The San Juan Health Service District board met in a marathon session on February 27, with the majority of the meeting held behind closed doors.
Before breaking into a three hour closed session, the board discussed critical issues facing the district, including a severe cash crisis and the resignation of three doctors and other key staff members.
The cash crisis was brought about, in part, by the acquisition of a new Electronic Medical Records (EMR) system approximately one year ago.
The new system, by Cerner, cost $1.4 million and includes a $29,000 per month maintenance fee. Despite the hefty price tag, implementing the EMR system has proven to be a financial nightmare for the district.
Accounts Receivable (AR) have grown to the point of creating a cash crisis. Officials state that AR for the district takes more than 90 days to collect, while AR at Blue Mountain Hospital takes about 30 days to collect.
“We have hired a new collections agency,” said Laurie Schafer, interim CEO of the District. “We have found that the queue of invoices is workable and payable, it is just going to take work.”
District employees discussed their strategy of getting on top of current billing, in addition to rebilling unpaid invoices from the past year. The district also plans to rebill invoices from the system that was replaced in 2013.
“The goal is to turn this around in 90 days,” added Schafer.
While discussing an assessment from Cerner about the billing challenges, board member Steve Simpson said, “The challenges and recommendations are daunting, to say the least. We have been brought to brink of ruin by policies that we shouldn’t have allowed to happen.”
While discussing ongoing changes, Simpson added that the district needs to “clean house, get a new start and move ahead better than ever.”
Despite the current conditions, Simpson added that he is hopeful for the future. Responding to a comment from the public that the district will close, Simpson said, “We are bailing mightily, and we don’t think that the ship will sink.”
Schafer outlined an aggressive strategy to replace three departing doctors. Five firms are seeking permanent and temporary replacements. The district is receiving proposals from visiting specialists from other areas.
In addition, local doctors outside of the system may also be used. In fact, increased cooperation between the district and other health systems in the area is a key component of any turn-around effort.
Donna Singer, who was instrumental in the creation of Utah Navajo Health Systems (UNHS) and Blue Mountain Hospital (BMH), said she had been instructed by both organizations to attend the meeting. They operate the hospital in Blanding and clinics in Blanding, Montezuma Creek, Monument Valley and Navajo Mountain.
Singer said, “UNHS and BMH are more than willing to work together, in whatever capacity we can, to help provide a countywide health system.”
“If we expand our vision,” added Singer, “there is no reason we can’t have high-quality health care in every area of the county.”
Board member Burton Black said, “We have been committed to two Critical Access Hospitals in San Juan County for quite some time and believe that the county has never been better served.”
Singer shared the BMH experience with EMR systems, adding, “It is an extremely difficult transition for everyone at the hospital. It is not an overnight transition. You have to be patient, but in the end, it elevates quality of care.”
A series of personnel changes have caused havoc in the district, which all came to a head when Dr. Curtis Black, Dr. Paul Reay and Dr. Bryce Peterson all recently announced that they are leaving.
In December, 2013, the board did not renew the contract of CEO Phil Lowe and hired Schafer as an interim CEO. At about the same time, the license of Dr. Kris Hayes was rescinded by the state.
In recent weeks, several additional staff members have resigned or retired, including key members of the billing staff.
The employee turnover has caused morale challenges and generated uncertainty in the communities served by the district.
Isabel Reay, the wife of Dr. Reay, told the board, “You have got to acknowledge that there is a personnel issue at the hospital. Problems have been there for a very long time. Are you going to investigate this properly, or not?”
Referring to the personnel issues, Simpson said, “Three doctors have chosen to leave, for whatever reason. That is there choice, not ours.”
The agenda listed the extended closed session to discuss “Personnel Issues/Possible Litigation”. Several board members said they are not aware of possible litigation, leading to the assumption that personnel issues are the main topic of the closed session.
(Next week: The San Juan Record will take a closer look at health district operations.)