review of the actual agenda and materials.
Thursday, March 31, 2011
Sunday, March 13, 2011
3/9 Board Meeting
Technical difficulties prevented audio or video recording so until the notes are available, this is the only record of the proceedings. It would behoove anyone trying to make sense of these notes (or the Hospital in general) to read the accompanying material available at the District's website.
1. The Board meeting begins at 6:00 pm with the closed session. I wish the trade secrets agenda items released to the public were more informative. I think considerably more descriptive titles (rather than the same caption always used) could be provided without compromising any interests of the District. I think that the spirit (and to a certain extent the letter) of the law calls for additional disclosure.
2. Consent calendar was somewhat lengthy. Most of the items were from the Finance Committee meeting. I asked that items 3, 4, and 9 related to the Wound Care program be pulled from the consent agenda so I could register a "nay" vote. Jaber funds will be used for upgrading and standardizing the defibrillators throughout the Hospital. Let someone at the Hospital know if you are in the market for a used defibrillator. These are not AEDs which, surprisingly, you can purchase on Ebay if you are so inclined.
3. The Wound Care program documents are all available on the website. Bottom line, in the first year of operation, the wound care program is expected to generate about 375k in net revenue to the hospital directly with another 335k in incremental ancillary net revenue from outpatient and inpatient services. So the total is just over 700 thousand projected. I imagine that these totals are optimistic, but not unreasonable. (In fairness, management describes them as conservative.) A point of comparison will be review of the 1206(b) clinic at the next Finance Committee looking at projected vs. actual results.
Since the numbers above do not begin to address the 5.7 million dollar subsidy that Alamedans provide the Hospital, I voted against the program. I think a plan to address seismic retrofitting and, additionally, a justification of the cost of the subsidy relative to benefit to the District must first be articulated.
Also, the DSCR covenants (debt service coverage ratio) in the wound care loan documents seem risky to me. Although due to extraordinary income, this year may see the Hospital in the black, that is extraordinary income (and may or may not apply to calculation of DSCR) and is a one time benefit. Based on a quick, back of the envelope calculation, there is a good chance (> 50%) that the hospital will not meet the required DSCR 1.00:1.00 for 7/1/11 to 9/30/11. This assumes a debt service of about 50k per month (10k interest + 40k principal which does not include PACS yet I think). The Bank of America master lease would probably double that if it's not included yet. Add another 10-15k for the wound care borrowing and I just don't see the District meeting even a 1.00:1.00 covenant (multiply these numbers by 3 for the quarterly totals). I realize that Bank of Alameda is a friendly lender and I appreciate the LOC that they provide (which I voted for as part of the consent calendar), but I could not support this.
The vote was 4-1 in favor.
4. The Hospital is implementing an EHR. To management's credit, an reevaluation of the COW purchase (Computer On Wheels) is going to save 20,000 by going with a lower cost vendor. Also, the Hospital is taking a reasonable incremental approach starting with 3 (purchased with discretionary funds from the CEO) then expanding to additional units based on Board approval for initial implementation in the ER. The first units should arrive by 3/23. These will be evaluated to see if actual use meets the expectations before additional units are purchased for the remainder of the Hospital.
5. In the President's report, Jordan Battani indicated that the compensation survey results readout may require a special meeting. I expect to be unhappy regarding the results because I think they have serious methodological problems and an inherent bias. Jordan also announced that she will be participating in the leading Alameda citizen's interview panel for the city manager position. Good luck to her, I don't know how much tolerance I would have for that kind of kabuki.
6. a.CEO Stebbins reviewed the FYE 2011 strategic goals and objectives. As you would expect, she struck a positive note. I am not sure who will be participating, but April 6 is legislative day for the California Hospital Association . Obviously the IGT funds, Medi-Cal reimbursement, and seismic retrofitting are all big issues for the District. There is 37,000 grant approved from the County for stroke education.
b. Monthly statistics for February down so probably a loss for that month given the status of IGT funds. Cash management will be very important going forward. First part of March very busy with possibly a late flu not covered by the vaccine hitting (reports lag by several weeks).
c/d. Hospital Updates/Events -The stroke screening is ongoing. Possibility of adding a 94502 location near the end will be explored. Stroke certification is nearing the point at which the application for an inspection date can be made. Training of personnel sounded like the major delay with this part to complete in March.
