Doctors Memorial Hospital - Part 1
A new modern facility with a history of management and monetary problems. What solutions are available for the betterment of health care in Taylor County? Each week I will post a specific question or comment for discussion concerning our hospital. I ask that your comments be civil and directed to the specific issue raised for that week. Should you have any questions that you feel should also be addressed beyond those presented forward e-mail them to me and they will be considered for future postings. DMH employees are welcome to participate with anonymity. The future of our hospital should be taken seriously by all of us and your input is valuable.
Part 1 - Retrieved from the Commissioner's packet on the web is the 2008/2009 financial statement from DMH reflecting a net loss for year ending May 31, 2009 at $1,264,996.00. This figure does not include $600,000.00 in contributions from the County Commission and other lease expenses.. Factor in the contributions from the County and the net loss is $1,864,996.00. Already the net loss for the first fiscal quarter for 2009/2010 is reflected to be at $373,719.76. The County Commission in addition to the $600,000.00 contribution just recently also provided DMH another $2,200,000.00 for equipment purchases. WHEW!!!!!!! This financial report also reflects a net gain for 2008/2009 of $261,296.00 which is an obvious accounting error as DMH has not seen a profit that I know of in many years.
QUESTION/COMMENT: Should the County Commission have raised concerns publically when provided this DMH financial report or should they continue to ignore a very obvious problem which affects all of their constitutes?
The fiasco that is DMH, it is a county funded jobs program plain and simple. Everyone knows; DMH is a joke, a money loser, the wrong closed MRI is not going to make any difference. The BOCC cannot run a hospital, a board composed of local potentates and charlatans cannot run the DMH. There is never an effort to attract dr.'s who are normal or even culturally based to fit in our community. Where are the DMH sponsored med students? When looking at DMH staff, such as ******** ******* staff, would you trust your loved one with these two (drunk and dumber) at DMH?
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What is wrong with our county commissioners? Are they blind or just inept. My God, how can they sit and do nothing after receiving a report such as this. We the tax payers built and equipped this hospital and have shelled out hundred of thousands of additional dollars just to keep it afloat. We have relied on the commissioners to see that a management team was in place that could manage it properly but the same ole problems continue year after year and the commission still does nothing. A line in the sand must be drawn and this report shows that that time has come. The buck stops at the top and in this case it is with the county commission. We the people deserve better from our elected officials. It amazes me how the commissioners can even show their faces in public let alone to their neighbors.
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One thing to keep in mind, Indigent care cost the Couty the person is from, that County is responsible for it, so if the people go out of town and that hospital will bill our county. So far the commissioners have done a good joib, the ind. care is in the millions each year, we are saving tons of monies, check before you critizise, if we close it all our taxes go up, but hey that would the Taylor County Talk bunch something ele to bitch about.
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I would like to a line by line report of all the money going in and spent. Every penny accounted for, salaries for all, equipment, rooms, indigent care, phone, etc etc. Perhapses there are areas that need improvement with some revamping.
Primer Medical has an MRI why can't that be a shared cost instead of buying new?
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Basically, Premier Care is in direct competition with DMH, why would they want to share theirs, maybe this is something you did not know, I hope this helps.
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These problems go back a long time. The reason Premier Medical got into the MRI business in the first place was because the past Administration at DMH refused to work with them. DMH has a long history of trying to isolate themselves. Dr Shugar tried to "partner" with DMH before he built his State of the Art facility. I hope the current Board is not as hard headed as in the past. Perry is too small for the hospital to go it alone. DMH needs other Dr's in town. Sometime competition can also be an asset if you will allow it. It's better to get part of the business than lose it all.
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True, indigent care has been a problem for many years but just what constitutes indigent care. There are those that truly cannot afford health insurance and on the other hand there are those that can but choose to impose their health care cost on everyone else while they drive their nice vehicle and live in a nice home with money left over for the nicer things in life. The latter category which probably is the majority should not be considered indigent but rather a common ever day leech. DMH indigent care has not been in the "millions" annually as stated and furthermore recently DMH was to institute policies to minimize this problem, what happened to these policies. All hospitals have problems with indigent care patients but yet many still show a profit. DMH cannot blame indigent care on it's continuing management problems so lets be realistic.
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No what I am saying is that if we do not have the hospital, then the indigent care becomes our problem, right now the hospital is charging way less for the care, so the monies given by the board is no where near the amount we would pay as tax payers if the hospital is not there, and I do believe if you check, you will find it is in the millions.
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DMH is still being used as a Out-Patient Clinic. People coming in at 2:00 in the afternoon with a 3 day old spider bite. This is indigent care that we do not have to pay for. Refer these to a local Dr. There is the Health Dept and I believe a clinic with reduced fees for those with no insurance in town. These clinics have ways of getting reimbursed and we should not have to foot the bill out of taxpayer money.
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You have to watch out for EMTALA laws and CMS requirements when referring indigent care out of the hospital. You have to be very careful or you'll incur fines and lose certification in some instances.
