WCRMC – Rural and Progressive

One way the Republican health plan will impact my rural county

Last night I used this nifty tool released by the Kaiser Family Foundation to calculate how the proposed health care bill released by the Republicans Tuesday night will impact Washington County.

In Washington County, if you are 60 years old and making $40,000 a year (per capita income is under $38,000 in my county), the Affordable Care Act (Obamacare) health insurance tax credit in 2020 will be $7,800. The House plan would provide a credit of just $4,000 in 2020. That means the cost of buying health insurance for a 60-year-old making $40,000 per year will GO UP by $3,800 if the Republican plan is adopted.

Washington County health data comparing ACA and proposed plan from Republicans

Under the current plan, insurance companies are capped at charging three times the amount charged for coverage for younger people. Under the Republican plan the cap increases to five times the cost of rates charged to younger people.

There are also considerable cuts to Medicaid and Medicare.

All of these proposed changes will impose serious financial and health threats to people in my county who may not be able to afford insurance any longer, and these expenses will be added to the other cuts to funding in the proposed legislation. These factors, plus others in the proposed plan, do not bode well for our hospital or facilities in other rural communities.

Last May Washington County voters took on a bond to support our hospital, knowing that the bond could not solve all of the financial problems for our struggling facility. We still have work to do if we want to keep our hospital open.

Washington County Commissioners want full control of our hospital

During the rare evening meeting of the Washington County Board of Commissioners (WCBOC) last month, the Commissioners adopted a change to the Washington County Regional Medical Center (WCRMC) Hospital Authority (HA) that now officially places full control of the Hospital Authority in their hands.

The Commissioners approved a change to the HA that allows the Commissioners to appoint, and remove, all members of the HA.(Appointments_to_the_Hospital_Authority)
After it passed WCBOC Chair Horace Daniel said they made official what they were already doing.

After the monthly WCBOC meeting on January 14, 2016,, the Commissioners went into Executive Session with Hospital Authority Chair Rob Mathis and Vice-Chair Marc Sack. The Sandersville Progress coverage the following week quoted County Attorney Tom Rawlings saying, “We had a nice discussion about appointees/potential appointees to the Hospital Authority,” said County Attorney Tom Rawlings. “We had a nice discussion with current members of the Authority and the Commissioners about the makeup of personnel – those are personnel issues as well.”

Members of the Hospital Authority are volunteers- they aren’t paid. They don’t get paychecks from WCRMC because they aren’t hospital personnel.

The pedestrian shorthand for what qualifies for Executive Session is real estate purchases, personnel, and litigation. The January 20th issue of the Progress included a letter to the editor raising concerns about Open Meeting requirements. (The Open Meetings Rule was revised by the Georgia General Assembly in 2012. The Association of County Commissioners of Georgia posted a summary of the revisions on their site.)

The Hospital Authority held a called meeting the day after the Commission met. Mathis and Sack resigned. HA members Bobby Anderson and Adam Adolphus weren’t present, but the Progress reported that, “Written resignations were submitted.”

Jim Croome took up the work as the HA Chair, John Brooker, Jr replaced Mark Sack as the Authority’s Vice-Chair, and Carla Belcher became the Secretary. Other HA members are Andre Jenkins, Andy Crabb, Raven Smith, and Terry Jackson.

The Washington County Commissioners have now positioned themselves in a very powerful position in regards to WCRMC.

Clearly they thought it was important to have their own slate of Authority members. The Progress’ coverage quoted HA Chair Rob Mathis saying, “There were concerns about Board members being here that overlap with the previous administration’s tenure.”

In doing that, the WCBOC have also removed all institutional history from the Authority. If an Authority member has a question about what happened, say, two years ago, there isn’t a single member among them who can answer. As a student of history, Edmund Burke’s quote, “Those who don’t know history are destined to repeat it.” comes to mind.

Since the Commissioners will be able to appoint, and remove, all Authority members, will they tolerate members who won’t march in lockstep with their vision? Is our county now set up to see a revolving door of HA members if they don’t agree with directions passed down to them from the Commissioners?

The Commissioners have spent over $116,000 on a consultant whose best recommendation to date is a two page document that includes a request for more consultants.

They will soon have a stranglehold on who will sit on the Hospital Authority.

And they are asking Washington County property owners to back a $15.4M bond in May.

We can only hope the Commissioners know as much about running a hospital as they think they do.

Who else is looking at WCRMC?

