PDH Board discusses Affordable Care Act
Nine million people in the past eight weeks signed up for Medicaid, CEO Doug Lafferty told Plumas District Hospital’s board of directors. And 6 million people lost their insurance. (Editor's note: Feather Publishing misquoted a local hospital official in its Dec. 11 newspaper. The official actually said that between 6 and 7 million Americans have lost their health insurance as a result of the Affordable Care Act.)
These are just a couple of factors among many in the complex web of the Affordable Care Act that health providers across the nation are dealing with as the deadline to comply gets closer.
Lafferty said Dec. 23 is the deadline to sign up and make a payment in order to be covered by the ACA beginning Jan. 1. March 31 is the final deadline. As of last week, 200,000 people in California had enrolled in the ACA, he said.
The impact on the hospital next year will be minimal, with some rate reductions for reimbursement and a small projected increase in Medi-Cal enrollees, he said.
Tahoe Forest Hospital in Truckee is turning patients away because of unknowns involving the ACA, Lafferty told the board. Consequently, Dr. John Foley, an orthopedic surgeon employed by PDH, may begin working more than his current one day a week in Quincy.
Chief nursing officer hired
Dan Schuessler was hired to replace former CNO Linda Jameson, who now works at Eastern Plumas Health Care. Schuessler was selected as the top choice for the job from among 30 initial candidates. His first official work day will be Jan. 6, 2014. He comes from Chico and has a past working relationship with PDH.
The good news is that the hospital received a 9 percent premium malpractice insurance credit, amounting to $27,587, for achieving zero preventable birth injuries.
Also good was the reduction of days in AR (accounts receivable) by five last month to 151. Chief Financial Officer Cindy Crosslin said the downward trend has continued for several months.
PDH hired two outside firms in an effort to collect outstanding debts and clear the books of nearly $5 million in bad debt. That sum includes $2 million in past timely and $3 million in self-pay debts. Much of that has been on the books for many years.
“If we’d have got it, we’d have a lot of money in the bank,” Lafferty said. “You won’t get bad debt down until bad debt is written off.”
“It really is reserves this hospital should have had,” finance committee member John Kimmel added.
“We’ve got it fixed now. The goal is to deal with it this year — to be done with it, then we can move on,” Lafferty said, noting that the bad debt comes from about 27,000 accounts.
Former hospital pharmacist Rick Foster had lots of questions for the board regarding AR and past timely billing. He said past timely billing should be zero. He wanted to know what the norm for AR is. Crosslin told him about 45 days.
That brought questions from Foster on how the hospital plans to reduce its AR to that number. “Are we going to be in the norm in a year?”
Crosslin refused to make a prediction. She said there are so many unknowns coming up: the Affordable Care Act, Managed Care, Medi-Cal, insurance.
“The bills are going out on time,” Crosslin said.
Lafferty echoed that statement: “We are billing on a timely basis.” He said that in his experience, AR ranges anywhere from about 40 to 125 days.
“We have totally redesigned the HIM (health information management), the coding piece is up to date. We had no denials (of insurance claims) the past month.”
The senior management team is looking hard at operational efficiencies, Lafferty said, including staffing ratios.
He said California has the strictest staffing ratio in the nation: 1 nurse to 5 patients, compared to other states with ratios of 1 to 6 or 1 to 7.
When PDH graphed the year’s patient care staffing ratio, the average was more like 1 to 3. Consequently, things need to change. Lafferty said they would not be laying off staff, but reorganizing.
He said that by utilizing the data to make operational decisions across the board, the hospital can save about $900,000 year.
The next board meeting is scheduled for Jan. 9, with the finance committee set to meet Jan. 8.