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The last few years have been a time of major ups and downs for Seneca Healthcare District, and that is not expected to change anytime soon.
Possibly the most influential struggle is the implementation of Assembly Bill 97, and how it could affect Seneca’s skilled nursing facility (SNF).
Cuts to California’s Medicaid program could potentially cause the closure of 13 rural hospitals’ skilled nursing facilities.
Each hospital district affected could soon be required to revert to its individually set 2008 MediCal rate, retroactive to June 2011. On top of that, an additional MediCal payment decrease of 10 to 20 percent would be imposed on hospitals.
When Seneca staff initially estimated the damage this would bring about to the district, they figured the repayment would be approximately $100,000.
Upon further review, however, it was determined that Seneca would have to repay $263,000. This amount increases every day.
While this may not seem like a lot compared to Eastern Plumas Health Care’s expected repayment of $2.4 million, it could have the same devastating effect — closure of the SNF.
The initial repayment amount is not the only factor that will determine whether or not the SNF doors stay open. According to SHD Chief Executive Officer Linda Wagner, Seneca’s 16-bed facility would lose $11,636 in revenue per patient, per year. This totals to a loss of $186,000 per year.
Wagner said the SNF is barely breaking even as it is. She said by imposing such a drastic cut, it would be difficult to serve the community with skilled nursing services while continuing to suffer such a high loss.
During its Jan. 24 meeting the Seneca board of directors voted to keep the SNF open and try to recoup costs through other means.
Wagner said, “That may not be feasible since we are looking at a loss of $186,000 per year just to run it. I do not think the community and the district can support such a loss but it is a decision to be made by the board.
“Between this, the new carport, and the already decreasing patient revenue, it will hit Seneca hard. It is very important that the community get behind us and contact governmental officials to put a stop to it.”
During the Jan. 24 district meeting, Wagner updated the SHD board on Seneca’s progress toward retrofitting its buildings in order to comply with the Hazards U.S. (HAZUS) Re-Assessment Program and seismic compliance bills.
In December 2012, Wagner received notice from the Office of Statewide Health Planning and Development that the former retrofitting plan for the emergency room ambulance acceptance ramp was denied.
In order to use the back ramp as intended, the hospital is required to completely demolish and rebuild it.
Effective Jan. 1, Seneca can no longer accept ambulance patients through the back ramp, and is required to only admit them through the front entrance. This meets California Department of Public Health’s new requirement that hospitals can only accept ambulance patients through a covered area.
In order to protect patient privacy, Seneca has put in place a plan to shield ambulance admitted patients while bringing them through the main lobby. “We are asking the public to bear with us and come through the front until we can complete the project,” said Wagner.
While the entire process is estimated to last between one and 1-1/2 years, Wagner said, “we are well on our way to getting the issue corrected.”
Plans to demolish the existing admittance area have already been approved by OSHPD and the plans to rebuild were submitted Feb. 11.
Wagner estimated the entire project could cost $139,000 to $200,000. She said OSHPD would not give her a timeframe as to when work can begin; however, once officials approve the final proposal, it should only take a few months to complete the project.
When the district initially requested the Electronic Medical Records loan, it was thought that Seneca’s current computer networking system could handle the increased strain on the server — it could not.
Wagner said because Seneca’s networking structure is not strong enough to handle such a “robust EMR,” the district had to request an additional loan of $750,000.
With a unanimous vote from the board during the Jan. 24 meeting, CSI Managed Services was contracted to build a new domain controller that will meet all compliance issues as well as support the robust EMR system.
Wagner said the additional loan will be placed in Seneca’s “meaningful use bucket,” and the majority will be reimbursed once Medicare determines the hospital has met all requirements for its EMR incentive program. The program allows for a one-time reimbursement of 96 percent of the costs incurred from establishing the system.
Clinic’s EMR goes live
For a good part of 2012, Seneca hospital staffers have been undergoing training and implementation of the EMR system.
During this time, contract labor expenses have increased and often gone over budget to ensure proper training of staff.
With the EMR system firmly in place within the hospital, the system was set to go live in the clinic Feb. 11.
While clinic staff and physicians are getting acclimated with the system, appointment availability has been cut in half. “This is so we can better accommodate patients when they come in,” said Wagner. The change is only temporary and is expected to let up sometime this week.
The decrease will allow physicians time to learn the system without encroaching on patients’ quality time with their doctor. “It is already taking longer per visit and we have to make sure each patient is getting the quality time they deserve,” said Wagner.
Walk-in patients will be accepted as normal, and operating hours have not been affected.
Wagner said the increase in contract labor associated with the implementation of the EMR system should remain steady, if not decline. She attributed this to the smaller staff of the clinic compared to that of the hospital.
Seneca was awarded a $9,000 CARE grant, which, in part, allows one person from the hospital to attend the two-day symposium “Transition Strategies for Rural Housing” March 13 – 15.
As CEO of Seneca, Wagner was chosen to represent the hospital.
The symposium will cover subjects such as local trends in rural hospitals, what’s new with OSHPD, and regulatory updates. There will also be discussion on meaningful use and EMR implementation.
Wagner, as well as other attendees, will have the opportunity to speak about AB 97 and how it could affect hospitals.
The remaining funds will be used to review and update Seneca’s patient service charges in order to “make sure the hospital is within industry standards. In order to be competitive, we will be equalizing out what we are charging,” said Wagner.
She said the review could mean either an increase or decrease in service charges.
Whatever the outcome, a change in pricing will have to be approved by the board and will not be implemented until the third quarter, which begins in July.
Staying on the positive side, Wagner said, “Seneca has a lot of changes that are positive, and a lot of changes that are going to hit us hard, but we will get through this."
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