Doctors Memorial Hospital - Part 2 - !UPDATE 10/29/09!
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 Two - Just recently the Doctors Memorial Hospital (DMH) Board of Directors decided to hire yet another CEO to manage the hospital rather than reach a management agreement with Tallahassee Memorial Hospital (TMH). TMH offered to provide interim management for 90 days with the understanding that if DMH was pleased with TMH's management, then a long term contract for management could then be considered. In electing to hire a new CEO will DMH again be embroiled in a contract dispute with substantial legal fees such as has occurred on multiple occasions in the past. Has the last CEO dispute ever been settled as of yet? In hiring a new CEO there are no guaranties, whereas TMH has a proven track record. If the perspective new CEO has hospital management experience, why then consider our rural hospital when opportunities are available elsewhere in larger hospitals?
Part Two - Just recently the Doctors Memorial Hospital (DMH) Board of Directors decided to hire yet another CEO to manage the hospital rather than reach a management agreement with Tallahassee Memorial Hospital (TMH). TMH offered to provide interim management for 90 days with the understanding that if DMH was pleased with TMH's management, then a long term contract for management could then be considered. In electing to hire a new CEO will DMH again be embroiled in a contract dispute with substantial legal fees such as has occurred on multiple occasions in the past. Has the last CEO dispute ever been settled as of yet? In hiring a new CEO there are no guaranties, whereas TMH has a proven track record. If the perspective new CEO has hospital management experience, why then consider our rural hospital when opportunities are available elsewhere in larger hospitals?
QUESTIONS:
Should the County Commission have had input on this decision also as millions in tax revenue has been given to DMH from the commission's money pit? Other hospitals earn theirs.
Should the County Commission have had input on this decision also as millions in tax revenue has been given to DMH from the commission's money pit? Other hospitals earn theirs.
Did DMH make the right decision or will we regret it later?
See also and respond to Part One concerning DMH.
See also and respond to Part One concerning DMH.
UPDATE - 10/29/09
Information received via email stating that a prior board member informed them that the DMH Board has now decided to enter into a management contract with TMH. I will post additional information as I receive it.
Well, you would be astounded at the contract price TMH wanted to "manage" DMH! You want to talk about wasting tax payers money then there you go! There are many CEO candidates in the field with and without experience looking for an opportunity and a challenge. A new CEO with little experience but the right training and background can bring be very successful in this environment. DMH presents quite a challenge for an individual who likes turn around opportunities. I applied for this position because I am familiar with rural healthcare, try living in rural Maine for a while as I did, you learn how to survive in a healthcare environment that is less than spectacular! I've been to Perry and it has quite a lot to offer in my book, a slower pace, by the ocean, the hospital is beautiful, and the challenge is fantastic. I had a COO and CFO team as well, we would have taken DMH and turned it around, you all would have been amazed, unfortunately it sounds like they wet in a different direction than my ideas. Remember, one of the past CEO's is to blame for some of the legal issues, not all of them.
The main issue in a situation like this is, in rural areas you get candidates with limited experience looking for a break into the business or you get cast-offs that can't operate and hold things together. Every once in a while you find a candidate just looking to slow down. The first and the last are probably your best bets. I have no idea who they hired and where they came from but I wish them luck! I will say the TMH management arrangement is not something you really want.
Reply to this
From my source the contract price proffered was for 90 days only with no figures discussed for long term management. If a subsequent long term price was unreasonable then DMH could have kissed TMH goodbye and then pursued hiring their own CEO at that time. No hospital can operate without physician support and here in Taylor County we desperately need more physicians and with TMH behind the wheel physician recruitment could have produced results. We also would have had direct access to many specialists within the TMH family with many of them eventually coming to our county opening a part or full time practice. There are positives and negatives in partnering with TMH but right now we need doctors first and perhaps TMH could have filled that void. We perhaps should have taken advantage of TMH's credibility as we have lost ours along the way.
Reply to this
I have to agree that a partnership with a bigger hospital sounds like an idea with great potential and should be pursued if the details could possibly be worked out.
Such a partnership would bring an infusion of knowledge about the effective management and operation of a hospital that DMH desperately needs.
It would also result in the public perception that things at DMH were being done significantly differently, which could increase trust (and business) within the community from those who currently don't want to deal with DMH. There are a lot of people here--from doctors to citizens/patients--who won't consider DMH at the moment. But if they looked at it as a branch of TMH, they would reconsider.
