Video and Audio
Jefferson Healthcare Commission Meeting – 06/29/2016
In Chelan, Wa the Jefferson Healthcare Board of commissioners met in regular session following the annual WSHA conference. Since our normal audio recording equipment does not travel with us, I recorded the meeting with my own handheld digital recorder.
To my surprise, the majority of my fellow commissioners took exception to me recording the meeting. When I refused to stop recording the meeting, they decided to conclude the meeting rather than continue. You can hear commissioner De Leo leave the meeting in protest of my recording. He later rejoins the meeting at about the 5:50 mark.
As I say during this brief meeting, I make sure a recording of all meetings is made because I feel it is essential for me to do my job. Everyone in that room needs to be held accountable for what we say- because what we say and do matters. Without a complete record of the meetings, too much time can be spent arguing about what we agreed to or said in the past, rather than discussing actually important and difficult subjects.
I truly thought this board was done debating the issue of recording our public meetings. A year earlier, I recorded our regular meeting in Chelan, WA in the exact same manner, but last year none of the objections raised during this year’s meeting were raised. The recording a year ago is here.
If you listen to the recording the following are the two objections raised as best I can discern.
- A hospital lawyer has advised that if a commissioner records the meeting, then the recording may be argued to be an official record and therefore needs to be archived with other recordings. The resolution to this point, as I say in the meeting and have said since this point was first raised two years ago: I will give the recording to the hospital to store with the other recordings.
- The second objection seems to be referring to the board policy on recording meetings which was intentionally drafted in a way to give the board the freedom to not record a meeting if it so chooses. The reason for this flexibility was to allow the board to meet with people off campus who might be disinclined to meet with us if we insisted on recording the meeting. If we insisted on recording such meetings, we might hamper our ability to serve our district if our access to elected officials became more limited. The policy in place at the time of this meeting reads as follows:
In addition to the written minutes of regular and special meetings, official audio recordings of all open public meetings may be made by board designated staff and said recordings will be processed, retained and made available in accordance with the Open Public Records Act.
Since this meeting was not with any outside entities and was merely a meeting of our board off campus, there was no reason for it not to be recorded. So I recorded it as I did the meeting in Chelan the year prior. Moreover, though this policy gives the board the choice to record a meeting or not, it does not take away every individual commissioners right to record the meeting if they so choose. I continue to be unsure exactly why my fellow commissioners decided to suddenly raise these objections and refused to continue the meeting while it was recorded. Below is the recording I made.
Single Payer and WHST Presented to Jefferson Healthcare Public Hospital District Board
At the 11/29/2014 Jefferson Healthcare Public Hospital Commissioner meeting the commission allowed 35 minutes to learning about single payer healthcare and specifically the Washington Health Security Trust (WHST), formerly known as HB 1085/SB 5224, a bill for single payer healthcare in Washington State. This is the first Washington State public hospital district to consider formally supporting (or opposing) single payer healthcare and or the WHST. This WHST is currently under consideration for inclusion in the 2015 Washington State legislative session.
This video includes a brief introduction by Commissioner Ready, a 10 minute presentation by guest single payer expert Dr. Ken Fabert of Physicians for a National Health Plan (PNHP), and approximately 20 minutes of public comment. The commissioners did not engage in any discussion of the issues during this session.
If the Jefferson Healthcare board votes to support this bill, this action might help convince the Wa 24th Legislative district representatives, Tharinger, Van de Wege, and Hargrove to also support the bill. Reps. Tharinger and Van de Wege sit on the House Health Care and Wellness Committee and Sen. Hargrove sits on the Senate Ways and Means Committee, making all of them highly influential regarding a bill like this.
It now appears likely the board an actual vote yes or no to support single payer and or the WHST will most likely happen at the following regular meeting of the Jefferson Healthcare Commissioners, Dec 3, 2014.
Candidates Matt Ready and Savannah Hensel Ask Jefferson Healthcare Board to Make Access a Top Priority
http://readyforhealthcare.org – On July 3, 2013 I spoke at a Jefferson Healthcare Hospital Commission meeting and asked the board to respond to the problem of healthcare access by taking the first step of making it a documented top goal in the Jefferson Healthcare Strategic Plan. Here is the video of my comment, their responses, and the followup comment from Hospital Commissioner Candidate Savannah Hensel.
I ask you declare healthcare access a top priority of this district, add it to the strategic plan, and set an aggressive goal for us to improve it.
A brief summary of the dialogue:
Matt Ready: The strategic plan is a great accomplishment, but it has something critical missing- access. Access is a problem in our community- and across our nation. 14-29% of the residents of our district are delaying or not seeking healthcare due to financial barriers. This is a serious problem with serious consequences. The ultimate solution is universal single payer healthcare- which I hope you advocate for when you meet with our State and Federal representatives, but you don’t have to stop there. Our hospital district can follow the lead of other local public institutions like San Francisco, Howard County Maryland, and Snoqualmie Valley Hospital and develop our own innovative solutions to make healthcare affordable and accessible for more people. We should be working to make healthcare financially accessible to 100% of our community- but we won’t do it if we don’t try. We won’t try unless you make it a goal of our district. You have the power to make it a goal and push us to work on this. I ask you declare healthcare access a top priority of this district, add it to the strategic plan, and set an aggressive goal for us to improve it.
Summary of Responses from Mike Glenn, Jill Buhler, Marc Mauney, and Tony Deleo:
- Absolutely, access is a top priority of the commission and all of administration. Everyone agreed to this…yet
- It is unnecessary and redundant to put access in the JHC Strategic plan- since we already focus on access in everything we do (like breathing).
