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Feather River Bulletin
Quincy, California
April 15, 2015     Feather River Bulletin
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April 15, 2015

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Bulletin, Record, Progressive, Reporter Wednesday, April 15, 2015 9B COMMUNITY PERSPECTIVE Weathering financial storms at Plumas District Hospital It was June 6, 1986, the day before my wedding. My father-in4aw to be took me out to lunch to have a serious "man-to-man" discussion. I still remember feeling nervous and nauseated eating a Reuben sandwich when he said, "You know young man, money isn't important until you don't have any!" He went on to grill me on what I knew about our insurance premiums, rent, car expenses, utility bills, food allowances, savings accounts and emergency funds. As I had already changed my career path four times, I scrambled for answers but knew by his expression that they were pitifully inadequate. Finally, my heart welled upand I boldly looked him straight in the eye and said, "Sir, I may not know much about bills and money things but I can tell you that because I love your daughter so much I wilt work my tail off to do anything I can to support her and our family." There was a long uncomfortable pause as we stared each other down and, as WHERE I STAND up and says, "I just want to take care of people, focus on DR. JEFF KEPPLE what matters with patient care, CHIEF EXECUTIVE OFFICER deliver great services with a PLUMAS DISTRICT HOSPITAL smile and a handshake and go the extra mile for those in naive as I was, I think I gave need." Then I remember my him an answer he couldn'tfather-in-law's words: "Money refute, isn't important until you don't Nearly 29 years later, have any." naturally, I have grown a little Here I am with our team, less naive. I have seen destitute recruiting great new poverty in Haiti, Honduras, physicians, renovating patient Mexico, Kenya and in the inner rooms, buying necessary city of Oakland. I remember the equipment, collaborating and times when Tracy and I lived partnering with local hospitals paycheck to paycheck as she and tertiary care centers, all put me through medical school the while improving work teaching second grade. I flows, processes and remember the growing burden efficiencies at every of school loans, credit card opportunity. Still, we are debt, car payments and coming struggling to break even. Pay back from Haiti to find our car scales for most employees are impounded. I remember selling too low, leading to high my beautiful banjo for turnover. Healthcare systems textbooks and regretting it and regulatory compliance forever, grow more complex and Now, as the CEO of Plumasdemanding. District Hospital, I am staring We rise to every one of these into the face of a complex challenges, but this forces the healthcare system that seems administration-to-clinical to be dally grilling me on how personnel ratios upward, a to pay the bills. My heart wells nationwide phenomenon, increasing the overhead of non-revenue generating departments. Additionally, at PDH our commitment to provide emergency surgery and obstetrics requires an on-call OB team, OR team, surgeon, anesthetist and ultrasonographer 24/7 leading to high fLxed overhead. Now, we have started a wonderful new service line called Swing Beds, but unfortunately we will not be paid by CMS (Centers for Medicare and Medicaid) until we have our Joint Commission survey. Nonetheless, we are mandated to start the program prior to the survey, which will not be reimbursed until we are accredited and it is not retroactive. Furthermore, we will not be informed of when the survey will actually occur. Yikes! In May of 2014, one of my first big problems to tackle was a legacy of billing problems. We hired a consultant to not only assess but implement new processes, systems and protocols Basically an overhaul of the entire revenue cycle. I hired a bright new Patient Financial Services manager to lead a motivated team. Strides have been made, but once again regulatory complexity, payer mixes that constantly change, challenging and clunky software together with high personnel turnover leaves a huge monkey on our back a legacy of old Accounts Receivable. It gets harder to work and harder to collect the older the AR gets. This leads to the necessity of outsourcing and this, in turn, leads to the risk of potentially overly aggressive collection contractors who are supposed to represent the PDH mission of "promoting healing, health and