Reply to this
perhaps you dont remember the last time tmh ran doctors memorial in the early eighties,prices went up doctors left revenue was directed to tallahassee andwhen they abruptly left the county had to buy new equipment,including beds and iv pumps tmh took what was there.with that trac record idlook at tmh with a wary eye too.i agreewe need to compact with a bigger hospital just not tmh.they left us high and dry once,whos to say they wont again.mr. yoder appears to have some good ideas and knowledge,hopefuly the new administrator will too.but realalisticly the board needs to be changed and a mentality of shape up or ship put put in place patient first,definitive care and better public relations would go a long way to help.the answers are with us the public we can insist on a better standard from our commissioners ,hospital board and hospital,when we do i feel like the end result will besomething we will all be proud of.so lets get started and make it happen
Reply to this
It would be a mistake to rule out a relationship with TMH based on something that happened two decades ago.
Reply to this
i dissagree .
Reply to this
Larger hospitals tend to lose sight of the little one's in these type of arrangements. I heard salary figures and from what I've seen on this blog about DMH it most certainly would have become another whipping post.
There are two avenues, one, become creative with recruitment, in the past DMH had a tuition reimbursement or some type of education forgiveness for med students who stay in the area, first off what happened to that? In recruitment, you could look at some type of financial assistance for school loans for physicians who want to locate to the area or could be enticed to do so, you have to watch enticement laws and various CMS regulations but with appropriate legal counsel you could navigate it. Two, you become a critical access hospital and affiliate with TMH or some other local-larger hospital. Another option would be to affiliate in certain services, ER, heart, cancer,etc., with a teaching organization that could provide these services to the area and thus be required to staff it as well.
EY
Reply to this
I was told by a very reliable source that Capital Regional was interested in partnering with DMH, something like the critical access unit you are talking about. They contacted the Board, and Jack Brown, never heard back from anyone. That was several months back, so the board has changed, it seems from what Mr. Yoder has said, and what I've heard, our board and county leaders have a hard time getting back to people who might help us with this situation.
Reply to this
From my view it is kind of absurd to fault TMH for the way they manage a hospital....in the black. I do not recall TMH requesting funds to make payroll and keep the lights on from the City of Tallahassee or Leon County. Maybe DMH needs to adopt the same business plan and principles.....a plan that would provide great care and a plan that would be economically based in the real world.
Reply to this
Not Fault, but fact, 20 or so years ago when DMH partnered with TMH it was a disaster. But that was 20 years ago, TMH is a different place, different management, different employees. I could be wrong, but it seems to me, now that DMH has new equipment, and the bills have been paid for the moment, the urgency to find a different path has disappeared.
Reply to this
Are the bills paid up to date? You best take a deep breath first before asking just who is standing in line and the overall amount.
Reply to this
Twenty years or not, DMH is a fiasco, TMH has not financially faltered in the last twenty years. DMH would be blessed if any larger medical facility could take it under their wing! New equipment does not mean that DMH will be successful, people do not trust or use DMH, it is just that simple. Bad management means losing patients, bad doctors the same, bad community relations the same.......the list could go on and on. DMH needs to close or seek life support other than from the tax payer!
Reply to this
DMH could not use TMH's help? WTF? LOL! The stupidity of this community when it comes to healthcare is beyond crazy!
Reply to this
WTF? I like that! What DMH needs is proper management. I'm not sure the board really knows what direction the hospital should take but it is looking for a leader who can do that and bring the board along. These guys really want what is best for the hospital, they do care, however, the past administrations have butchered DMH when it comes to management. I hope whomever they have chosen has a plan. I did but they seemed not to believe in it or trust it. If the community is left out of this re-birth it will be a huge mistake. If the staff is not brought along to believe in the plan it will fail. If physicians are not recruited to the area there will be no business. I will keep my fingers crossed and re-apply for the CEO opportunity if it all fails again. I like the area and hope that the hospital becomes profitable once again.
EY
Reply to this
Most folks with insurance or ability to pay go to Tallahassee (TMH-CRM), Gainesville, Shands Live Oak, Jacksonville (Mayo), or many other medical providers. I always laugh when folks on the blog talk about going to these other places for health care and say that it is like Taylor County home week, everyone in the waiting room is from Perry. This applies also to dentists, pediatricians, and many other providers. What DMH needs to do is discover their niche, partner with others and mov e ahead with a viable business plan. Everyone is aware that an investment will be made to find a new CEO, then the new CEO will not stroke the right potentates / charlatans and will soon be gone. A shame!
