Sutter Health, Eden Medical Center
Health Care Legislation

Cassandra Clark, Project Communications Director

shakemap2While California earthquake safety legislation is the driving force behind new hospital construction such as ours, earthquake safety doesn’t begin or end with new construction. For many years, Eden Medical Center has participated in the California Strong Motion Instrumentation Program (CSMIP) by placing seismic motion sensors in the building to gather vital information when an earthquake strikes.

Recently, the Sutter Medical Center Castro Valley project team reached agreement with the California Department of Conservation to place sensors in the new hospital once it is completed. The agreement is good news for seismic research, and it ensures that Castro Valley joins other Sutter hospitals with seismic sensors, including Sutter Coast Hospital, Alta Bates Summit Medical Center and Novato Community Hospital. New construction at Mills Peninsula and California Pacific Medical Center will also have seismic instrumentation to provide essential data on San Andreas fault activity and to record the performance of the unique seismic structural systems employed at these facilities.

The instruments are part of a statewide network of strong motion instruments that ensures any strong ground motion, from a moderate to larger size earthquake, in California will be recorded.

CSMIP map

Monitoring the Data

The CSMIP installations are advanced earthquake monitoring devices called accelerographs, which are placed at various representative geologic foundation materials to measure the ground shaking. When activated by earthquake shaking, the devices produce a record from which important characteristics of ground motion (acceleration, velocity, displacement, duration) can be calculated.

Accelerographs that are installed in buildings such as hospitals, bridges, dams, utilities and industrial facilities are selected by engineers and scientists representing industry, government, and universities. The program has installed more than 900 stations, including 650 ground-response stations, 170 buildings, 20 dams and 60 bridges. Many of these installations can be found locally along the Hayward fault (see map for more information).

The Office of Statewide Health and Planning and Development (OSHPD) arranged for CSMIP to begin instrumenting hospital buildings in 1989, and the program has instrumented 29 hospitals and health facilities throughout California.

Significant strong motion records have been helpful in shaping California’s seismic safety standards. Data gathered from the 1994 Northridge earthquake, for example, led to changes in California’s Uniform Building Code and gave engineers a greater understanding about the integrity of building structures after an earthquake.

An example of an accelerometer, placed at the Los Angeles Fire Command Center.

An example of an accelerometer, placed at the Los Angeles Fire Command Center.

About CSMIP

The CSMIP is a program within the California Geological Survey of the California Department of Conservation and is advised by the Strong Motion Instrumentation Advisory Committee, a committee of the California Seismic Safety Commission. Current program funding is provided by an assessment on construction costs for building permits issued by cities and counties in California, with additional funding from the California Department of Transportation, the Office of Statewide Health Planning and Development, the California Department of Water Resources, and other agencies.

More Resources

To learn more about the data collection and dissemination process, visit the CSMIP Website. To view existing data gathered from recent California earthquakes, visit the Center for Engineering Strong Motion Data.

All photos courtesy of the California Department of Conservation.

georgeby George Bischalaney
President & CEO, Eden Medical Center

National health care reform is now apparently right around the corner. After years of discussion, and more recently, weeks of debate in the House of Representatives, legislative action is now in the hands of the Senate. If enacted, it will be the most significant health care legislation in decades.

As a provider, it is both welcomed and feared. Welcomed in that it will help bring insurance to millions of people for whom it is now out of reach. In making this possible, it creates the possibility of opening doors for routine health care services that should help prevent late diagnosis of disease, which becomes problematic and costly to treat. From our perspective as a hospital provider, better access should redirect many people who use our emergency departments as their primary care providers.

But change comes with a cost.
The mind-numbing price tag of reform is expected to be offset by future savings. In the short term, it will require shifting payments currently dedicated to the Medicare program.

Most hospital providers do not make a profit in caring for Medicare patients overall. There is no doubt that we need to drive inefficiencies out of the health care system in order to help address this issue. But that alone may not do it. When costs are rising at a rate of 4-8 percent per year and reimbursement is 3 percent or less, we are constantly falling behind. There are many reasons for escalating costs. Consider the constant introduction of new drugs, high tech and high-cost diagnostic and therapeutic equipment, and of course labor. Health care is a service business and 60% of hospital costs can be tied to salaries and benefits. The cost escalation of these items alone will keep us chasing the elusive break-even point. And once there, if achieved, there is still ongoing capital investment that is necessary to maintain the capabilities expected of community hospitals.

The final package is likely still months away. Even then, it will take time to analyze and truly understand the effects, positive and negative, of this landmark movement. We hope that the final outcome will have the proper balance, consider as much as possible all the consequences, and result in a healthier and more stable provider system.

I welcome your feedback.