EY
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I would like to see where this whole indigent care rule comes from. Florida Statutes? Is the county really liable and mandated to provide indigent care? Sounds like a flimsy excuse used to justify keeping DMH open at taxpayer expense. I understand and have seen many "county" hospitals across Florida that appear to take the poor in while private hospitals in the same community take others. I thought with Florida Kid Care program and others people could go to other medical providers. If the indigent care rule is in fact, our county can no longer provide "free" medical care to folks in the community who are below the poverty level and/or folks who just do not and/or cannot pay. It sure would not be a viable business plan for operating a business. All you anti Obama folks need to look closer to home, the Obama Health Care Plan is alive and well, with the public option and jobs program. It is called Doctors Memorial Hospital. Although I use neither DMH or Premier Medical, hats off to Premier, they are operating a private business and appear to have a business plan that works, and I would suspect provide a lot of "free" and reduced cost healthcare services and are still able to make payroll on a regular basis. I would rather see tax payers support a profitable business than one that is not. Contract the indigent care services to Premier, DMH needs to find a private provider to run the business in the real world!
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It is my understanding from hospital employees that Premier sends their indigent patients to DMH for services.
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How could my county commissioner or any of them in fact not question this financial report as it appears obviously that something is wrong at DMH. I printed this report out from the commission website and after reviewing financials for the past 3 years I have lost confidence in the county commission. Needless to say I am not only disappointed but I am ashamed of my representative to the commission. After giving DMH all this tax money there should be some concern by the commissioners but instead because it's not their money but rather their constitutes they look the other way. No private business could survive with this kind of loss but I guess DMH knows that AGAIN when payroll cannot be met or they need new equipment they can always turn to the free money pit, the county commission. Taylor County needs help and change.
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Indigent care is a crucial part of the over all expense, but what about the care that has to be given to all the prisoners in the county? This is free care to them, also.
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I have been in the healthcare business from the hospital side for 20 years and back in November of 2008 I sent a letter and resume to the board chairman Joe Collins on how to save his hospital and how I could help from a CEO perspective. I immediately received a call from Joe and came down for an interview.
I was stunned to learn how many CEO's the organization had been through and all the problems they had with them. I was also amazed to learn that most of the BOD had no health care experience, outside of Mr. Collins and that the city commission had the attitude that the hospital could run itself. Bill Brynes had been doing the job since the last CEO left and it all seemed to be moving along. There was no real sense of urgency to get new administration within the hospital. I asked about a 5 year strategic plan (SP)and was told there wasn't one. You must have the SP as a road map for the organization, you are rudderless without it! I outlined my healthcare philosophies and how I could help the hospital become profitable. I had a COO and CFO that I would bring along as an administrative team. I even gave them a low salary figure that was incentive bonus based with a guarantee of break even by the end of year 3 of my employment and profitable by the end of year 5 or I would leave, providing they wanted me too. At this time they are still wading through candidates while the hospital continues to flounder.
You need the imaging equipment to make your out-patient revenue side viable, however, you also have to work on the employee culture, quality, physician recruitment, and customer aspects of the business. Recruiting physicians to the area is key to the hospital survival as they are the one's referring business. Joint ventures with area physicians are a possibility and should be throughly investigated. There is so much potential at the hospital, you just need great leadership!
The first place you need to start is to get the community and the employees on board with creating a healthcare environment that offers compassionate care, worthwhile work, purpose, making a difference, and creating passion. This is done through culture change and ridding yourself of low performers, here, hiring expectations and the hiring of the right personalities is key. Staff must deliver quality care and the only way to obtain this is to have a staff that is committed to excellence, this starts at the top of the organization. With all the issues that are within the community you also need to have community focus groups, as an administrator you have to know what your community wants, needs, and expects from your business, only then can you offer a product they want!
To create a healthcare revolution you have to be a fire starter! You have to make a difference. I've heard it said that life is a pond and we are all pebbles within it, never underestimate the difference one pebble can make! I'd love to save your hospital and I can, I just need the opportunity
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Here is the bottom line. You need to strategically decide where this hospital needs to go, should it be a critical access hospital and align itself with TMH or grow with another facility like Shands that could provide physicians for ER care and perhaps help grow programs like a heart or cancer program depending on what your top admitted disease processes are, if I remember right it was heart issues. Or do this all on its own. Physician recruitment will be the key.
The hospital needs to concentrate on the issues that cause cost, high supply costs are not indicative of wrong ordering or over ordering, you need to understand the root cause, for instance patient falls, hospital acquired infections, and bed sores, all of these processes add significant costs to the bottom line and could be the root cause to higher supply cost.
You also need to have goals that the staff know and buy into and that support the overall strategic plan. This is accomplished through a pillar foundation, with goals related to each pillar. These start at the top and work their way down to the departments, every one working toward the same pillar goals. The pillars are customer, community, culture, finance, and quality when successfully obtained they will equal growth and profit. Staff should share in the success and success should be celebrated. Year end bonuses for profitability should be shared by all staff members as they are the one's who will drive the organization towards its overall goal attainment. This causes engagement of staff into the organization and make them an important part of its success.
My hope is that your selection committee within the Board of Directors (BOD) or City Commission will have the foresight to select some one with a plan that will guarantee success, my plan does and I am willing to back that up!