Reply to this
As a relative newcomer to Perry I have tried to follow and understand the history and progress of DMH. I have attended several county commission and DMH board meetings to gain a n insight to the problems. While I feel the commission, board and public really do want a successful hospital, but have been unable to make the difficult decisions to be successful. One has to wonder about 5 administrators in seven years and all the legal problems that followed. There is no question that Perry needs more physicians, especially specialists but the history of the hospital's treatment of past physicians will make it very difficult to attract quality physicians. Why does Perry have only 1 non-board certified surgeon? After 5 different administrators have come and gone, it appears that all dept. heads are still on the job. Since these are the people ultimately responsible for the quallity of the work at the hospital, or lack of quality, why has tere been so changes here? The county commission gave the hospital large amounts of money for needed equipment but what about qualified people to operate and interpret the tests? Equipment was needed but qualified personnel are what makes this equipment work. I strongly feel the citizens of Taylor County really do want a quality hospital for their community but most of them have lost any confidence due to the long history of poor management and in fighting. I have spoken with many who honestly want a quality hospital but many will conclude "If I need to go to the hospital, I'm going to Tallahassee or Gainesville." The road to recovery will not be quick or easy, but the work must continue. In my opinion, the hospital board needs to keep the county better informed about the needs, problems and proposed solutions or options rather than just tell us what they did with very little information about why. This site may be a good place for a start for the hospital board to keep all of Taylor County informed as to ideas, plans,and options. Come on board members, step out into the sunlight, put the spotlight on the problems and maybe the people who want the hospital to be successful can provide some help!
Reply to this
Why would TMH Physicians want to come to Taylor County? Money, pure and simple. I have no problem with that except why should we go through a 3rd party (TMH). If we can afford to pay physicians what it takes to bring them here do it now. I agree with most comments. However, TMH was not coming to Taylor County out of the goodness of their heart, nor should they. The cost would surely put DMH out of business. EY sounds like he has a lot of good ideas and experience. I hope he will attend some of the Board meetings and get to know the current BOD's better. I personally know most of the current board and believe they are honest people. That's a great start when you are trying to straighten out a mess like this. Experience is something that takes time but when you have a solid foundation to work from this turn around can happen.
Reply to this
Thanks for the support on my ideas. I currently reside in Polk County but did apply for the CEO position in November and had a interview with 3 of the board members. I loved the area and really wanted to settle down ad retire there much later in my life, after, of course, many years of successfully running DMH. I lack CEO experience but have been taught and schooled well, I am looking for an opportunity. The advantage with me is, I have a great idea, I know I can have this hospital at break even in three years and profitable in five, off of the tax payer back, and I'll guarantee that! I want to work with the board and community to create and extraordinary healthcare facility. It can be done despite past history. However, I think my lack of previous CEO experience scared the gentleman I interviewed with off. Although I was told I was very impressive and they wanted me back to interview with the rest of the board, that never happened though. I have to agree with you, they had their hearts and minds in the right place. They want to see DMH succeed. I think part of the problem is the board members and the city commissioners do not read this blog, if they did they may get some good insight into the communities thoughts on DMH and how to proceed and involve the community.
I've heard through my contacts that TMH is slated to run the hospital temporarily, at a cost of 10 to 20k a month as a management contract, they will interview the two candidates selected by the BOD as well as some of their own. They, TMH will make the decision on a final candidate, however, long that takes, then I assume, they will back out of the picture. I believe that is the current plan.
EY
Reply to this
Well the Drs here are not here out of the goodness of there heart as well. There is no managed care, DMH supplements their expenses, DMH provides a place to work, DMH pays a stipend. I would say the Drs who have been here over the years have done well.