7. Finance and Management - Clinic update will be next meeting. I requested a timeline of budget process for 2011/2012 be provided for new Board members. The process is beginning already since there is only 3 full months and associated Board and Committee meetings left to this year.
8. Community Relations - Failed to meet a quorum. Please let Stewart Chen know if you would be interested in joining. Stewart is thinking about inviting major Foundation donors to join, but I am sure applications from any member of the community will be accepted. (I am not sure how to finesse it if you want to serve, but are a critic of the Hospital as I am, but it might be worth it to at least inquire.)
9. Medical Staff report - I failed to note anything remarkable except that the time was relatively early for this part (usually near the end) of the agenda.
10. And that was it. Any corrections or clarifications, please let me know.
(Not really something I want to emphasize, so I will sneak it in here. The Board of Pharmacy sent me a letter about two weeks ago letting me know that they would be taking no action with regard to the libelous charges - my characterization, not theirs - that Leah Williams made regarding the November election. That is a relief for me, of course. )
1. The Board meeting begins at 6:00 pm with the closed session. I wish the trade secrets agenda items released to the public were more informative. I think considerably more descriptive titles (rather than the same caption always used) could be provided without compromising any interests of the District. I think that the spirit (and to a certain extent the letter) of the law calls for additional disclosure.
2. Consent calendar was somewhat lengthy. Most of the items were from the Finance Committee meeting. I asked that items 3, 4, and 9 related to the Wound Care program be pulled from the consent agenda so I could register a "nay" vote. Jaber funds will be used for upgrading and standardizing the defibrillators throughout the Hospital. Let someone at the Hospital know if you are in the market for a used defibrillator. These are not AEDs which, surprisingly, you can purchase on Ebay if you are so inclined.
3. The Wound Care program documents are all available on the website. Bottom line, in the first year of operation, the wound care program is expected to generate about 375k in net revenue to the hospital directly with another 335k in incremental ancillary net revenue from outpatient and inpatient services. So the total is just over 700 thousand projected. I imagine that these totals are optimistic, but not unreasonable. (In fairness, management describes them as conservative.) A point of comparison will be review of the 1206(b) clinic at the next Finance Committee looking at projected vs. actual results.
Since the numbers above do not begin to address the 5.7 million dollar subsidy that Alamedans provide the Hospital, I voted against the program. I think a plan to address seismic retrofitting and, additionally, a justification of the cost of the subsidy relative to benefit to the District must first be articulated.
Also, the DSCR covenants (debt service coverage ratio) in the wound care loan documents seem risky to me. Although due to extraordinary income, this year may see the Hospital in the black, that is extraordinary income (and may or may not apply to calculation of DSCR) and is a one time benefit. Based on a quick, back of the envelope calculation, there is a good chance (> 50%) that the hospital will not meet the required DSCR 1.00:1.00 for 7/1/11 to 9/30/11. This assumes a debt service of about 50k per month (10k interest + 40k principal which does not include PACS yet I think). The Bank of America master lease would probably double that if it's not included yet. Add another 10-15k for the wound care borrowing and I just don't see the District meeting even a 1.00:1.00 covenant (multiply these numbers by 3 for the quarterly totals). I realize that Bank of Alameda is a friendly lender and I appreciate the LOC that they provide (which I voted for as part of the consent calendar), but I could not support this.
The vote was 4-1 in favor.
