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.”

I don’t have a full record of the March 5, 2014 commissioner meeting, but I do want to share several items I brought up to the board during the board business portion of the meeting.  Please note, these are not exact quotes, but are paraphrased from my recollection and the statements I had prepared and brought with me to the board meeting.

Item 1:  Board Policies and Bylaws Transparency

The first issue I raised was regarding the publication of board policies and bylaws on the hospital district website.  I said something to this effect:

“I think it is important that this board operate in a transparent and open manner so that the public can best understand what we are doing and why we are doing it.  With this in mind, I think we should publish our board policies and bylaws online.  These documents inform virtually every action and decision this board touches upon during these commission meetings.  Moreover, I know we are considering revising these documents and as such, isn’t it appropriate for the public to understand the current policies so they can appreciate our discussions of how to change them?  I would like to know my fellow commissioners thoughts on this.”

The other commissioners made some remarks, but I do not have their exact words, so I do not want to attempt to paraphrase them in case I misunderstood.  We did not take action on this suggestion during this meeting.

Item 2:  March 21 Special Session Questions

Next, in reference to the March 21st special session I said:

“I believe the March 21st special session is largely being scheduled in response to my request for information and discussion which I stated during our board retreat and at the following board regular session.  With this in mind, I wanted to make certain everyone understood clearly what questions I am hoping for us to focus upon.  I am more than happy to meet with and work with the facilitator who is planning that special session to help make this happen.  My questions are:

1. What is the current organizational view of community health needs- which it has been using to guide major policy and decision making including the ESS building project?
2. What is the current organizational priorities amongst these recognized community health needs?
3. How will the new building project impact/ benefit the community?  (This might be titled a “Community benefit Analysis” or “Community Health Needs Impact Analysis”)
   1. What will be our mechanism’s for evaluating the building project’s effectiveness regarding community benefit?
   2. What are the building projects measurable objectives re community benefit?”

The other commissioners made some remarks, but I do not have their exact words, so I do not want to attempt to paraphrase them in case I misunderstood.

Item 3:  Community Health Needs Questions

The 3rd major issue I raised were questions about the Community Health Needs Assessment which the hospital is participating in collaboration with the Health Department.  I said:

I propose we formalize in policy this organizations relationship to community health needs assessments.  I think this will help us moving forward.

Questions we will benefit from asking and answering clearly include:

1. Why are we participating in a community health needs assessment?
2. Who is responsible/accountable for the successful completion of a community health needs assessment?
3. Is the community health needs assessment important for the board to effectively govern and for JHC leadership to successfully strive to fufill the hospital districts mission?
4. How often should a community health needs assessment be done?What is to be done with the community health needs assessment upon completion?  Based on my research, there are 3 things that can happen after a community health needs assessment.  First and most common is NOTHING.  This, Dr. Locke reminded us is far too often the result.  But the two very positive constructive things that can happen are a Community Health Improvement Plan, which would be done in collaboration with other community stake holders, and a community benefits report, in which the hospital would clearly state its plans to take action to positively impact the health needs of the community.  Which of these choices will we make?
   1. Will we participate in a community health improvement plan process?   If so, how often?  Who will do it?  How will it’s effectiveness be monitored and evaluated?
   2. Will we require a community benefit plan be drafted for JHC?  If so, how often?  Who will do it?  How will it’s effectiveness be monitored and evaluated?
5. Does the current JHC mission statement adequately affirm that our policies integrate and reflect the public interest in our meeting our responsibilities as a public hospital district?  In other words, does our mission statement clearly state our simple responsibility to “identify and meet the healthcare needs of our community?

I have found some models used in other healthcare institutions that answer the above questions which I am considering consolidating into an amendment proposal for this board to consider.

There was no discussion following the above remarks.

Item 4:  Charity Care and Collections Policies

Regarding hospital charity care and collections practices I said,

“I have some concerns that our charity care and collections policies and practices are not as fair and reasonable as they could be- and as the board might expect them to be.  I met with a private citizen this past week who had done some interesting research into our collections practices and it was very thought provoking.  I suspect we have some strong opportunities for improvement.  I also think it is appropriate for this board to set very clear expectations about our hospital district charity care and collections policies, perhaps even if it is merely to say, “The charity care and collections policies of this hospital district will be fair, reasonable”  and perhaps even “compassionate.”  With this in mind, I am considering drafting an amendment to our board Ends policies regarding our charity care and collections practices and how we might monitor such expectations.”

There was no discussion following the above remark.

Next Commission Meeting:  March 19, 2014

I will keep this blog updated as I continue to work with the commission towards action on the items above and more.