Hospital candidates discuss billing, cancer center
October 17, 2014
The billing system and cancer center and were among topics discussed by seven candidates running for the Tahoe Forest Hospital District board at a political forum on Oct. 14 at the Tahoe City Public Utility District office.
Dale Chamblin (incumbent), John Falk, Mark Spohr, Chuck Zipkin, Greg Jellinek, Ned Hughes and Ronda Brooks are vying for three, four-year seats in the Nov. 4 election.
Below is a sampling of some of their comments given at the forum in front of roughly 50 people, presented in random order:
On the billing system …
Zipkin: … What I keep hearing is that the bills are opaque, and nobody really knows what they mean. … I think transparency in billing is maybe even more important or as important than transparency on the board. I think we need to make the bills readable and understandable. I think there should be more patient counseling. Patients are counseled now when they come into the hospital to have something done. One of the first people that they see is a billing counselor who explains what the bills could be … I don't think that's working as well as it should because when I talk to people they say, "I went in, but I still don't understand it," and part of that is because when you go into the hospital when you're ill, you're not thinking about much else.
Jellinek: The system … was an unmitigated disaster. It was a disaster for inpatients. … What they need to do is to look for a vendor that can provide a coherent simple system, so when you get your bill, you at least understand what you're being asked to pay for.
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Spohr: Everybody keeps saying how great the administrators are, but they really messed up with the health information system. … Working in this area for 30 years, I've programmed health information systems. I've installed health information systems. I've recommended health information systems. I know how to do it right, and they certainly didn't do it right here. I don't want to micromanage this by any means, but I hope I can give them some good advice in getting a good health information system.
Hughes: I'm not really aware of too much of what happened with the (electronic medical records) … As far as the billing of the hospital, I have nothing to do with billing. I don't know what's going on with patients' billing per say, if that's the question.
Chamblin: The decision to purchase a new electronic medical records system took place long before I got on the board. It was an unfunded government mandate as I understand. You had to meet what they call ICD-10 requirements by a specific date, … or you weren't going to get paid by Medicare or Medicare services. … It's a tough deal. The system, as I understand, wasn't performing the way they thought it would. It did not meet HIPAA requirements. There was some major issues, but you know, coming on the board where I came in, I've got to be looking through the windshield and not at the rearview mirror. … They've hired IT Optimizers and Jacobus Consulting, and believe me, we've made tremendous progress in getting this thing on the track.
Falk: The federal mandate that was spoken of in the question relates more to electronic billing and having the connectedness between various aspects of practices again, … not the actual software that is utilized, and unfortunately, by all accounts that I've heard, the software that was deployed in the service of Tahoe Forest Hospital's effort to meet this requirement has failed to put it bluntly. To that end I don't think we should be tweaking a system that is already showing incredible shortfalls and failure. I think rather than trying to throw good money after bad, we just have to accept the fact that we got a system that didn't work out and look for a more productive and secure system. At this point the billing structure is woefully inadequate. When a person receives their bill from the hospital, it is cryptic and confusing, so I would say at this juncture we just need to look at a new direction.
Brooks: Mr. Falk I agree with you. We need to look in a new direction. … We just keep going in circles spending good money after bad, and I agree Mr. Falk, we need to start over.
On the cancer center …
Jellinek: Two words — more patients. Measure C appropriated $98.5 million from our pockets (and) 32.5 percent of that went to the cancer center. … (It's) treated 2,100 patients over the last 8 years. That's comes out to one half of 1 percent of the population, so boys and girls, we spent a third of the money to treat one half of 1 percent of the population. That said, we've got it. We're not going to throw it away. We need to figure out some way to increase the utilization. …
Spohr: I've been critical of the cancer center. I don't believe that it was necessary to spend $32 million to provide the services. The original budget for the cancer center was less than $1 million, so it grew way out of control, and it's, again, a failure of the board to control the administration and a few doctors, who are controlling the agenda. … Now that it's built of course it would be foolish to stop using it, so the solution is more patients. We need to have more patients there, and one of the deterrents to patients coming there is the high cost. … That has to stop.
Hughes: … The cancer center is in black. It's supporting (hospital programs). … You've got to remember that the center itself, the building has only been open for a year and a half. … Cancer is part of our treatment program, and we've got to keep it and keep the quality. I don't mind if we have more people. I think we've got to give it a chance.
Chamblin: The cancer center was only built after a thorough professional study and then a group of interested citizens — about 30 — spent their own money traveling around the US vetting this thing thoroughly, so it got a tremendous study at the time before it was even built. It's so popular that it's drawing patients as far north as Quincy, Carson City, they're coming up from Reno, coming up from everywhere because it's such an incredible state of the art facility. They're almost 15 percent ahead of budget. As it was said, it subsidizes the OB. If you check out the July 11 edition of Moonshine Ink, you'll see where Mark Spohr said that building should be repurposed. Closing the cancer center is just not in the best interest of the community. It needs to stay open.
Falk: First and foremost, I ask you don't buy the lie that myself and my colleagues, Greg and Mark, are seeking to close the cancer center. Hear me clearly, this is just not true. Anyone that perpetuates this is lying to you. … The facility was built larger than it needed to be for the given time because that's prudent to do when you have a contract to build and the money available. The repurposing is really looking at the second floor, and I've suggested that perhaps we work with the federal government and the Reno VA to open an out patient VA clinic on that second floor. We could also have a drug and alcohol treatment facility on that second floor. We could have other mental health outpatient services. There are a range of things that could and should be done with the space that's available, but the cancer center itself is in place and valued.
Brooks: I agree with you John. We need to multipurpose it. A consultant has been hired to study what other market opportunities will be available to utilize the top floor of the cancer center, so I think we really need to see that study, since we paid for it and see what advice that gives us. Personally, I would like to put a nursing program up there, medical students, nursing students and a simulation lab. I think that would be a great benefit to our community.
Zipkin: … Cancer is a devastating diagnosis. All the clinicians in the room, and I see a few, a few up here, understand that. It isn't just the patient; it's the family, the friends, the coworkers. … Remember you won't be able to go to Reno because if you have Covered California, you'll have to stay in California for care. People who have cancer, hav(ing) to drive to Sacramento, vomiting in both directions, staying in Sacramento overnight, being treated in Sacramento for any complications they might have is absolutely non-compassionate. My patients loved when I was practicing here, loved the fact that we have a cancer center in our community, and I'm very proud that we have it. I would not repurpose it. I would not think of other uses for the facility and the equipment.