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Sonoma County. A diverse county of over one million acres. It's famed for its agriculture, industry and recreation, boasting a booming economy and unique lifestyle for its citizens. Described by the same Luther Burbank as the chosen spot of all the Earth, Sonoma County is the place to

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live, work and play as we move into the 21st century. Led by the forward looking philosophy of its governing bodies, Cinema Counties, 340,000 residents are, Ah, harmonious, successful blend of ethnic and economic backgrounds. We invite you to take a closer look at Sonoma County in the

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nineties with your host, Rich McGlinchy. How do we get everyone? Welcome to Sanoma County in the nineties. You know, an institution has been part of Sonoma County for a century, is Community Hospital and Community Hospital has been having some tough times lately. You've probably been reading

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about it. Okay, we have a new administrator, Jim night, and Jim is doing his best to write the tilted chip, if you will, and get us back on the right track. I'm going to talk to Jim, not only about the hospital, but about some of the

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things that have happened that are happening, and that will be happening in the future. Jim, it's nice to have you. Thank you, Richard. I place the first time you visited with us. But certainly not gonna be. The last will be will be having you over to

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tell us about what's happening frequently. The first thing that comes to mind him is it to the recent presidential campaign. Health care was frequently mentioned as a national problem, and we certainly know what has been. But what are some of the major concerns with the current

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system rich? I think the two items that are most frequently mentioned with the current system are the escalating health care costs and the access to the system. If you look at the national level, health care is currently costing approximately 13% of the total gross national product,

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or about $800 billion a year is being spent on health care. Along with that, there are an estimated 37 million Americans that do not have adequate health care insurance. So if you take those two issues together and look at the high cost of care and the

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number of people that do not have adequate insurance. This results in people simply having an extremely difficult time gaining access to the health care system. That's a national problem for us. Okay, Jim, as an aside here, that means people actually were dying in, like for Michael

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Healthcare. In some cases, doesn't I think that could be concluded? Yes. There are those who do not receive adequate care in a timely fashion. All right, What you just said. How did those concerns relate to the state of California? Think if you if you take those

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numbers and apply them against California, we're spending 70 to $80 billion a year here in California on health care, It's estimated that one out of five Californians also does not have adequate health insurance. So this this again is representative of the national picture. It is something

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that we have to deal with. Yeah. Excuse me for tipping on your lying there. You said 70 to 80 billion correct. California that z 10% in the national. Approximate. That's correct. No. All right. What is community hospitals role in the health care system? As of today,

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they think rich The situation in that community is in is typical of the public hospitals around the country. That's the safety net. Hospital, as they're sometimes referred to that, says We provide health care to the entire population. We looked to provide the care for four. Whatever

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patient may be out there, we provide character, the indigent or the uninsured or underinsured as well as we provide care to the to the rest of the population. So we're providing comfort and care whomever may be requiring it. Well, Jim, I think as an aside here,

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it should be mentioned that Community Hospital is our Sonoma County hospital of the past, and this has always had the requirement of taking care of the indigent. Where's Jim? Said the underinsured and these people who had no place else to turn have been cared for, and

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we must care for those people must have we gym in most cases. Yes, in most cases, clearly any patient with an emergency can be cared for it. Any facility that's that's, uh, in fact, a law patients will be cared for in an emergency wherever the second

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week of idea we go. Beyond that, the public institutions, one of the primary mission is to provide care for indigent patients as well as the rest of the population. And this in itself, I would think, then certainly has is is partly responsible for the fact that

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we've had tough sledding economically amount of the factors I know have entered into it. But this certainly has to have some bearing on it, doesn't it? Oh, yes, very definitely. That's where the so called cost shift comes in. It's it's saying that there there is very

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little reimbursement to pay for your expenses associated with providing care to the underinsured. And those expenses must be made up somewhere. Jail. Let's look at community itself as as an institution. What services are provided at Community Hospital Community Hospital Riches is a full service acute care

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general hospital. We provide a comprehensive range of services and essentially do all of the services that one would expect in a community level hospital. Excluding cardiovascular surgery, we we have some very sophisticated services in our neo Natal intensive care unit, which is recognized as one of

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the best in the northern part of the estate. We have a an OBE program for high risk mothers that delivers approximately 24 babies, 24,000 babies a year. About half of those are in the high risk category. So that's again a very strong service. Forest emergency department

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imaging services and others are extremely strong. We have an excellent hospital, provides outstanding quality of care supported by a good staff of physicians. Uh, I'm very familiar with your emergency room. I've started out there for two different heart attacks in two different open heart surgery sessions.

