Need a Hospice Plan

Certain patients in the hospital have no chance of recovery.  The medical team struggles mightily, but their health continues to deteriorate.  First one organ and then another starts to fail until nobody remembers what the patient was in for in the first place.  Now all they are is just a bunch of tubes, medicines, and procedures; making sure no mistakes are made in the regimen and hoping that they don't die on your watch becomes an end in itself.  At that point somebody might suggest a palliative care consult (it should have happened much sooner actually).  That meeting may go well if the patient's family understands the situation or it can go poorly with people accusing the medical team, other members of the family, and the insurance payor as just trying to kill off the beloved family member because that's more convenient/saves money/or they never really liked him/her.  Thing is, the patient dies eventually no matter how fiercely the family fights. 

Highlights from the Finance and Management Committee Packet for tomorrow (8/31) at 7:30 am:

1.  135,000 loss for the very first month despite the cost savings measures being pretty much fully implemented.  The District did this horribly despite successfully performing on the expense front favorably to budget.

2.  Only 250k drawn down on Bank of Alameda emergency line of credit, but no pay down on accounts payable.  In fact, accounts payable increased by over 350k.

3.  I like the presentation of fixed assets that breaks it down more.  Construction in progress in over 3 million dollars and the part of the number that is associated with the seismic retrofit is pretty much worthless in my opinion.

4.  The "cushion" on the 1:1 current ration is down to 930k.  This does not factor in any issue with possible CMS reduction in the IGT reimbursement.  Since the IGT reimbursement is still on the balance sheet, I assume that there has been some indication of when it will be paid finally so maybe there was no reduction after all.  (Also, no update on the SPA for the skilled nursing facilities, but I would be surprised if CMS does not approve it.  Luckily, the reduced compensation is build into the budget.  Unfortunately, the District is already missing its budget by 238k.)

5.  Mandatory stroke training in July negatively impacted the nursing budget in July.

6.  Cash is down to below 700k but there is 500k left on the emergency line of credit plus eventually the IGT funds will be returned so this seems manageable.

It is [fill in your favorite word for not taking care of business] for the Board to not direct management to create a contingency plan for winding down acute care operations.  Management should be recommending to the Board that they engage in that planning on their own initiative.

It seems that a reference to the old quote about the inevitability of taxes and death is the best way to end this entry.