Dave Emery, LWV Observer
Reports
1. Staff reported on a new delivery and fetal monitoring system. The system records observations from both the mother and the fetus. Information on up to four simultaneous deliveries is displayed at the nurse’s station, allowing more efficient use of nursing time. Information on a specific patient can be accessed by the attending physician from either home or office; a feature much appreciated by physicians. The record for each delivery is stored electronically, and requires less administrative input than the old system. These systems are common in large hospitals, but unusual for a hospital of Northfield’s size.
2. The CFO reported on Northfield Hospital’s compliance with the Attorney General’s Agreement. AGs around the US negotiated agreements with the hospitals in their states pertaining to discounts for patients without health insurance and the provision of uncompensated care. An uninsured patient in MN receives a 34% discount on a hospital bill, which is the discount received by Blue Cross of MN, and then may fall in one of three categories for paying the bill. (This is my interpretation of the report. It may not be accurate.)
a) Charity care: patient denied Medicaid coverage and family income less than 200% of federal poverty guidelines. $259,000 of charity care provided in 2009
b) Private pay: uninsured patients who are cooperating with the hospital to pay their bill. 2009 hospital billing $6.9 million; discounts $0.9 million; collected $2.7 million or 45%.
c) Processed bills: uninsured patients whose bills received special collection efforts by the hospital or collection agencies. As a government owned hospital, NH may seek to collect unpaid bills from tax refunds.
2009 hospital billing: $2.3 million; $406,000 collected from tax returns; $267,000 by other efforts. Collection rate 29%.
Two complaints were filed regarding the activities of the collection agencies used by Northfield Hospital. The CFO responded that the complaints were handled in an acceptable manner by the agencies.
Action Items
1. The Board voted to require that physicians granted privileges at the hospital be required to have liability insurance of $1million/$3million. This means that doctors without malpractice insurance should not be using the Northfield Hospital. A small number of physicians in the US are disposing of their assets and going uninsured.
Other Items
1. The Hospital Auxiliary has met their goal of raising $100,000 for the hospital over a 3-year period.
2. Hospital system revenue continues to be slightly below projections.
3. The city and the hospital continue to have discussions regarding the financial plight of the city. Questions: might the hospital make an annual payment-in-lieu-of- taxes to the city? Could the city sell the hospital as a way to raise cash?
Comments
Thank you, David. It will be good to have your reports as the hospital board meetings don't seem to find their way into the News.
Who raised the questions about how the hospital might help with the city's financial situation? It sound to me as if the hospital's finances aren't in great shape, either.
David: I also would like to know how the question of selling the hospital came up... it has been mentioned at the council.
Hoe does the Hospital Board react to that option?
Hi Jane,
John Dennison mentioned the conversation between the City and the Hospital regarding finances in his report as City-Hospital liaison. John had mentioned this last month too, so the conversation is ongoing. The City is very worried about future finances, as the budget situation in the state is only going to get worse for the next several years. I don't know if the thrust of the conversations are for immediate financial help for the city or anticipating future financial problems of the city.
Section 14.5 of the City Charter limits the transfer of hospital funds to the city, and the hospital's bond rating could drop if the hospital's reserve funds were to be significantly reduced.
The hospital faces some financial challenges, in part due to the downturn in the economy and the cutbacks by the state. My sense from the discussions is that the hospital views the problems as manageable.
Dave Emery
Hi Kiffi,
Again, the comment regarding the possible sale of the hospital came from John Dennison's liaison report. There was no comment or reaction by the board. This leads me to believe that this conversation is mostly going on in private, but I don't attend City Council meetings. What do you think?
Dave Emery
Dave - the possible sale of the hospital, as I recall, was only alluded to but not discussed at council meetings. I hope that the council will have an opportunity to consider the pros and cons of that move before the staff puts serious work into it. I would really want to know, for example, what the hospital board and administration think about being owned by another entity - or, as was discussed several years ago, becoming a non-profit entity itself. As far as I know, no funds from the city go to the hospital. If I am correct, selling it wouldn't reduce the budget.
Wouldn't selling the hospital be a short term benefit? Once the money from the sale is gone, it is gone. They could invest it and apply the income to the general fund. How much money would that be?
The council focus has been on budget reduction. The council received a chart showing near-, mid- and long-term "Budget Retrenchment Actions", If there has been a similar set of revenue alternatives provided by staff, I've missed it. Moreover, the "Annual Budget Development Policies" only refer indirectly to revenue alternatives. "A long-term sustainable approach shall be used in assessing service level/staffing level changes, revenue changes or alternative revenues. The approach shall also emphasize long-term growth and encouraging economic development."