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And also your cardiac, uh, ward center on the third floor of the new building. A moderately new building 72. When you say moderately new building 72 you're talking 20 years ago. But but it is. It is a very foreign facility. I've been in here and and

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also the service in the treatment, and there is the equal of any place I've ever been. And I'm getting to be familiar. I've been to quite a few of them, right. But it is interesting to know that all those things are available at community. Um, would

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community hospital also be considered a trauma center? Rich, we we are not designated as a trauma center. A. So you may know, there there are no trauma centers designated in this particular geographic area. There are a number of good reasons for that. To to operate. A

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trauma center does require a level of you saw a number of trauma cases to key the the skills up, and it requires a number of other things, like having a variety of physicians in house or on call 24 hours a day. So it's a very expensive

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operation. I think we clearly have the skills, and we provide probably most of what 1 may call the major trauma cases in the area. So we have an excellent team of physicians both in the emergency department and on through the rest of the hospital, to provide

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the appropriate services for trauma victims. But we are not designated as a trauma center. Travis Center is really a very specialized operation, isn't it? Yes. Sidious. Yeah, you said dreams don't know other ones up here. Well, Jim, as we said earlier on the Community Hospital, for

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all of the reasons we've sighted and probably many more, has been struggling for Nancy for the past couple of years Now, how you your recent the appointed administrator? How would you describe the current situation at Community Hospital Richard, I I think it's it's probably fair to

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summarize our current situation in a single word stable. I think we have, in fact, stabilized and improved our financial condition in a variety of ways. We've, uh and we'll talk about that. I'll talk about that a little bit more later on. There's some things that have

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been within our control and some that are outside of our control that have contributed to that. For example, due to some recent adjustments in our payer mix and so forth medical, the state program was under paying a somewhat last year in our cost reports and other

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mechanisms that that payment for last year has been adjusted and resulted in a $2.4 million payment that is coming in this year. That was really payment for services provided last year. That's of course, provides us a bit of a cushion for against the current year's expenses.

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The advantage, of course, is that that payment at that rate will continue on through the rest of this year and so forth, so that again gives us some more stability. So I think we're looking good at the moment. You know, I remember Jim Di aggress again

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for a moment. I remember in the community hospital was losing two or $3 million a year in the early seventies and they contracted with I believe it was in the Army at the time. Master Medical Enterprises and and for the next, uh 0 15 years or

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so things gradually got better and got on a stable of circumstance. And the I don't hospitals making money, but it was certainly paying its own weight throughout. And then, of course, the the creation of Kaiser Hospital appear, which is a major health plan and medical facility

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was bound to. And of course, we have room more in which is a fine hospital. Well, Rick, which is a doctor's hospital and these all combined Teoh put pressure on who got the patients in this case. So these things are not, um I don't know what

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the ramifications, but certainly they were not totally unexpected. It was It was, as you said, community institutions, you're going through these kind of problems, and this certainly indicated we were going to do it. But, um, what have you donor has been done to improve finances. There

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are a number of things that we have focused on during my my brief 10 year layer among them there. We've tried to focus on being sure that we're getting paid for the services that we provide, which is a key element. So we focused on collecting our

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accounts receivable. We have also focused in assisting our patients through financial counselors, in other words, making them aware of entitlement programs that they may qualify for. That has also helped us substantially. Andi. We've done some other things positions that were that were vacant that we felt

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we didn't need to feel. We have kept vacant. We've done some management reorganisation and things of that nature as a way of holding our expenses in line with our projected revenues. So a number of things of that light line have helped to improve things. Yeah, your

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community hospital has. Certainly It's been a fine institution. I have great fondness for it. I worked there my last year of high school. I've been in here whenever I have had to go for medical services, and I have great fun this for it. Um, I think

