Merced County Grand Jury • 2004-2005

This Final Report HAS Been Reviewed and Unanimously Approved by the

Published: June 27, 2005 69 pages Consolidated Report
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Note: Missing finding numbers detected: F7, F8, F17, F20

Findings and Recommendations 22 findings

F1 Page 24
Impact Evaluation Report of the Proposed Closure of Emergency Services, Mercy Medical Center Merced, Dominican Campus dated 10/18/02.
No recommendations for this finding
F2 Page 24
Proposal from Mercy Hospital (CHW) to enter into lease of Sutter Medical Center Merced, (formerly MCMC) from Merced County dated 5/18/00.
No recommendations for this finding
F3 Page 24
Review of Welfare & Labor Code # 17000 – Indigent Care in Merced County.
No recommendations for this finding
F4 Page 24
Asset Purchasing Agreement between MMH & Sutter dated 11/21/00.
No recommendations for this finding
F5 Page 24
Assignment & Closing Agreement #2000240 dated 11/21/00.
No recommendations for this finding
F6 Page 24
Amendment to Hospital Lease Agreement between CHW & Merced County #2000236 dated 11/21/00 7. Amended & Restated Health Operating Agreement between CHW & Merced County # 2000244 dated 11/21/00 8. Hospital Lease between Sutter & Merced County #9595 dated 11/12/96.
No recommendations for this finding
F9 Page 24
Health Care Operating Agreement between Sutter & Merced County #9596 dated 11/12/96.
No recommendations for this finding
F10 Page 24
Master Service Agreement between CHW & Merced Co # 2000241 dated 10/8/02.
No recommendations for this finding
F11 Page 24
Security Agreement between CHW & Merced Co # 2000242 dated 10/8/02.
No recommendations for this finding
F12 Page 24
Guaranty Agreement between CHW & Merced Co # 2000243 dated 10/8/02.
No recommendations for this finding
F13 Page 24
Merced County Goals & Objectives.
No recommendations for this finding
F14 Page 24
Various newspaper articles.
No recommendations for this finding
F15 Page 24
CHW Financial Statements – 1997 through 2000 and 2003.
No recommendations for this finding
F16 Page 24
Summary of MCMC Employee job classes and salary ranges – 1996 17. County Financial Obligation for Accrued Time of MCMC Employees at Transition to Lease dated 4/22/96.
No recommendations for this finding
F18 Page 24
Merced County Indigent Healthcare Program review of Operating & Facility Use Agreements & Medical Assistance Programs. Prepared for the County by Pacific Health Consulting Group, an outside consulting group.
No recommendations for this finding
F19 Page 24
Public response concerning CHW takeover. 24 20. Summary of medical services referred outside of Sutter (SMMC) that used to be provided by MCMC dated 8/22/00.
No recommendations for this finding
F21 Page 25
MMCM Capital Improvements for 2003.
No recommendations for this finding
F22 Page 25
Correspondence regarding ER problems in 2001.
No recommendations for this finding
F23 Page 25
CHW Charity Care/Financial Assistance Policy adopted 1/27/04.
No recommendations for this finding
F24 Page 25
State of California Employment Development Department, Labor Market Information Division, updated Jan. 14, 2005.
No recommendations for this finding
F25 Page 25
State of California Employment Development Department, Labor Market Information Division, Planning Information Packet Merced County 2004.
No recommendations for this finding
F26 Page 25
US Census Bureau FINDINGS • Merced County is one of the poorest counties (sixth smallest budget among 58) in a state with a significant budget deficient ($ 8-9 billion) that is in a nation with a tremendous budget deficient ($412-422 billion). The County has one of the highest unemployment rates (13.8 %) in the state. The state rate is 5.4 %; the nation’s rate is 5.1%. Merced County is among the most rural counties in the state. It is primarily agricultural with virtually no manufacturing or industrial base. The 2002 US Census estimates that 18.8% of all citizens in Merced County live in poverty. The hospital is required to provide services for a large majority of the indigent and uninsured populations. • Of the various government programs (Medi-Cal, Medicare, State of California Extended Access Program (SCEAP), Indigent Health Care Program (IHCP) formerly known as Medical Assistance Program (MAP), no program appears to compensate the provider enough to cover expenses. While some state funding is available in the form of secondary programs, these as well do not seem to make up the loss. In other words, there is a very high level of un-reimbursed medical care in Merced County. • The primary service area for MMCM consists of the eastern two-thirds of Merced County and parts of Madera and Mariposa counties. The latter two counties are almost exclusively rural as well. • The secondary programs, available through the State of California