wellness." When you are sick or suffering from a chronic illness and you responsibly pay your bills, there is nothing worse than gett'mg called from an outside entity calling prematurely or errantly, especially if they lack professional courtesy. (We are taking a close look at this by the way.) From na'ivet6 to the following a crash course in accounts receivable, accounts payable, general ledgers, profit and loss statements, credit balances and adjustments, bankruptcies, depreciation, insurance denials, payer stalling tactics, growing documentation requirements, working and re-working of accounts, large patient deductibles and price shopping, Medicare "over payments" and take backs ($224,000 last month), frustrated vendors wanting to be paid, and frustrated patients thinking PDH is "money hungry" in asking for upfront co-pays and self pay portions. Sometimes, I just want to go home and love my wife and kids, go to the Polka Dot, work in the garden and play my guitar. I received a letter of complaint dated April 2, 2015, by a very informed and intelligent couple who in two See Kepple, page 148 County management would be better with administrative officers This commentary is in WHEP I STAND There are 58 counties in work force has grown to 413Colusa County is about 80 representatives from the two response to Supervisor : California, and only fivefull-time personnel, withpercent complete in employee organizations, and Simpson's request for input BILL COATES aren't using a CAO form of another 100 extra:help transforming into a CAO almost all of the department on the need for the office of a RETIRED PLUMAS COUNTYgovernment. There may have positions. Alarmingly, theform of government, after not heads and elected officials. I SUPERVISOR County Administrative,been a good reason state passes about 5,000 new having it for about 12 years, am sure that they would Officer, or not. I believe the temporarily for Plumas laws each Year to further Quoting from their study, share their experiences and answer is a resounding YES. of Board of Supervisor County to get in this position confuse matters. Personnelsavings from not paying for a process with us without I would like to compliment affairs. In 1979, the county (and hats off to those that law gets more complicated CAO "may actually represent charge, if we were to become the Feather River Bulletin started losing ground with made it work), but not each year, and with it the a false economy. Lost interested. Also, CAOs from for its Feb. 25 editorial about the state in our struggle to permanently. According tothreat of more "employee opportunities, adverse other counties could be asked the need for replacing the keep our own property taxes, our personnel department,rights" lawsuits, personnel actions and to appear before our board of CAO's position with the After employee lay-offs and Plumas County has 39 The county can continue operating below maximum supervisors to answer county, which has been facility closures (and the departments reporting to five with this convoluted form of efficiency all come with a questions, pro or con. vacant for the last three reduction of services), we county supervisors with no organization. That will be up cost." I took the time to speak to years. The newspaper's began to finally stabilize county manager. This is like to the supervisors, and the They could have also about 13 department heads consistent presence in the Plumas County fmancially,a baseball team having five department heads which are mentioned the additional cost and elected officials. Most boardroom gives it a valuable The largest single factor in managers. One elected consulted. I was encouraged for outside consultants. Their cited the need for a CAO if vantage point from which to the turn-around was the official pointed out, "When that Supervisor JeffEngelcounty, is smaller than the funds are there, if the observe trends, both good acquisition of a county you have five people in ran on the idea that he Plumas County. Their selection is carefully done, and bad. administration officer, who charge, you really have no supported the CAO form of decision to implement this I haveexperienc~d 18 years guided our efforts, one in charge." The county county government, change was supported by ,'~: See Coates, page 11 B LETTERS to the EDITOR Guidelines for letters BOS should promote attract new micro-industries? All letters must contain an development Create tax-free enterprise address and phone number. Do you realize that the zones, remove red tape, Only one letterper weekper