During this board meeting, I presented the following 2 proposals to the board:

Proposal 1:  Define Board Expectations for Collections Practices and Policies

This board has defined and often talked about what our expectations are for how this public hospital district conducts medical care, but we have not given similar clear guidance regarding our expectations of our financial services.

I think it will be helpful moving forward, if we add to our Ends goals a clear statement characterizing our expectations for how this hospital district financially impacts the lives of our patients and their families.  With this in mind, I propose we add to the Boards ends policy the following:

1. The Jefferson Healthcare billing, charity care, and collections policies and practices will be fair, reasonable, and as compassionate as possible, within the limits of the law and available resources.

After we agree to this amendment, we can then begin discussing how to monitor the districts effectiveness in achieving it.  But the first step is simply stating our end goal.

Proposal 2:  Board Monitoring use of 3rd party Collections Activities

My 2nd proposal is that this hospital board immediately begin monitoring the use of 3rd party collections companies by this hospital district.

A collections monitoring report will serve to help monitor several board policy goals including those in finance, patient satisfaction, public image, community health.

I know the Jefferson Healthcare financial counselors strive to work with patients to come up with affordable solutions.  But, when this does not work out-for any reason, patients may end up sent to collections on a medical debt they cannot afford- and the consequences of this are severe.  These consequences include:

1. The patients credit getting damaged.

2. The patient being subjected to extraordinary collections actions – in the name of Jefferson Healthcare but without the direct oversight of Jefferson Healthcare staff.

3. The patients learning to view Jefferson Healthcare as an adversary rather than as a partner and steward of healthcare in our community.

4. The patient learning that seeking healthcare will have severely negative financial consequences- and so they stop seeking it promptly when needed- putting their future health at higher risk, and contributing to the likelihood of expensive yet preventable emergency care in the future.  (Note: if the patient is unable to afford the emergency care bill, the public will end up paying for it- at a much higher cost than the cost of the initial preventative care.)

I know my fellow commissioners want Jefferson Healthcare to relentlessly strive to be a partner and steward of our communities health and by monitoring our collections activities we will gain a valuable perspective into how well we are doing towards this goal.

I recognize this hospital district has a fiduciary responsibility to act to collect debts.  But I also recognize that its mission is not to maximize profits at the expense of the health of our community.  Our mission is to serve as compassionate partners in the health of our community- and this means we must be particularly mindful of any actions we take that may in fact harm community members.

So, due to the significant consequences in the realms of finance, customer satisfaction, community health, and public image- that result when sending a patient account to collections, I propose we immediately begin taking steps to monitor data related to our use of these 3rd party collection services.  

I recommend we begin by reviewing as soon as possible a detailed study of Jefferson Healthcare collections practices including the following data:

Trends and totals for:

1. Total number of open accounts currently held by 3rd party collection agencies.

2. Monthly # and % of patients sent to collections.

3. Monthly total money recovered through collections agencies.

4. Monthly total money written off despite use of collection agencies.

5. Annual trends and totals for these same items going back 5 years.

After we review the data, I will then recommend we immediately discuss setting clear goals and guidelines related to it.

I also repeated the following proposal I made at the 3/5/2014 meeting:

Publish Board Bylaws and Policies Online

Jefferson Healthcare immediately publish the most current versions of our hospital board policies and bylaws on the hospital district website for easy review by the general public.

Below is a transcript of the verbal exchange about the board policies and bylaws proposal.  This was basically a discussion on whether or not we wanted to discuss the idea.  There was no support for a 2nd for my motion to consider this proposal, so we did not officially consider it.  (According to Roberts Rules of Order the way a board action works is 1- someone makes a motion,  2- someone seconds the motion, 3- Discussion of the motion, 4- Vote).  If you wish to listen to the dialogue it is at the 01:46:30 mark! :

C. Ready:  Last meeting I asked if there was interest in publishing our policies and bylaws online.  There was some thought that you would like to think about it.  I was wondering if there is anyone that is interested in discussing putting our board policies and bylaws online?”

C. Dressler:  I think this would come again at the April…because we don’t have anything we’re going to put up at the moment because we’re going through reviews and revisions and the decision as to what form of governance.  So that’s my personal take on it.  So I don’t know what you…

C. Deleo:  I believe I recommended at the last meeting that we wait on publishing that until we have the final out of our rewrite.  I think publishing one and then a month later publishing a second one could be confusing.

C. Dressler:  And do you have any comment Chuck.

C. Russel:  No.  I agree with Tony.

C. Ready:  Personally, I think it’s…they are our current policies and I think it is reasonable to put the current policies that we’ve been operating under up.  But I sense I am not going to get a second to that motion.”