4. The Hospital is implementing an EHR. To management's credit, an reevaluation of the COW purchase (Computer On Wheels) is going to save 20,000 by going with a lower cost vendor. Also, the Hospital is taking a reasonable incremental approach starting with 3 (purchased with discretionary funds from the CEO) then expanding to additional units based on Board approval for initial implementation in the ER. The first units should arrive by 3/23. These will be evaluated to see if actual use meets the expectations before additional units are purchased for the remainder of the Hospital.
5. In the President's report, Jordan Battani indicated that the compensation survey results readout may require a special meeting. I expect to be unhappy regarding the results because I think they have serious methodological problems and an inherent bias. Jordan also announced that she will be participating in the leading Alameda citizen's interview panel for the city manager position. Good luck to her, I don't know how much tolerance I would have for that kind of kabuki.
6. a.CEO Stebbins reviewed the FYE 2011 strategic goals and objectives. As you would expect, she struck a positive note. I am not sure who will be participating, but April 6 is legislative day for the California Hospital Association . Obviously the IGT funds, Medi-Cal reimbursement, and seismic retrofitting are all big issues for the District. There is 37,000 grant approved from the County for stroke education.
b. Monthly statistics for February down so probably a loss for that month given the status of IGT funds. Cash management will be very important going forward. First part of March very busy with possibly a late flu not covered by the vaccine hitting (reports lag by several weeks).
c/d. Hospital Updates/Events -The stroke screening is ongoing. Possibility of adding a 94502 location near the end will be explored. Stroke certification is nearing the point at which the application for an inspection date can be made. Training of personnel sounded like the major delay with this part to complete in March.
7. Finance and Management - Clinic update will be next meeting. I requested a timeline of budget process for 2011/2012 be provided for new Board members. The process is beginning already since there is only 3 full months and associated Board and Committee meetings left to this year.
8. Community Relations - Failed to meet a quorum. Please let Stewart Chen know if you would be interested in joining. Stewart is thinking about inviting major Foundation donors to join, but I am sure applications from any member of the community will be accepted. (I am not sure how to finesse it if you want to serve, but are a critic of the Hospital as I am, but it might be worth it to at least inquire.)
9. Medical Staff report - I failed to note anything remarkable except that the time was relatively early for this part (usually near the end) of the agenda.
10. And that was it. Any corrections or clarifications, please let me know.
(Not really something I want to emphasize, so I will sneak it in here. The Board of Pharmacy sent me a letter about two weeks ago letting me know that they would be taking no action with regard to the libelous charges - my characterization, not theirs - that Leah Williams made regarding the November election. That is a relief for me, of course. )
Wednesday, March 2, 2011
3/7 Board Meeting Cancelled
This meeting should be rescheduled relatively quickly. The meat of the next Board meeting will likely be the issues discussed at the last Finance Committee meeting (wound care clinic, financials, purchase contracts) which I attended to get the details.
Also, I want to say that I attended the 2/28 Employee Recognition Reception. Unfortunately, I had to leave early, but it was nice to see an organization recognizing employees like that. To some it may seem that my critique of the Hospital is aimed at the people who work there. I am certain that there are less than stellar people at the Hospital, but I am also certain that it has its fair share (or more than its fair share) of outstanding employees. The problems at the Hospital are institutional and systemic rather than individual and performance related.
Anyway, congratulations to all who were recognized and especially to Diane Pasquini with 45 years of service who has been a nurse since 1965! If I'm not mistaken, several wings of the existing hospital did not exist when she started.
Also, I want to say that I attended the 2/28 Employee Recognition Reception. Unfortunately, I had to leave early, but it was nice to see an organization recognizing employees like that. To some it may seem that my critique of the Hospital is aimed at the people who work there. I am certain that there are less than stellar people at the Hospital, but I am also certain that it has its fair share (or more than its fair share) of outstanding employees. The problems at the Hospital are institutional and systemic rather than individual and performance related.
Anyway, congratulations to all who were recognized and especially to Diane Pasquini with 45 years of service who has been a nurse since 1965! If I'm not mistaken, several wings of the existing hospital did not exist when she started.
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