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it is an excellent institution, and I felt little heartsick that it was going through. All the problems is going. I'm really glad to see you there and hear what you have to say about the to 4.4 million we'll get for services rendered in the past. And

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these other things and in your own efforts I know are tending to bring back this to the word you used stability, which is what we must get to before we go anywhere else. All right, now, what is the impact of this new, horrible state budget on

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health care of Community Hospital, if any, And I don't think I need to add that, if any. That's a good question rich there. There clearly have been some impacts. One of the one of the biggest impact, of course, was the delay in passing a budget. So

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we were operating in unknown, if you will, or in a vacuum to some extent for a major portion of the year, Then once the budget has passed, one of the items that impacts community hospital and other providers I should add very directly are the potential reductions

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in the CMS P or county medical services program. The budget calls for a 30% reduction in the reimbursement to providers for sir of services for that program. The thing that is still unknown to us at this moment is whether that will affect county hospitals. We are

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getting an inclination even here. We're almost ah, what were third of the way through the year and and some of the details of this air still unknown. But it does appear that the impact of that particular item on the on community hospital may not be as

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great as we had originally thought, based on the way the budget was passed. So I hope there's a little bit of good news in that that that that that is good news. The possibilities and ramifications there certainly augur well for us. You know, the county is

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planning to close most really of its department. I was going to say some what's really most of during the month of December in response to the fiscal impacts from the state's actions. They're cutting the budget now. What will happen in Community hospital? You won't have to

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close. We'll you know, clearly we would not be able to shut down the hospital. We will have patients that are in there. It is typically a low time of the year. Just traditionally, that is the time clearly, that patients would rather be at home with their

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families, so it is normally a low period or for hospitals everywhere. There is a good possibility that our patient load may be reduced so that, for example, we could close one of the nursing units as a way of allowing our own staff to be home with

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their families during that period and still provide the care that's necessary for the patient. So we will. We will have the in patient units open to the extent necessary to provide the care to the patients on. Clearly, the emergency department will remain open and on our

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various support departments, radiology and lab and so forth will obviously be open to the extent necessary to support the patient volume, both for the emergency department in the inpatient side. On the outpatient side, most of our regularly scheduled non emergent type clinics will be closed. We

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do tend our intend to keep our urgent care clinic open. There's reasons for that. There will be drop in patients that are unanticipated, and we want to be able to accommodate those patients. And there are other patients, such as some of our O B patients that

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must be seen within certain timeframes. And so we're ensuring that we will have services available again to accommodate those patients. But those nonessential functions in terms of them being open to contribute directly to patient care personnel administration, for example, those functions will be closed during that

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period. All right, um, we have a lot of other questions. You want to ask you about the hospital and what's happening there. What's going to be happening? Ladies and gentlemen, Jim Night, the administrator for Community Hospital and I will return in just a moment with Mawr

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Welcome back. Ladies and gentlemen to this tradition of Sonoma County in the nineties hope you're finding this an interesting program. But because we're talking about Community Hospital, which has been a institution that were taken pride in and Sonoma County for 100 years, it's had its ups

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and downs in the last few years. It's had some very tough fiscal struggles. We have, ah, moderately new administrator Jim Knight, who is doing a fine job up there, and Jim has been telling us of what has been happening. Some of the good fortune were experiencing,

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with the state kicking off, kicking in rather 2.4 million that we didn't know whether we get or not. But Jim Knight has been working very, very hard to bring stability back to the hospital, and we're going to question him in this next few moments about the

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rest of these things. Jim, um, the continuing reductions in payments to hospitals and physicians for services provided to medical patients and the others with all that. The fact is, Community Hospital able to maintain a high standard for quality in regard to patient needs. Absolutely rich that

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that is one of the things that is that is critical to any hospital operation there. There are established standards that are used throughout the industry, nursing hours per patient day. For example. We know that it takes a given number of nursing hours in direct patient care

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to provide adequate care. And we had here very rigidly to those standards. Aziz. You know, during the course of a day, our volume will change. It will go up and down on, and we reassess our staffing at the beginning of each nursing shift, for example. And

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if if we've had admissions that we that we didn't know we were going to get, then we can call in additional staff. So those are the kinds of things that we do just as a part of our routine to ensure that we're providing an appropriate level