Economic Survey Shows 64% of Hospitals
Cannot Secure Funds for Seismic Compliance Mandate

The nation’s ongoing credit crisis and deteriorating revenues, caused in large part by governmental underfunding, is jeopardizing the ability of California’s hospitals to comply with state-mandated deadlines for seismic retrofitting, according to an updated economic impact report released today by the California Hospital Association (CHA).

The report, which is based on a survey of hospital chief financial officers (CFOs) conducted in April 2009, shows that 64 percent of hospitals report that they will not be able to access the capital necessary to comply with the state’s 2013/2015 seismic deadlines. More than a quarter of hospitals statewide (28 percent) have seen their interest expenses increase during the first quarter of 2009, while many other hospitals have been frozen out of the credit market entirely. As a result, hospitals throughout California are faced with limited access to capital and increased costs of borrowing. These dual challenges come at a time when hospitals are facing an unfunded mandate for seismic improvements estimated to cost up to $110 billion without financing charges.

“This report makes clear that revisiting the current timelines for the seismic mandate is essential,” said CHA President and CEO C. Duane Dauner. “The faltering economy is forcing all segments of our society to make difficult decisions. For many community hospitals, these decisions come down to whether or not they will be able to ensure that patients have access to care 24 hours a day, seven days a week.”

Under current state law, the state could force hospital buildings that are not in compliance with the seismic standards by January 1, 2013 (or January 1, 2015, if an extension has been granted) to close their doors to patient care. An estimated 900 acute-care hospital buildings, out of a total of 2,700 structures, face closure if they cannot meet the 2013/2015 deadlines.

In order for hospitals to access affordable capital for projects such as those related to the seismic mandate, creditors and rating agencies evaluate a hospital’s balance sheet and its demonstrated financial stability. Creditors also look for sustained operating results, specifically operating income of greater than 3 percent. In aggregate, California hospitals reported operating margins of less than 1 percent for each of the last three years, with margins in 2007 and 2008 in the red, according to the CHA report.

Among the factors impacting operating margins is a significant increase in the number of uninsured patients seeking care in hospital emergency rooms. According to the CHA report, more than 57 percent of hospitals have seen a rise in the number of uninsured patients during the first quarter of 2009, most likely as a result of rising unemployment and the loss of job-based health coverage. This is a 22 percent increase since CHA released its first economic impact report in January. Additionally, more than half of California’s hospitals are reporting a decrease in inpatient admissions and elective procedures.

In 2008, the costs of uncompensated care provided by California hospitals totaled $11.3 billion. Of that amount, Medicare payment shortfalls accounted for nearly $3.7 billion, while Medi-Cal underpaid hospitals to the tune of $4.1 billion. An additional $2.1 billion in 2008 losses are attributable to bad debt and charity care.

“California hospitals are not unique to the negative impacts of the economic recession,” Dauner noted. “The unfunded seismic mandate, however, places an extraordinary burden on our community hospitals at a time when they can least afford it.”

Access the full copy of the special report, called California Hospitals and the Economy — Ongoing Credit Crisis Jeopardizes Seismic Compliance Mandate.

George Bischalaney, President and CEO, Eden Medical Center

By George Bischalaney, President & CEO, Eden Medical Center

Health care reform is on the agenda, again. The stakes are high, but our President is determined to make some significant changes. As the discussion moves from general to specifics, special interests are staking out their positions. None of the stakeholders—hospitals included—wants to feel the impact or be at a disadvantage.

Amidst the demand for cost reduction and health care coverage for all, there is and must be continued investment in care. Physicians demand it. They expect to be able to practice with state-of-the-art equipment and facilities to produce outcomes that meet national, state and local quality standards. Patients demand it. They want to know that their local hospital has the right number of well-trained staff as well as the latest diagnostic and treatment equipment, and contemporary facilities.

With this backdrop of conflicting needs, Eden Medical Center is about to begin a three-year project that will result in the replacement of the Castro Valley hospital. The project cost is estimated to be $320 million. The current 55-year-old building is anything but contemporary. With few private rooms, small operating rooms and inadequate support space for clinical services, a new hospital is very much needed.

Eden Medical Center has served the community well, but it was not designed for patient comfort and needs, more for staff needs and functionality. While our project may seem ill timed given the uncertainty of hospital reimbursement, we are required to meet California legislated standards for seismic safety in hospitals. And it truly is needed.

We’ll celebrate our long sought goal with a ground-breaking ceremony on July 1st. Then we’ll spend the next three years continuing the investment in the new buildings and equipment, while observing and hoping that decision makers do not enact legislation that essentially penalizes us for the commitment we are making. When we celebrate the grand opening and our new beginning early in 2013, it should be with the same hope and dreams as those who celebrated the first ceremony in 1954.

George Bischalaney, President and CEO, Eden Medical Center

 

By George Bischalaney, President & CEO, Eden Medical Center

Last week, the Obama Administration kicked off its efforts to address one the President’s stated priorities, health care reform.  What does that mean, and what will be the result? I wish I really knew.