Plumas County Board of fast-track the entire building person will be published; only Supervisors has no plans for process. Then advertise your one letter per person per economic development? This"incentives" to the outside month regarding the same is another great reason for a world, have them consider topic will be published. CEO or professional Plumas County. That would Feather Publishing does not administrator for this be a start. print third-party, anonymous county. The BOS doesn't Trent Saxton or open letters. Letters must have the time, money or Lake Davis not exceed 300 words. Writers vocational experience to responding to previously manage economic Biomass boilers will be published letters may not development on the scale that harmful mention the author by name. is needed. This newspaper's editorial The deadline is Friday at 3 The key to success in board iS correct - having p.m.; deadlines may change building a healthy business these biomass boilers due to holidays. Letters may community is to create an throughout Plumas County be submitted at any of Feather economic development plan will have far-reaching Publishing's of]'wes, sent via that maximizes the impacts not only on our fax to 283-3952 or emailed to community's strengths and county but our state, too., minimizes its weaknesses. Biomass plants will be It's vital that the bulk of the located near dormitories, Knight right about Clinton populace is included in hospitals, schools and county Having just finished planning and execution, buildings. Air pollution from reading Greg Knight's 'My Get public input and buildthese biomass plants and Turn' regarding Hillary consensus. I like to believe diesel trucks transporting Clinton and her candidacy that in the end, old fashion wood chips will increase risk for President, I wanted to debate results in the best way for disease in children, compliment him on his to drag out hard issues, students, patients, healthcare forthright outspokenness, identify them, and addressproviders, county workers Hillary is not the favorite in solutions. You must fred out and citizens. and around the people I what the community will The justifications for know, and hopefully she will support and what it won't cutting down the forest for just fall by the wayside and support, industrial firewood started be a bad memory. What a You must identify all with "healthy forests" and thoughtless, inconsiderate, sources of money coming wildfire mitigation. Now the conceited, been on the public from the outside into the new propaganda concerns dole far too long, lawless community. This is not only water. The latest claims are person from the sale of goods andthat more water evaporates It is just too bad that with services but also such items in the canopies of un-thinned the current atmosphere in as retirement income. It is forests and that thinned Washington, with its 100 this external income that forests boosts water supply. percent corruption i.e.: Lois drives your internal These claims are bogus. The Lerner, Benghazi, Bergdahl economy. The internal Nature Conservancy report and the five released economy is the sale of goods states " it may [transpire terrorists, 'I have a pen and a and services by local more water]," and that it phone,' 'If you like your plan, businesses to local residents "may boost water supplies" you can keep your plan,' to and local businesses. This(SacBee 3/21/2015). There's a voice an opinion that is the information will allow you to big difference between "may" opposite of the current address expansion and and "will." occupants, can bring a world retention issues. Evaporation rates depend of grief onto oneself so Hey, county and city on weather conditions - not good, honest, thoughtful leaders: Do something. Build where the snow accumulates. people tend to keep their it and they will come. Snow would evaporate mouths shut. Encourage building an quicker in an open patch Good for you, Greg, I hope industrial park to attractthan in the shade of a tree. If more young people let their business or industry, thinning actually boosts voices and opinions be heard Determine as a team what water supply, that means in the coming months and would this county be willing much needed water is years to help get rid of all'the to offer new businesses toremoved from the forest. This riffraff in Washington. locate here? What incentives dries out the forests, kills Rosemary Key-Barnesare available that would keep trees and increases fire risks. Indian Valleyour existing businesses and Yes, these biomass plants