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of care. It's very important to us, and I'm pleased to say probably the care that's provided a community is as good as any I've ever seen. That's good. Um, we're kind of pointing out here an improved fiscal picture for the hospital. Does that mean our hospital

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worries were over? I wish I could say that they were, Unfortunately, you know, if again, to go back to the national health care seen toe. Look at the state in the impact of those things. It's clear that there are changes that are going to be made

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A to both the national and I think the state as well as a local level. It's going to be imperative that that initiatives be generated that will allow us to start controlling costs translated a different way. When he gets down to the individual facility means in

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some way or other, there will probably be reductions in the reimbursement. Clearly, we cannot continue to spend the amount of our gross national product that we're currently spending on health care, so they're I think they're going to be increasing emphasis placed on ways that we can

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reduce the costs of care and that really comes back again to reduced payments on bmore emphasis on proper utilization management off patient care back to what the average family has to do live within our budget. So speaking that's course have to do it. What is community

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hospital doing to position itself for the future? You think they're there to things that they're going to be absolutely crucial to us that we're in the early stages off One is that as looking at cost control measures, looking at possibly unnecessary use of services, there is

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increased emphasis on so called managed care, and that is one of the things that we're currently working to. We're in the very early stages off developing our managed care group that will allow us to start controlling our utilization. I think that's one of the key things

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that will help us. Another that we're doing it again and I think is equally crucial is the board just recently approved a ground lease for us to move forward with the medical office building and clearly again we need physicians that are going to be admitting their

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patients and using community Hospital key to that is having a medical office building that's close by and I think that will also be a major step forward that will pay dividends for US. Jim number things asking about 34 minutes to do it here. There have been

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reports of merger and consolidation of administration with center of the Memorial Hospital and the Kaiser Hospital. What is that plan? Well, the consolidation of administration as as was publicly announced, if you will, it really was not a consolidation of administrations at all. But it was, in

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fact, a support services agreement that we entered into with Santa Rosa Memorial Hospital that allows us to take advantage of some of their expertise in various areas. One of those that we that we have entered into at this point is to draw upon their financial expertise,

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and we have in fact, had one of their consultants come in to assist us. And I think that's in fact attributable to that. The other on with Kaiser. We recently approved an agreement whereby Kaiser patients may be admitted or sent to community hospital to use. Our

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resource is if they're in an overflow situation where they don't have a bed available. Clearly that will be to our advantage as well as to the patients and that they would not have to leave the area. I just to anything so we gotta cover right quickly

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here. With about 2.5 minutes, the hospital operates a nationally recognized medical residency program. That's the family practice program, Um, training in what area of medicine is offered here and what is, Or rather, what university is a training program affiliated with. We do operate probably one that

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is, that is considered in the top five residency programs in the country for family practice physicians. We have 39 residents in our training program that's 13 in each of the three years of training were affiliated with UCSF for that program. So where we have a good

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program and it isn't one, it's so well recognised. Very, very well, Where did most of those physicians go after they complete their training rich? In the last five years, over 50% of the physicians that have have completed our program have remained in cinema county. So again,

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getting back to the access issue Clearly the access and entry into the system is through the physician. So we're world really pleased to contribute that resource to this community. Two things here quickly. How is the rest of the medical community assisted orders of assisting and helping

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I keep community hospital viable? I'm really pleased at the support we've gotten from our physicians. They have contacted their colleagues. They've encouraged him to to admit their patients to community hospital. It's been a very positive thing. So we've seen our Our patient payer mix improves substantially

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as a result of those kinds of efforts. Jim, we're just about out of time and there are many other things. Begin Concolor. So I would like to ask you and saying in a few months in the spring, would you come back and tell us how things

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were going again and what new programs are being skated and how community hospital is writing itself? I would be pleased to do that, Rich. Thank you for having me. Oh, it's a pleasure to have you, lady and gentlemen. We talked to Jim Night. A new administrative

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for the community hospital was doing a fine job and is helping to write. The hospital show would say, the ship of state from its tilted circumstances of the last year or two. We'll have Jim back sometime in the near future to talk more about Community Hospital.

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My name's rich prevention programs. So McCann in the nineties with you every week until in good night good luck and good health gauge and every one of you