According to the President’s advisers—and Obama himself during the campaign—there is a need to extend health care coverage to millions of uninsured people across the country, while reducing cost and improving quality. Truly admirable goals with which very few could disagree.

Early discussion of President Obama’s plan calls for creating a savings of $634 billion over the next ten years to help fund reform. A recent article referred to this as a “down payment” on the overall expected costs. About half of this amount is targeted to come from reduced payments to Medicare and Medicaid (known as Medi-Cal in California) providers. On the surface, this is a disquieting concept.

Not too long ago, Eden Medical Center was recognized as one of lowest cost hospital providers in California. It should be no surprise that our costs have risen over the past few years. We have invested heavily in new equipment, both in medical technology and information technology, in order to continue to bring state-of-the-art services to our communities, and to provide our physicians and clinical staff the best tools to diagnose and treat our patients.

Last year, our labor settlement with registered nurses resulted in a three-year agreement that will give the nurses a 20% wage increase over the term of the agreement in addition to improved benefits. This kept our wages comparable to other local hospitals.

One of the benefits Eden Medical Center employees enjoy is a fully paid health plan for themselves and their families. Last year, the average cost was approximately $22,000 per year for an employee and family.

Despite these costs, Eden remains one of the lowest cost providers when compared to peer groups throughout the State. But as can be imagined, it is difficult to contain costs in our environment, especially when 60% of our costs are employee-related expenses. We are, after all, a service industry that is people- and technologically-driven.

The early announcements about health care reform create some concern. To expect to realize the savings needed to fund the plan through reduced payments to health care providers is very troubling.

Physicians are increasingly affected by efforts to reduce reimbursement. Many physicians talk of extending their days, working longer hours, much of which is devoted to the increasing amount of paperwork demanded from them. At the same time, we as patients expect them to remain current in the knowledge of new drugs and treatments in order to serve us to the best of their ability. This is resulting in a shrinking primary care base at a time when our population is aging. How does the plan for reform intend to address this?

Government payers of healthcare services for hospitals—the Federal Government for Medicare, and the State for Medi-Cal—are not paying the full cost of care at the present time. For each patient that is covered by Medicare or Medi-Cal, the cost to care for that patient exceeds current reimbursement. Further reductions will increase the gap that is, out of necessity, made up by insured patients—those lucky enough to have coverage through their employers. This is a cycle that needs to be broken if we are to have true health care reform.

The problems with our health care system are very complex. Reducing payments in an attempt to reduce costs will not yield the full reforms that are needed. I can only hope that this is not another piecemeal approach to change. A broader view of the systemic issues is needed. With the President’s staff talking about implementing reforms by the end of this year, it is questionable as to whether or not this will actually occur.

As always, your questions and comments are welcome. We will respond as quickly as possible.

George Bischalaney, President and CEO, Eden Medical Center

By George Bischalaney, President & CEO, Eden Medical Center

This past year was another busy year for our elected representatives, passing another bevy of bills that will impact hospitals and other health care providers. In every case, I have no doubt, each bill was written with some positive motive; to provide better access to health care services, to help control or reduce costs, to protect confidentiality or a patient’s right of choice, or in some cases mandating policies or practices that are costly to implement and monitor and may have a questionable cost benefit to patients.

But will more legislative remedies to the extremely complex and already cumbersome system of health services in California actually improve the patient care experience? One has to wonder.

In most service industries, the consumer helps direct change by withholding use of a service that doesn’t meet his/her needs. This is not as easily done when someone needs medical care. Yet the consumers, our patients, speak to us through direct communication and through their responses to the surveys we send. What we need to do is listen more attentively and respond more appropriately.

At Eden Medical Center we randomly send out surveys to patients who have been hospitalized, patients who use our mental health services, patients who have surgery and leave the same day, and patients who use the Emergency Department. We ask about every aspect of their experience, from the time they are registered through their discharge from the hospital. This includes physician and nursing interactions, quality of food and housekeeping, and the staff that drew blood or took an x-ray. Patients or family members are also invited to write comments, good or bad, and tell us anything else they think we should know about our services.

Hospitals are for the most part, stops of last resort for all. People come here already laden with apprehension, uncertainty and even a certain amount of fear. They have seemingly little or no control over what is about to happen to them or their loved ones. It is our job, our responsibility, to care for them as we would members of our own family.

If more legislation is needed to encourage us or force us to care for patients as we would our own family members, then we deserve what is given us. However, if we truly listen to our patients, our customers, and respond as a service industry that needs to be attentive to the needs of its customers, the industry would be vastly improved in terms of quality care and the patient’s experience. What more is really needed?

As always, we want to hear what you have to say. Please feel free to comment or ask questions in the comment box beneath each post, including this one. We will respond as quickly as possible.


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