will have far-reaching effects. More air pollution will harm human health. The forest will become drier and more prone to wildfire. Mechanized thinning will compact soil, kill ground vegetation and harm the.forest's ability to filter water. Animal habitats will be destroyed. Climate change and extreme drought demands extraordinary actions to protect our forests. Thousands of fulltime forest specialists (fn'e[ighters, botanists, zoologists) must be " hired to patrol and protect the forest from wildfire. It doesn't include destructive thinning for polluting biomass energy. Campfires and all outdoor burning must be prohibited. Finally, create a Manhattan-like project to utilize the free energy from the sun. Mark Mihevc Graeagle More research needed I am a little late in addressing what has been bothering me. This is in regard to the My Turn article in the March 25 issue. At a time when so many Christians are being persecuted for their faith, I was upset by your article putting such negativity on the subject of the Creation and Original Sin, especially so close to the holiest time of the year for Believers You failed to mention what a Godly man St. Patrick was or the good he did for that part of the world, snakes or no snakes. I have no knowledge of your beliefs, but I do think a little more research would have put more truth in what you wrote. Beverley Thielen Cromberg Frog wins, our economy loses Darla DeRuiter, in her well-reasoned January 21st column in this newspaper, made very cogent arguments for saving the yellow-legged and state Fish and Wildlife frog. The yellow-legged frog personnel to justify saving was referred to as the cause the yellow-legged frog when of the cancellation of the Lost our economy is failing and Sierra Endurance Run which we desperately need jobs. she states is a "significant No one from the public, the economic hit" to the county. Forest Service or Fish and Plumas County is losing its Wildlife cared enough about population base at the rate of the yellow-legged frog to one soul per day. If this is respond to our letter. allowed to continue, it won't DeRuiter states that 99 be long before our county percent of all species will lack the funds to support eventually go extinct. Maybe our critical services and our public servants smell a infrastructure. We lost cause? desperately need every single Another point DeRuiter job that can be created, raises is the $6,186 fee the Events like the Lost Sierra Forest demanded of the Endurance Run create jobs. sponsor of the race. Ms. In a letter to the editor at DeRuiter suggested that a about the same time as campaign might have raised DeRuiter's article, we invited the Forest Service personnel See Letters, page 11 B Contact your relected officials PLUMAS COUNTY SUPERVISORS- 520 Main Street, Room 309, Quincy, CA 95971; (530) 283-6170; FAX: (530) 283-6288; E-Mail: Individual supervisors can also be e-mailed from links on the county website, PRESIDENT - Barack Obama, the White House, 1600 Pennsylvania Ave NW Washington, D.C. 20500. (202) 456-1414. FaX: 202-456-2461. E-mail: U.S. SENATOR - Dianne Feinstein (D), 331 Hart Senate office Bldg Washington, D.C. 20510. (202) 224-3841; FAX: 202-228-3954; TTYflDD: (202) 224-2501. District Office: One Post Street, Suite 2450, San Francisco, CA 94104; Phone: (415) 393-0707; Fax: (415) 393-0710. Website: U.S. SENATOR - Barbara Boxer (D). District Office: 501 1 St Suite 7-600, Sacramento, CA 95814. (916) 448-2787; FAX (916) 448-2563. 112 Hart Bldg Washington, D.C. 20510. (202) 224-3553. FAX (202) 228-0454. U.S. REPRESENTATIVE, IST DIST. - Doug LaMalfa. 506 Cannon HOB, Washington, D.C. 20515. (202) 225-3076.; Facebook.eom/RepLaMalfa; twitter: @RepLaMalfa. DISTRICT OFFICE: 1453 Downer St Suite #A, Oroville, CA 95965, (530) 534-7100, FAX (530) 534-7800. STATE SENATOR, 1st DIST. -Ted Gaines. State Capitol, Room 3070, Sacramento, CA 95814. (916) 651-4001, FAX: (916) 324-2680. El Dorado Hills Constituent Service Center: 4359 Town Center Boulevard, Suite 112, E1 Dorado Hills, CA 95762. (916) 933-7213, FAX (916) 933-7234; Redding Constituent Service Center: 1670 Market St Suite 244, Redding, CA 96001, (530) 225- 3142, FAX (530) 225-3143. STATE ASSEMBLYMAN, 1ST DIST. - Brian Dahle, State Capitol, Suite 2158, Sacramento, CA 94249-00001, (916) 319-2001; FAX (916) 319-2103. District ONce, 280 Hemsted Dr Ste. #110, Redding, CA 96002; (530) 223-6300, FAX (530) 223-6737. GOVERNOR - Jerry Brown, once of the Governor, State Capitol, Suite 1173, Sacramento, CA 95814. Website: 445-284 I. FAX: (916) 558-3160.