Department of Health Services (DHS), consist of ‘Acute Hospital Inpatient Disproportionate Share’ (DHS-855) and ‘Emergency Services & Supplemental Payment Fund (DHS-1255). Both of these programs make supplemental payments at a facility level. Basically, DHS-855 is available to hospitals that have a 25% or greater rate of indigent care. • Most Medicare HMOs left due to the combination of low reimbursement levels and a lack of cooperation from local doctors. • Many of the local physicians refuse to accept Medi-Cal reimbursement rates that are offered by CHW (roughly what the hospital receives for the same service) for staffing clinics or ER On-Call. The physician’s view is there is no incentive to leave his or her own insured patients for un-reimbursed care emergency calls. It becomes a financial burden to the physician. • The County will not reimburse non CHW clinics, (i.e., Golden Valley Health Centers) that will accept Medi-Cal reimbursement rates for treating IHCP clients. 25 • Due to the low rate of reimbursement, CHW has no incentive to hire on-staff specialists. Having the specialist on payroll would only increase their non-reimbursed care – It is fiscally unsound for both the private physicians and the hospital. • In 1993, there were seven hospitals in Merced County: Westside (Gustine/Newman), Dos Palos Memorial, Memorial (Los Banos), Bloss & Castle (Atwater), Dominican & Merced Community Medical Center (Merced). There are now three that are still open – Mercy Medical Center Merced (formerly MCMC) in Merced, Memorial in Los Banos and Dos Palos. • The MMCM Emergency Room is a high financial drain. Across the nation, emergency rooms have closed because of the cost to run them. Medical costs are high for a multitude of reasons all the way from the billions spent in research, expensive equipment, people living longer and the high level of over utilization by patients, etc. • There is a shortage of nurses nationwide. Competition is fierce and Merced County is not in the best competitive position. This can be said of doctor recruitment as well. MMCM currently uses registry nurses to fill open spots in their schedule. Besides the high cost, there is generally as issue of lack of commitment and buy in from a temporary employee. Registered nurses in Merced County earn $27.09 to $39 per hour. If they are in a lead position, they earn 5% more. When they work in-house registry at MMCM, they are paid double time for overtime, with a number of provisions for on-call and call-back situations. There is also a clinical ladder that provides additional pay for certifications. • Recruiting of new surgeons and specialists to the Merced area is another concern to the community. The current hospital facility and the economics of the county are a major issue to the potential new physician and their families. • The closing of the Dominican Campus hurt the surgical community financially as many of their paying (insured) patients refuse to go to MMCM and opt to have their surgery performed out of the area. MMCM is often perceived as the “County” hospital and carries a stigma because of this perception. Its physical location and the age and look of the buildings itself. Many people are afraid to go to the facility. • Some local surgeons have opened their own private surgical center in Merced. In response to this, MMCM contracted with the major health insurance companies to be the exclusive provider in the area. • Dominican Campus had a long tradition of community support, including donation of time and money. Many contributors and volunteers are not committed to MMCM because of the stigma of it being a “County” hospital, it’s location on 13th Street and it’s physical appearance. • There were no cleanliness issues during the unscheduled visits to MMCM. SUMMARY & RECOMMENDATION A new Emergency Room team has been hired as of early December 2004. Not enough time has passed to truly evaluate their performance. A LVN is on duty in the ER waiting room 10 hours every day to assist waiting patients. Additional auxiliary staffing, (technicians in radiology, labs, etc.) would help to improve emergency room wait time. At this time, this appears to be a result of the overall makeup of the County’s economics, social perceptions as well as a game of sour grapes. All parties, (CHW, physicians, community) need to put aside their hurt, prejudices and differences and work together. Each group has a beneficial interest in its success or failure. Cooperation and respect between all parties could only help the situation.
No recommendations for this finding

Commendations 58

Comments 1

No Responses Found 3

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Merced County Board of Supervisors Elected County Office
Merced County District Attorney Elected County Office
Merced County Sheriff Elected County Office