- Jefferson Healthcare already does more than other hospitals since we don’t turn anyone away- and this is good enough.
- The Affordable Care Act will expand Medicaid and create more subsidies for people to buy private insurance, so we should wait and see how well that helps improve access.
- If people are not coming to Jefferson Healthcare due to cost, then that is their fault. JHC doesn’t “bar the doors” or turn anyone away. We constantly tell everyone in our community to come in, even if they cannot pay.
- Years ago, the Jefferson Healthcare Board of Commissioners considered two major actions to improve access:
- Creating an affordable access program with KPS that would give people a way to have catastrophic insurance coverage, pay JHC a small stipend, with the guarantee they could get all their medical needs met at Jefferson Healthcare at a reasonable affordable cost. This initiative was stopped when the State Insurance commissioner said it was “illegal”.
- Creating a larger free healthcare clinic similar to the one at Olympic Medical Center. This was voted down by at least one commissioner because he didn’t want people to have the indignity of having to go to a separate facility if they lost their job and insurance.
Matt Ready: In response to Commissioner Buhler description of the affordable access program that was considered but never implemented, I remarked that that is exactly the type of innovative thinking we could be doing right now to improve access. Maybe there was a way around the roadblock created by the State Insurance Commissioner.
Savannah Hensel: Savannah asked if in the last 10 years any of the Hospital Commissioners had experienced life without health insurance and without financial access to healthcare. (No commissioners responded.) Savannah then shared that she has spend 95% of her adult life without health insurance and without the ability to afford her hospital bills despite the sliding scale policies of the hospital. She said she knows what it is like to not have access due to the financial barrier and she seconded the request the Jefferson Healthcare make access a top 5 priority and add it immediately to the Strategic plan.
There were no further responses and the meeting adjourned.
Conclusion
This was a great opening dialogue with the hospital commission about access! It is obvious all the commissioners care about access, the problem is they either think access is not a problem or that the hospital district is already doing everything it should be doing. At a future commission meeting I will address some of the reasons they think this way and continue to challenge them to recognize the opportunity for helping make healthcare more accessible to all people in our community.
Anyone who has any thoughts, questions, or comments about this please feel free to contact me at readyforhealthcare@gmail.com or use our contact form.
Update!
Here is a sneak peek at what I will be saying (my current rough draft) in response to the Board’s concerns at the next commission meeting:
At the last commission meeting I asked you to declare access to healthcare a top priority of this hospital district, add it as a top 5 priority in the Strategic Plan, and challenge us to work towards an aggressive goal for improving it.
I received a number of thoughtful responses- although overall I would summarize your response as:
You agree access is a top priority, but you feel you are already doing everything appropriate in that realm, and there is no need to add it to the strategic plan. Tony even went so far as to say it would be like reminding employees to breath- since access is always considered in our decisions.
I work in performance improvement. It is my job to help directors, leaders, departments, and staff solve problems. When I am called into a meeting about a problem, the first step is always working together to clearly define the problem- and agreeing to clear metrics for measuring the problem. If you don’t do that, then you are not all speaking the same language.
You and I are not currently speaking the same language about access.
Is access a problem in this hospital district? If it is, how big of problem is it? Is it more or less of a problem than it was 2 years ago? How are you answering these questions?
Several of you said, this hospital is more generous than any other hospital district in the state. That may be true- but is that good enough? Maybe sometimes being the best is not good enough.
Several of you said in essence that access is not a problem since we don’t turn anyone away. As Tony said, we don’t bar the doors. If they aren’t coming, that is their choice.
I applaud you for having a policy more generous than other hospital districts. I applaud you for not denying people health care if they cannot afford it. But remember, what do we do if someone gets care here and cannot afford their portion of the bill- even after we adjust their bill for sliding scale? What do we do? We collect on them. We pressure them to pay just like any private corporation would. Those who cannot pay what we judge they should, we send to collections. We don’t close our doors to anyone- and if you cannot pay your portion of your bill, we will send you to collections. That is the current state of access at Jefferson Healthcare. Yes, it may be better than other hospital districts- but that doesn’t mean it is good enough. This is one area, where I think you should stop comparing yourself to your peers, and start looking more closely at this problem in your community.
We offer access to healthcare to people who cannot afford it like a credit card company offers access to money- we are happy to give it to you- but we will come after you for it. When given that choice- the people who cannot afford healthcare suffer. They suffer when they struggle to pay their bill. They suffer when we pressure them. They suffer when they are sent to collections. They suffer when they choose to delay or avoid care altogether because they don’t want to go into debt.
How do you know if healthcare access is a problem or not? To know, you have to define it and measure it. That takes some serious thoughtful conversations that will not happen in this brief public comment period of the commission meeting. But you can make these serious thoughtful conversations happen- if you as our leaders declare it a priority.
It doesn’t mean you are committing to any specific action, all I am saying is make us delve into this, make us figure out how we measure access, make us report to you the state of access, and then decide if there is a problem. Then you will have a measure to monitor. Tony said, if the ACA falls apart, then we will do something. How will you know if the ACA is working or not if you aren’t measuring anything?
If you declare it a priority- and put it in strategic plan, that sets the gears of improvement energy in motion. That forces us to be accountable to this goal. I know- as this is what I do at Jefferson Healthcare. The strategic plan drives our focus- as it should.
As I said last time, if you look at this, you will see a serious problem- a great opportunity to help our community.
Thank you.