EY
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Amen to this! Get DMH a CEO and CFO with RURAL hospital experience!
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EY
You'll probably never hear anything from the board, you sound like you could fix the situation, or at least make an effort. I'm afraid if you were to get the position, you would find that, to accomplish your pillars, you would have to let a lot of the staff go, our board would never do that, they prefer to continue on in the same old way, not reaching out to anyone with any experience, for "they" may show up the board. So while I wish you well in your search for a position, and what you've written on this blog all makes great sense, I'm afraid our board isn't interested in anything like that, why you might find out what's really wrong, and you might be able to fix it.
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Hey thanks for your support! My plan works, it has been accomplished at many other hospitals across the country. I will tell you that I found board members Joe Collins, John Yarborough, and Bill Brynes to be interested in solving the issues at DMH, Joe especially. However, Joe has left the BOD as chief and as a member, frustrated over the lack of movement and involvement and lack of medical knowledge and hospital operation knowledge. I have not met the rest of the board, that was going to be the next phase but that never happened and I've heard nothing since. So, in essence you are most like hitting the nail on the head as you are much more aware of the situation than I, I only know what I've been reading on this blog. Though I can tell the community is frustrated and had enough, which is why I would involve them as we moved forward solving the issues. Community focus groups can help move us forward in having products and solutions that work for the community.
As far as the employees go, we'd get rid of the dead weight, even if that is the entire staff. You have to have engaged employees that can make a difference, however, you also have to have senior administration that can give them the tools to do their jobs with purpose and worthwhile work, once that happens some of them may amaze you with what they can accomplish. And the one's that can't will see us at the door....holding it open so it doesn't hit their backsides on the way out or we give that extra push so it does....hard! Some folks get so discouraged over years of mismanagement that they take on that personality as well, when they have a chance to shine and be involved them many step up to the plate. It is a beautiful facility and a needed resource, I hope things work out. I heard they have two candidates picked out, perhaps they have a solution?
EY
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Finally, someone that has a positive and constructive thing to say, THANK YOU MR. EY
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Thanks! Well, from the interview I had with these three gentleman I can tell you they truly want to see the hospital succeed. They lost the CFO after the last CEO left and Bill stepped in, think about it...here is a gentleman that was a CPA, but I believe I got the impression he was retired, and was just being aboard member. He stepped up to keep the hospital viable. Whether he did or didn't isn't the question but he stepped up when no one else wouldn't. AS you can imagine there is a huge time commitment here, So I can at least tell your community that John, Bill, and Joe are dedicated individuals who want to see the hospital succeed and although Joe is no longer on the board he still wants to see DMH stay viable and be successful I believe.
EY
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When can you start?
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I have followed TCT blog and the local politics for several years now. I too was a candidate for the CEO position, initially in 2007 and again in November 2008. Following a very positive interview with three board members, including the Chairman (Joe Collins), there was no follow-up. As it was explained to me, both internal and external politics prevailed.
As a seasoned healthcare professional and administrator, it is disappointing to see this hospital founder. The Board has options, they have candidates, and they have a duty to act!
I’m not campaigning for the position on this site, but merely want to concur with EY that there is a fatal flaw in the governance.
I don’t know Mr. Yoder, but I’m sure we both interviewed during the same week in JY’s office last November. I submitted a strategic plan template that I have found successful in other healthcare organizations. My experience (in Emergency Services/ED, Trauma, Surgical Services, EMS, Disaster Preparedness, Quality, HIM, Revenue Cycle etc.) is certainly preparation enough to drag DHM out of the muck. My background working with national consulting firms under “turn-around” conditions is probably not dissimilar from Mr. Yoder’s.
What an opportunity it would have been to inspire and lead DMH.
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When they say that "politics prevailed," what did they mean? Whose politics? And to what end are those politics working?
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Too bad, you would have made a difference. As a tax-payer who does not use DMH for any services, I would have like to see a positive direction taken. Unfortunately we do not have a DMH board or a county commission that would provide any leadership. Be thankful that they did not choose you, imagine what it would be like working for such a ship of fools. Although maybe the third thime would be the charm. LOL!!! God Bless You!
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Can any one teel me the website and where I can find this financial statement you are all talking about?
Thanks,
EY
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I can email you a copy. Make sure you either add my email address to your trusted list or check your spam folder in case it gets sent there.
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Many thanks!
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Without one ounce of doubt, we all know that DMH has a failed business plan, does not have a board with the skills to manage and operate a county hospital, does not have a county commission that has the ability to own and operate a medical facility, and does not have a completed community that supports it's services. It is time for someone of the DMH Board, Board of County Commissioners or the State of FLorida to step in and have some exit plan or transition plan to get the facility in the hands of an organization that can operate and sustain the facility.
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TCC, I'm sure he means "Taylor County Politics" as usual (you have to be a friend of a friend). But remember, this is a new board from last November and we need to give them a chance and not label them by the actions of past boards. I agree that a decision needs to be made and made quickly. I can see things getting done, bills are getting caught up slowly. I agree with another poster in that I also have a lot of confidence in the current board. They all seem to have integrity and that's a good place to start when you are making decisions.
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