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September 22, 2022 - Community Engagement Virtual Meeting


    1. Positive COVID-19 cases currently in Kaweah Health: As of yesterday, we had 19 COVID-positive inpatients in the acute medical center; all were adults; only one was in the ICU and not on a ventilator.
    2. Are the current patients admitted due to COVID or is that a secondary diagnosis? Approximately half of our COVID-positive inpatients have COVID as a secondary diagnosis and not the primary reason they were admitted. However, having COVID can exacerbate their primary medical condition (e.g., heart, lungs, immune system, etc.)
    1. How long has it been since Kaweah has had a COVID death? We had a patient pass away on September 14th with a primary diagnosis of COVID. We did have two other patients pass away this last week with COVID as a secondary diagnosis.
  1. When can we see the hospital re-opening fully for visitors and guests? We’re getting close. Here is the current policy/practice as of yesterday, September 21st:

Downtown Campus:

  • Visiting hours remain unchanged: 9am-9pm, ICU/ICCU 10am-5pm, 7pm-9pm.
  • Masking enforcement only at all entrances (AW, MK and ED); no longer screening for illness/vaccine/testing, etc.
  • Non-COVID Visitation: 2 at the bedside, but able to switch out.
  • COVID Visitation: Team evaluating keeping 2 per day or moving to 2 at time like non-COVID; don’t have a final answer on this quite yet.
  • OR Visitation--2 in waiting room, 1 pre/post op.
  • Cath Lab--2 visitors pre/intra/post procedure.
  • Emergency Room--2 once in a room and 1 in the waiting room but will allow visitors to switch out.
  • MCH--Will keep current visitation.

Clinics: Masking enforcement only. No longer screening for illness/vaccine/testing, etc.

Mental Health:10/1/22 they are starting Sat/Sun visitation 2:30pm-3:30pm.

Acute Rehab/Short-Stay SNF/TCS/Subacute:

  • Visiting hours 8am-8pm.
  • Still required to screen for symptoms and temperature, resources for screening will continue for now. Will just remove the vaccination/testing proof part of screening.
  • Will not restrict visitors, non-COVID or COVID (OR if we do COVID 2 at a time)

  1. When can we go back to no-masking throughout all facilities? Local doctor’s offices are not requiring them – so why is Kaweah? Not until CDPH and OSHA tell us it’s OK. Effective last week, employees no longer have to screen with a documented temperature check upon arrival to work and we no longer require COVID surveillance testing once or twice a week for unvaccinated or un-boosted employees. I had a doctor’s visit yesterday and had to wear my mask the entire visit; I also had some recent diagnostic screening procedures performed at a non-Kaweah facility and had to wear a mask the entire time, as did all of the employees and providers. We do hope that we are just a few weeks away from removing the masking requirement in non-patient care areas.
  1. Can you summarize the August financials? Like July, August was another very difficult month. While total operating revenue of $72.6 million exceeded last year’s August of $66.2 million, this year’s August was $3.0 million under budget primarily due to less-than-expected patient volume in our acute medical center, psychiatric facility, and neonatal intensive care unit. Outpatient volume was very strong and exceeded budget by 4.8%.

Unfortunately, while revenue was under budget, operating expenses were significantly over budget with labor costs leading the way with a $3.3 million negative variance. Contract labor, primarily through the use of nurse registries, was $4.7 million over budget, offset by slight positive variances in employed labor and employee benefits. Medical and other supplies, physician fees and third-party claims costs under our Humana Medicare Advantage plan were collectively $1.9 million over budget.

For the month of August, we posted a net operating loss of $8.6 million and received no financial support from federal or State sources. Our year-to-date operating loss now sits at $16.5 million, $14.0 million worse than projected through the first two months of the fiscal year.

  1. Staffing and Retention
    1. How many open positions? As of August 31st, we had 626 open positions representing 12% of our workforce; as of today, we are down to approximately 580 open positions, including per diem staff who work for us on a periodic basis
    2. How many travelers? We currently have 242 nurse travelers; in addition, we are incurring approximately $320,000 per pay period in extra shift bonus payments to our employed RNs.
    3. What would happen if the hospital cut all travelers? We would definitely have to close beds, and likely entire nursing units, as well as cut back on availability of surgical, endoscopic and other procedural services; could require putting the Emergency Department on diversion at times.
    4. How is the minimum wage increase affecting Kaweah? Beginning January 1, 2018, minimum wage has increased by a dollar each year starting at $11.00 per hour and growing to $15.00 per hour effective January 1, 2022. Each of these annual increases has added approximately $1.5 to $2.0 million to our payroll each year. On January 1, 2023, the minimum wage is scheduled to increase to $15.50 which will add another $1.3 million to our labor costs and will affect approximately 2,000 employees.
    5. Why are staff members leaving for other facilities? A variety of reasons: spouse or family moving, retirement, returning to school, moving out of California, leaving for a job in another industry or profession, higher pay or large sign-on bonuses being offered by other hospitals or businesses, to become a traveler, etc.

An important note on travelers: rates are coming down significantly as the demand for staff is declining and/or hospitals will no longer pay the high rates due to their financial losses. As a result, we are seeing RNs returning to Kaweah. We are also having staff return to Kaweah finding that the “grass wasn’t greener”. It will take some time to stabilize our staffing.

  1. Any District updates that you can share with this group?
  • Dr. William (Willie) Brien—CMO/CQO candidate;
  • Stanford Cardiothoracic Surgery affiliation agreement;
  • USC Urology and Dr. Indi Gill coming October/November;
  • Master Facility Planning;
  • Healthgrades.
  1. We have not seen you since your sabbatical.
    1. What was the most enjoyable part? Travel and downtime with just my wife and me; celebrating my wife’s 60th birthday in the Caves at Eberle Winery; Italy.
    2. What were your biggest challenges when you were away? Trying not to think about work.