To give my urban readers a glimpse of rural life, the legal organ in Washington County, and the one that people mean when they ask, “Did you see this week’s paper?” is The Sandersville Progress. The Progress is published weekly, and has no online presence. They have been doing some really good coverage of the issues that have surfaced about Washington County Regional Medical Center.

One of the two local radio stations, Waco 100, includes local news coverage as part of their programming. Last week they posted a breakdown of the travel expenses incurred by Washington County’s hospital consultant Alan Richman, at InnoVative Capital.

As pointed out by the Progress and Waco 100, former County Administrator Chris Hutchings reminded Richman that he was requesting reimbursements without providing receipts.

I submitted two more Open Records Act requests last week. The more I learn, the more questions I have.

$15.4M of legalese

Nothing says exciting reading like a county bond resolution. If you want to pour over the legalese before Washington County citizens vote on the proposed $15.4M hospital bond in May, this is a short read. WCBOC_bond_resolution_WCRMC_Feb_2016

update: Friday, February 26, 2016
If you language in the bond is clear as mud to you, I suggest contacting your County Commission representative for answers to your questions.

Contracts, consultants, and hotel bills

Note concerning documents: some of the documents I am posting pertaining to Washington County Regional Medical Center and the Washington County Board of Commissioners have notes and underlined portions. I have not marked up any of the documents, they are uploaded exactly as I received them. All documents here and in a February 15, 2015 post on Rural and Progressive were obtained through Georgia Open Records Act requests.

Sometimes the best way to solve a problem is to have a fresh pair of eyes look things over. In September 2014 the Washington County Board of Commissioners (WCBOC) received a contract from consultant Alan Richman, the President and CEO at InnoVative Capital(IC). Richman offered to assess and advise on several areas of hospital operations.

On October 9, 2014, Board of Commissioner Chair Horace Daniel signed the contract (InnoVative_Capital_contract_Sept_2014) . The contract detailed seven tasks for Richman to complete:

Hospital Financial and Operational Review
Staffing Study Review
Review of Outstanding WCRMC Funding Requests of Washington County
Review and Critique Management and Consulting Proposals Received by WCRMC
Identification of Issues Statement
Produce a Strategic Roadmap of Next Steps
Present Finding to Washington County

The contract included the possibility of an extension through December 2015. Washington County agreed to pay a “hospital consulting fee” totaling $40,000. A non-refundable payment of $20,000 was due when the contract was signed, and the remaining $20,000 would be paid when Richman presented his findings to the county.

My Open Records Act document search included an email to former County Manager Chris Hutchings in late March 2015 from Richman detailing his suggestion that additional consultants may be required for his project here. These consultants would be “retained” by Washington County. Richman credited the county’s earlier $20,000 payment to his new contract proposal and requested an additional $10,000. On April 13, 2015 Horace Daniel signed a new agreement on the county’s behalf that included a monthly payment to IC for $7,000 plus expenses. (InnoVative_Capital_contract_April_2015)

What is especially interesting about the April 2015 contract is item 14 on page 2: “If the Transaction involves the WCRMC’s Partner’s commitment to a replacement hospital or major renovation/project (“Hospital Modernization Project”), InnoVative Capital may provide mortgage banking services for this purpose under a separate contract with the WCRMC Partner, if asked to do so by the WCRMC Partner, the Hospital Authority, or the County.”

The county’s hospital consult also does mortgage banking services.

And bonds.

Think about that for a minute.

If the county’s consultant recommends a new hospital building or major improvements, he can then step up and offer financing services. If bonds are needed, Richman’s consulting company does those too.

And there’s more.

On pages 3-4, (InnoVative_Capital_contract_April_2015) the contract spells out what Richman’s company receives in different scenarios. for example:

The county requires debt funding of $7-10Million, signs an “External Management Contract” or extends the Management Agreement with University, or “retention of Replacement Internal Management”

If University Hospital is the signing partner InnoVative Capital would be paid a $40,000 transaction fee.

If a partner other than University was the Partner for an External Management Contract, Richman’s company would receive an $80,000 fee.

WCRMC enters into a Lease or Change of Ownership and the county has a net debt funding requirement of less than $5Million:

If University is the Partner, InnoVative Capital receives $100,00 plus 5% times the final Net Debt Funding required < than $5M

If a Partner other than University is engaged, IC makes more money. Richman’s company would be paid $140,000 plus 5% times the final Net Debt Funding required < than $5M

Any agreement or modernization project that didn’t include University Hospital meant a bigger check from Washington County for Richman’s work.