Reply to this
I just finished reviewing DMH financial statements for the past year, though the organization took a loss I found a few things that could be corrected for some savings. One hiring me as CEO, LOL, I was cheap and would have saved considerable amount on salary, I was willing to work on goal accomplishments.....okay, okay,I'm letting it go! I see IP volume down so either Taylor County is pretty healthy or the physicians are referring elsewhere. I would suspect, from this Blog, that folks are asking to be set elsewhere. So, we need to fix this by understanding why and giving the community the services they want and need. OP Volume is up, and looks good, so local residents are using the OP services at the hospital, this is good and all the more reason to invest in needed equipment. I can detail this better in an operational plan which I may draw up for kicks and get the moderator to upload if there is an interest? I can always use it in a portfolio for other organizations. What troubles me is the account receivables, there is a lot of money out past 60 days, you want this to be around 45 to 50 days. This makes me wonder about the collection ability and bill drops of DMH, I'd have to understand that process better to comment further but you would want to look at that process pretty closely and insure bill drop on time, collections are successful, denials are investigated and corrected, and upfront, and coding processes are correct and efficient. Your Medicare payor mix looks good and appears to be declining while your private pay mix is strong and increasing! Charity care is down which is good, however, bad debt is increasing, this is a national trend but I would be concerned with the increasing accounts receivables that tags along with it. Home Health continues to decrease, I'd do a contribution margin analysis on this service to assess its feasibility. Salary and supplies trended down and if I remember are tracking below budget, which is good, however a 10% pay cut will do that while it erodes any moral left among staff. DMH's has close to 2 million in contract labor, this needs to be eliminated, you'd almost break even by getting rid of a good portion of that, by creating an organization that excels and focuses on excellence, gets rid of those who do not believe in the overall organizational goals and grow a culture that provides passion and worthwhile work, this would be in my operational plan......you are headed down the road of profitability. the organization should be able to stand on its own without help from the tax payers.
Reply to this
Thanks for the analysis!
AR has been a problem for DMH for years. They just don't seem to be able to get them under control.
As for IP, you're right that many people don't want to be admitted to DMH--that's a factor that will take some time to change. The community (both patients and doctors) will need to believe that the care they get there is as good as the care they'll get in Tallahassee. Sometimes it is, sometimes it isn't; there's definitely inconsistency in quality. DMH needs a different organizational culture, and that's a challenge. It will have to come from the top down, of course. The CEO will need to set the example and make it clear that nothing but consistent top-quality performance will be acceptable. Those who can't or won't fall in line will have to go.
Another issue is the limited number of specialists we have here. I don't know of any cardiologists, for example. Heart problems are common, but anyone who has them is going to be sent to Tallahassee or Gainesville.
It's hard to comment on the contract labor without knowing the details of what's being contracted.
Reply to this
You are right, depending on what the contracted labor is will depend on its continuance.....if it is nursing then one needs to embark on culture changes that make working at DMH desirable to nurses. We did this at our current organization by getting magnet designation we were able to attract top quality nurses and reduce contract labor. There is a lot involved in this including shared governance and employee empowerment. I would imagine that is probably one of their top contracted labor expenses?
As for specialists, Gainesville would be more than happy to partner with a heart program, as would Ocala Heart Institute, may be some others? This would allow a much needed specialty into the area.
Reply to this
Generally your area physicians are self employed, though they can be employed by the hospital, it is better from a productivity standpoint if they are not. The can be enticed to the area with some help from the hospital, their gain is they get a facility to practice in (OR) and refer to (Lab)(Imaging). Having these modalities, Lab and Imaging, up to date, as well as the latest in OR technology, gives the physician a state of the art facility in which to practice. You can entice recent medical students with an arrangement of reimbursement for school loans and soon attract quite a wide range of physician specialties. Seasoned physicians will follow and all will gain from increased business that no longer travels elsewhere. Throw in a joint venture project with Shands of Gainesville on an open heart program and cancer center and you are well on your way to profitability.
Reply to this
Please see update above. Thanks.
Reply to this
Though not confirmed apparently the DMH board of directors have now decided not to hire another CEO but rather they have decided to work out some type of management agreement with TMH after all. Don't know whether this is an interim or long term agreement so we'll have to wait and see. Sure would be nice if the public were made aware of the goings on rather than finding out second hand but we must realize that this is Taylor County and the citizens usually come last unless someone is holding out their hand for money.
Reply to this
This is true, apparently TMH will interview the two candidates chosen by the board. Then they will present two candidates from TMH, TMH will make a decision. In the meantime, their consultative management rate will run between 10 to 15K or more may be, per month...nice work if you can get it.
Reply to this
At least some of the uncollectable debt is because of the treatment people received. I know I have had several tests performed here just to take them to a specialist that says they are useless and had to pay to have them redone. Why should you pay? I have been burned more than once and for the last time until they prove things have changed. At this point they have to prove it to me!
Reply to this
EY, you seem to be knowledgeable on this topic. What is the advantages of having an agency such as TMH pick your new CEO? I know these Board members and they are no dummies. They don't have healthcare experience but they are no dummies. I'm sure there is a reason. I would think they are capable of picking a CEO.
Reply to this
The comment "they are no dummies" is somewhat subjective. I could agree that these folks are great folks and great to see at Walmart, church and at a local service club, and may be smart individually, but the decisions that have been made by this group collectively shows no sign of a group dynamic with any smarts, only penny wise and pound foolish!
Reply to this