The medical center must learn to compensate for its underprivileged status in the county bureaucracy. Dave Kears, much like George Bush, has pushed a privatization model on county health services. Non-profits, the medical center, and for profit healthcare providers all compete for limited county healthcare dollars; instead of cooperating to provide coordinated care. So if a mental health agency can drop off an alcoholic for a week or two at Highland and then let the medical center find them a place to live, it makes their bottom line look good.
Here’s a hypothetical you’re a private hospital administrator with a problem patient: she needs a nursing facility, she’s too young for Medicare, she has multiple sclerosis, she can’t walk, she’s incontinent, she has bedsores and psychiatric problems (which she refuses to treat.) She’s sitting in your thousand dollars a day hospital bed screaming and scaring your paying clients with non-stop profanities. In an effort to manage her screams and complaints her doctor has her on enough morphine to knock out a bull elephant and of late she’s taken to throwing food at the nursing staff and talking about suicide. Then she does you a big favor, she jumps out her first story window and sustains some scratches landing in the bushes below. In a stroke of administrative genius, it occurs to you, this is your opportunity. You dial 911 and when the ambulances arrive you tell them she is a trauma victim and have them take her to Highland. Patient dumping or appropriate triage, you be the judge?
Enough speculation, it suffices to say many clients with complex needs and problems miraculously end up in the medical center. This occurs in spite of private and public mental health services, adult protective services, the county conservator, Telecare, Regional Center and more. We have an enormous number of poorly coordinated county services and contractors. Somehow problem clients from all sorts of county funded services end up at the medical center in bad shape, at this point it falls on the medical center to fix not just their medical problems, but also their social and economic problems. The hospital has to get them well and get them a place to live. These patients sit in the hospital for weeks to months, until medical center’s social workers can find them a place to live with an appropriate level of care. These clients get put on administrative days (Medi-Cal won’t pay for their stays) so the medical center eats the costs.
So county agencies, private hospitals, non-profits and for profit providers all dump their “problems” at Highland. Once these clients end up in Highland the medical center must find them a place to live. At the end of the year county contractors receive “fiscal rewards” for providing cost effective services and the medical center gets to booby prize for spending too much on the sick. So what is to be done, well Cambio Healthcare Consulting could use a tool frequently employed by our corporate cousins, the “charge back.” This is a sound business move and since county healthcare services are based on competition instead of cooperation, it’s a smart defensive tactic. If the CEO of the moment kept records of all the costs incurred by medical center clients who are supposed to be managed by other agencies they could “charge back” these costs to the county at the year’s end and demand their “fiscal reward. “