Richman made seven trips to Washington County that cost taxpayers $14,483.45. Some of Richman’s expense reimbursements are a simple word document with no receipts attached. However, the request submitted on June 29, 2015 reveals that Richman’s hotel of choice isn’t anywhere near Sandersville. The county’s consultant stays at the Ritz Carlton in Atlanta’s toney Buckhead district near the Governor’s Mansion, and commutes to Sandersville in a rental car. (see page 10 InnoVative_Captial_invoices)

Richman submitted another contract for his services in November of last year, one that would run from November through July 2016. Richman’s monthly consulting fee jumped from $7,000 per month to $10,000 per month, an increase of almost 43 percent. Horace Daniel committed the county to the higher monthly consulting fee when he signed the contract on November 13, 2015. (InnoVative_Capital_contract_November_2015)

The November 2015 contract includes a list of 12 items for Richman to work through. Item 8 reads, “Identify potential partners for the County and Authority and work to make the process competitive, if possible.”

If possible.

Hospital leaders here did a call for proposals for management/lease options in the fall of 2014 from nine companies/organizations. University, Navicent Health, and Augusta University were among the nine asked to submit proposals. The resulting document includes a response from University but nothing from Navicent. Augusta University (Georgia Regents Health system at the time, still often called the Medical College of Georgia) was interested in a partnership but “without any change in management,” i.e. they didn’t want to run our hospital.
( see the last page in WCRMC_requests_for_proposals_fall_2014)

We had a plum lease agreement from University Hospital last spring that was left on the table by county leaders (University_proposal_to_WCRMC_April_29_2015). Navicent Health never made an offer last summer, which prompted local officials to pursue a partnership with Augusta University Hospital (which had already said it didn’t want to manage WCRMC).

The contract Horace Daniel signed in November includes a scope of services for Richman to complete. The resulting recommendations for the county to consider are contained in no more than two pages in a January 21, 2016 document, titled Washington County Regional Medical Center-Plan B:Repurposing WCRMC-Business Plan Development is “for discussion purposes only.”

The proposed plan development team includes two consulting firms in addition to InnoVative Capital. Richman allows for eight weeks of work. Depending on the amount of work required, the fees for the market and financial feasibility consulting firm DHG Healthcare could range from $35,000-$45,000. Adams Management Services, a capital consulting company, would ring in at $12,500. Both companies would also bill for expenses in addition to their fees.

Who would manage this project?

If you guessed Richman proposed that his company should serve as the Project Manager you would be right.

Through January 2016 Washington County taxpayers have spent $102,000 on consulting FullSizeRender fees to InnoVative Capital. Combine those fees with $14,483.45 in travel expenses, and we’ve spent $116,483.45.

The more time I spend reading these documents, the more I scratch my head.

Of course we need a hospital here, and it should be a good one. We are fortunate to have good doctors and hospital staff who want their friends and family to receive the best care possible, at home, when they need it.

I don’t expect the bond to fail in May, and I am not suggesting that people consider voting against it.

What we need to understand as voters and property owners, is that we didn’t get to this question overnight. We are more likely to hold our local leaders accountable for our hospital’s sustainability if we know the full story.

Lite reading

The Friday Photo
February 19, 2016

Nothing says “lite reading” like the documents resulting from an Open Records Act request.

The documents behind a $15.4M question

Washington County Regional Medical Center (WCRMC) has steep financial challenges. That doesn’t make the rural hospital in Middle Georgia unique.

The solution proposed by recently appointed Hospital Authority members led by Chair Jim Croome, and, the Washington County Board of Commissioners (WCBOC), is to ask the county to approve a $ 15.4Million dollar bond.

The debt that citizens can choose to take on in a May referendum will fund $9M for infrastructure, IT, and computers at WCRMC. Property owners will have to decide if their personal budgets can stretch to take on more in property taxes to also give the hospital $6.4M to pay down debt, address pension plans, and general operations.

Last year the Washington County Tax Commissioner included a neon green insert with 2015 property tax bills stating that one mil of their taxes was being used for the hospital.

Last year county leaders could have chosen a course of action that might have made last week’s 2.5+ hours county commission meeting a lot shorter.

In late April 2015, county and hospital leaders had an option to improve operations and secure $5Million in capital improvements through an offer from University Hospital in Augusta. A management agreement already in effect between the two hospitals had already secured a $1Million line of credit for WCRMC.

University’s offer included a 20 year lease with an option for Washington County to sell the hospital if it decided that was the best course of action (University held first right of refusal. After that Washington County could pursue another buyer: page 3, University_proposal_to_WCRMC_April_29_2015). University guaranteed 24/7 Emergency Department operations, surgical and inpatient nursing services, and diagnostic and imaging services.

