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November 21, 2022 - Community Engagement Virtual Meeting



Positive COVID-19 cases currently in Kaweah Health:

We currently have 22 COVID-positive patients housed in our acute medical center with another two holding in the ED; none of these patients are in critical care or on a ventilator. The medical center remains busy with an acute adult inpatient census of 92.5%, including 20 admitted patients holding in the ED; we also have 7 pediatric patients admitted; 22 of 41 ICU, 15 of 54 ICCU and 8 of 237 medical surgical beds are open. We currently have 23 employees and one provider out on a COVID leave of absence.

From October 30, 2022 through November 12, 2022, we’ve had 591 confirmed cases of flu (20 admitted) and 161 cases of RSV (11 admitted); 92% of flu cases are influenza A; admitted patients range in age from two months to 94 years.

How were the October Financials?

Better than July, August and September but we still experienced an operating loss of $5.8 million for October. While total operating expenses of $77.5 million were only $692,000 more than budget (0.9%), contract labor expense of $5.9 million for the month exceeded budget by $3.5 million. October’s operating loss was largely attributable to a $4.9 million shortfall in revenue as both inpatient and outpatient demand was soft for the month. Through the first four months of the fiscal year, Kaweah Health’s operating margin stands at a negative $34.4 million; total operating revenue of $280 million is $20 million below budget and contract labor of $26.0 million exceeds budget by $16.5 million. While management will do everything it can to minimize the need for employee layoffs, we still have to work very hard to tighten our belt and continue with our financial recovery plan.

What are the areas that have been shut down and how do those changes affect patient care?

We will soon close our 22-bed skilled nursing unit located in our Court Street long-term care facility; all but two patients have been discharged home and we are working to place the two very-long-term patients in other local skilled nursing facilities. We also will be closing our outpatient neurosurgery clinic and our outpatient diabetes clinic. Unfortunately, the closure of these three services will impact patient access to these services, particularly for the Medi-Cal population, who may not be able to find alternative access.

How can community members help regarding the letter to the Governor?Does KH have templates that can be used?

We are working this week to launch an electronic platform that will allow community members to send letters to the Governor and State legislators at the push of a button. It will be accessed through the Kaweah Health website which will include template letters asking legislators for one-time emergency funding for Kaweah Health as well as for increases in Medi-Cal reimbursement rates which haven’t been increased for 13 to 30 years.

Why is Kaweah going to the expense and work of doing their own nursing school when there are several nursing programs in the local and surrounding areas?

In an October 26th article in the publication “Health Affairs”, the author stated that “the national nursing shortage is a continuing problem as a substantial segment of the labor force is approaching retirement, and the shortage of new nurses is projected to reach 450,000 by 2025”. Given this long-term prognosis, coupled with our current nursing crises, Kaweah Health has been pursuing deeper partnerships with several nursing programs including San Joaquin Valley College, College of the Sequoias, Fresno State University, and now Unitek. I’m delighted to report that the Board of Nursing recently approved expansion of the nursing program at COS and the newly-developed relationship between Kaweah Health and Unitek.

Why don’t we leave the district hospital model and move towards being a community hospital.

While there are unique differences between private, non-profit, 501(c)(3) hospitals (e.g., Saint Agnes, Valley Children’s, Community Regional Medical Center, Adventist Health, etc.)and public, non-profit hospitals (e.g., district hospitals, county hospitals, and University of California hospitals), the governance model of a hospital does little to nothing to insulate it from the financial devastation currently being felt by hospitals across the nation. Here are some of the differences between private and public hospitals:

  • District hospital board members are elected by the community; private hospital board members are appointed;

  • District hospital board and committee meetings are open to the public; private hospital meetings are closed to the public;

  • District hospital reports, data, contracts, agreements, meeting minutes, etc. are all subject to public disclosure under the Public Records Act; private hospitals do not have to disclose any of this information to the public;

  • District hospitals cannot invest in equity investments, only highly-rated, short-term fixed income securities; private hospitals can invest in both equity and fixed income securities;

  • District hospitals can issue tax-exempt, property-tax supported, general obligation bonds if supported by a two-thirds affirmative vote of the district’s voters; private hospitals cannot issue general obligation bonds;

  • District hospitals have an opportunity to receive a higher level of Medi-Cal supplements funds (funded entirely by the federal government) through intergovernmental transfers (IGTs) and participation in the State’s Quality Incentive Program (QIP); both private and public hospitals receive supplemental funds through the State’s Quality Assurance Fee program but only public hospitals participate in the two other programs referenced above;

  • District hospitals receive a “sliver” of the 1% annual property tax collected each year within its county which can be used for operations; private hospitals do not receive this property tax support; and,

  • District hospitals are subject to prevailing wages when constructing new facilities and must publicly bid their projects; neither of these requirements apply to private hospitals.

After weighing the pros and cons of being a district hospital, I believe that the transparency of its governance and operations and its access to special funding only available to public hospitals makes being a district hospital a very positive thing.

There was an article in the newspaper this weekend regarding the need for new management at Kaweah Health. Can you address this article?

The letter to the editor in this weekend’s edition of the Visalia Times-Delta didn’t actually mention anything about a change in management but the editor’s headline did. Unfortunately, like so many people across the country, this writer is not aware of the financial devastation being felt by most all hospitals across the nation. In its September 2022 publication, Kaufman Hall, one of the nation’s leaders in healthcare finance, wrote: “Ultimately, U.S. hospitals are likely to face billions of dollars in losses in 2022 under both optimistic and pessimistic models, which would result in the most difficult year for hospitals and health systems since the beginning of the pandemic…”

Providence Health System, a 51-hospital system located in Renton, Washington just announced a $1.2 billion loss for 2022. Common Spirit, one of the largest non-profit health systems in the U.S. just reported a $1.3 billion loss for 2022. In 2020, St. Agnes Medical Center laid off 175 employees. Adventist Health laid off 52 employees last month and more than 1,000 employees in 2021. Community Regional Medical Center laid off 658 employees in May 2022.