As Lakeside Medical Center’s bleeds red ink, some people are asking whether the public hospital should stop delivering babies and instead become a sort of emergency room and a place where patients are stabilized until they can be transferred.
When the Palm Beach County Health Care District’s board meets for its annual strategic planning session on Tuesday, July 21, that option is likely to come up, if only for discussion.
Keep in mind, it’s a 30 mile-plus drive to the nearest hospitals in Loxahatchee, Wellington or West Palm Beach; and the special taxing district’s state charter holds it responsible for operating “at least one” hospital in the Glades.
As the Post’s John Pacenti reported, the hospital booked a $16.6 million loss last year, and over $6 million of that came in the form of a penalty from the state for overcharges, a penalty that hasn’t been paid and is under negotiation, according to district CEO Dr. Ron Wiewora.
Given the economic realities around it, it’s unlikely the hospital could ever turn a profit. Still, high subsidies might be forgivable if more people were staying at the hospital. But they’re not. Lakeside’s average daily census is now 26.4, down from 30 in 2011, when the Health Care District hired a consultant to try to improve Lakeside’s market share. To be fair, its busy emergency room has held its own, with 24,500 visits last year.
It’s not that Lakeside is providing sub-standard care. On the contrary. Its outcomes as measured by Medicare stand up to those of much larger hospitals.
But time after time, its wounds are self-inflicted.
In late 2013, Wiewora abruptly dismissed the district’s chief financial officer and health operations officer. The business manager who was left in control of the district checkbook didn’t show up for work a few months later. It turned out he had been arrested, accused of taking money from an unrelated nonprofit. Auditors found no evidence that he had misappropriated taxpayer funds, fortunately, but they found he had set up new companies and was trying to recruit district staff.
That mess came on the heels of a crisis in inventory management, which came on the heels of a billing crisis, which coincided with a crisis in information technology, and so on.
The Health Care District doesn’t just run a hospital. It manages insurance products, clinics, school nurses, Trauma Hawk and a nursing home. Arguably, the district’s executives have too many disparate, highly complex responsibilities. Wiewora, a physician by training who’s energized by helping patients, seems unwilling to admit his weaknesses and too prone to cast blame on others. So what to do?
1) One option may be for the hospital to become part of a strong local accountable care organization, a group of affiliated health providers that shares in whatever it saves Medicare and private insurers. The most successful ACOs use information technology and data to drill down into their cost centers. That’s not happening in a systematic way at the district, so there’s room to improve, and build relationships with area doctors.
2) Ultimately, it might make sense for the hospital to hire its own staff obstetricians, instead of paying a fortune to an outside group that sends insured moms elsewhere to deliver.
3) The smartest option of all may be to contract with a hospital management company that specializes in running small, rural hospitals, and has the bench depth the Health Care District lacks.
What do you think? Would struggling Lakeside Medical Center be better off run by a management company?
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