11/2 Board Meeting (Actually the Water's Edge Public Forum)

Just some odds and ends:

1.  AB97 cuts for distinct part SNF's were approved.  The rate cut chart is here.  The sub-acute rates for distinct part were not cut due to a shortage in beds.  The impact on the District's finances will be substantial - somewhere around 1.5 million dollars or more (I believe it is more) positive.  I think one way to calculate it is to go to here and compare the difference between the 08/09 reimbursement rate and the most current reimbursement rate.  The District has somewhere between 900 and 1000 sub-acute days per month and it looks like the difference is around $725 vs. about $875 so about $150 per day.    This makes the first three month loss out to be somewhere between 150k and 250k which is quite an improvement from the $585k in the current financial report through September.  This will be updated for the 11/7 Board meeting.

2.  The South Shore facility was originally estimated to contribute 800k per year to the bottom line.  A comparison between that number and the actuals may be available for the next Board meeting.

3.  Mr. Zimmerman of Waters Edge wants a partnership to continue operation of Water's Edge.  He sees this as an opportunity to do estate planning and make sure that the facility stays locally operated.  One glitch is that he was not prepared to allow that the Board can exit the deal by exercising the "escape clause" with an exit from acute care services.  It is clear that he does not envision that this will happen, but I believe that it is clearly a possibility especially over a 20 year period.  He was NOT willing to say that such an event would trigger this "escape clause".  He felt that discussion was too speculative to commit to allowing the Board to exit the deal in that fashion.  Debi Stebbins wants to insist that she is being unfairly maligned, but this is exactly what I feared and if that cannot be part of the deal then the District is potentially liable for the entire 20,000,000 of lease payments.

4.  Both Stebbins and Battani talked about using this deal so that the District would be "less reliant on the parcel tax."  That suggests that without the parcel tax, the District loses money, but that with the assistance of the parcel tax, the Hospital stays open.  The truth is without additional revenue, the parcel tax is not enough to allow the District to continue to operate the Hospital.  In addition, the Waters Edge project has to meet the numbers in the pro forma's or it might not be enough to save the Hospital.

5.  Stebbins does not want an urgent care center in Alameda.  As best I can recall, the statement went, "That is so nineties; read the literature.  Why would we want to open an urgent care center when we have a fully staffed emergency room available for people to use?"  My answer was that there was a difference in cost for people, but I confess, I do not have the literature.  I do know at Kaiser, there is a separate clinic that triage will divert patients to at the ER that looks, to me, a lot like an urgent care center.  I also know that many Alameda residents I have spoken with want to keep the Alameda Hospital ER open for urgent care issues, but are not interested in being admitted to Alameda Hospital for acute care.  So I don't know if that makes Stebbins right and me wrong or vice-versa, but clearly these Alamedans would be just as satisfied with an urgent care center and clearly they value the Hospital's ER because it can offer those services.  I will point out that the tremendously successful Washington Hospital runs an urgent care (and an ER as well)