The lease proposal also stated that University, “will not seek any support from Washington County for the operation of WCRMC” during the first five years of the lease agreement (page 3, University Hospital offer to WCRMC April 2015).

University has already proven it can right-size a small hospital; just ask McDuffie County residents and patients at University McDuffie County Hospital.

Instead of saying “No thanks” to the offer, the Washington County Commissioners took a different tack, one that broke the management agreement with University and a retraction of their April offer.

County Attorney Tom_Rawlings hand-delivered letters on June 8th to local doctors inviting them to a private meeting with Navicent Health representatives from Macon to “structure a partnership with a larger hospital system.’ The meeting wasn’t planned for county offices or Rawlings’ office , both located on the high visibility Courthouse Square.

Instead, the June 8th meeting to discuss a possible relationship with Navicent was planned at Daniels Heating, Air, and Electrical just north of Sandersville, where cars travel pass at 55 MPH. The Chair of the Washington County Board of Commissioners is Horace Daniels.

While Navicent Health was planning a meeting with Washington County leaders and physicians, their 11 month old management arrangement with neighboring Oconee Regional Medical Center was spiraling towards a fatal crash.

The meeting Rawlings convened where the WCBOC Chair works violated the Management Agreement between University and WCRMC according to a letter dated June 12 from University’s CEO Jim Davis.

Davis closed his letter with, “We wish you and the Commissioners the best of luck in preserving a hospital in Washington County.”

Washington County leaders signed an agreement with University that secured a $1Million line of credit for our hospital. The organization that right-sized McDuffie County’s hospital proposed a 20 year lease agreement with $5Million of improvements to our struggling hospital. It did not include a request for $15.4Million in bond debt funded by Washington County property owners. It did include a restriction on future requests for taxpayer dollars.

Washington County needs a good hospital. Voters should have an opportunity to read the documents that brought us to a $15.4Million bond referendum in May. As I work through more documents I’ll post them here.

Crack addicts aren’t running my rural hospital

State Representative Jason Spencer thinks Georgia’s hospitals are like crack addicts because they support Medicaid expansion funding. Spencer, a Republican who represents citizens in the Woodbine area, said in a Face Book post, “By the way, many hospitals are addicted to the current reimbursement structure in Medicine (the main problem with the healthcare). They are like addicts on crack.”

I’ve been lucky enough to know every person serving on the Hospital Authority Board of Washington County Regional Medical Center (WCRMC). Chaired by retired Elder Middle School Principal Bern Anderson, the Board includes former County Commissioner Carl Forrester, retired state employee Bobby Anderson, Head Start Director Susie Wilcher, retired teacher Adam Adolphus, and Thiele Kaolin employees Marc Sack and Rob Mathis. When the hospital’s CEO, Jimmy Childre, Jr. began working there, he did so initially as a volunteer, taking no salary.

These people know that having a good hospital does more than save lives; it creates jobs (375 full-time employees at WCRMC, according to the hospital), keeps money in the local economy, helps attract businesses to our county, and improves health outcomes. The Authority Board also wants to cover the costs of running a good hospital.

That doesn’t make them crack addicts.

Hospitals, including WCRMC, get just 93 cents on the dollar for Medicaid patients. Every time they do what hospitals are supposed to do, like save a life or safely deliver a baby, someone has to find a way to collect the unreimbursed expenses (which holds for private insurance, Medicare, and Medicaid patients). The Sandersville Progress has reported on new ways WCRMC is improving collection of payments for services, but, like many other rural hospitals, we will always have some patients who simply cannot pay their bills.

Governor Deal could still take action in the legislative session that begins today to increase the flow of Medicaid funding to our state’s hospitals while the Federal government carries the full cost for three years. Deal chose to pass on that, sending the money to other states who did the math on protecting rural hospitals (even the conservative Georgia Hospital Association said we need those dollars in Georgia).

According to Hometown Health CEO Jimmy Lewis , one million rural Georgians are treated in small community hospitals every year, in addition to those traveling through rural areas who may need emergency care. Governor Deal’s decision has already hurt the communities of Folkston, Arington, and Richland in the southwest part of our state, who saw their hospitals shuttered last year. Rep Spencer said (boasted maybe) that as many as 20 more small hospital closures could happen in our state in the next two years.

Our elected legislators will be hell-bent for leather to finish the session that opens today so they can raise campaign money and get on with the work of being re-elected in the November elections.

Elected power, just like crack, can be addicting. Maybe Georgia’s voters will consider electoral interventions when they go to the voting booth in 2014.

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