Janet Norton, Special to the Town Crier
El Camino Hospital nurse Kitty Bergham Kantor performs a hearing test for newborn, Charity Sue, at the Mountain View hospital last week. The hospital has rebounded from an integrated delivery system that almost doomed it, but myriad hurdles, from Y2K compliance to seismic retrofitting mandates, still remain.
Town Crier Staff Writer
El Camino to face challenges aplenty in the new millennium
Time capsule: how we got here
El Camino Hospital's current status is like other 1990s health care stories you've heard before. Insurance payments aren't covering costs, not to mention inflation and administrative overhead. Retiring doctors will soon create a demand for quality replacements, but physicians' salaries have shrunk while local housing prices continue to soar.
If that wasn't enough, state seismic retrofit requirements might force management to tear down the hospital and rebuild, but where? Medical advancements and health care are better than they've ever been, but carry a hefty price tag.
What will the hospital be like in five years? That question had one board member laughing, but not because there's a whole lot of humor in sizing up the challenges of this longstanding, stand-alone hospital in Mountain View. The return to public, district hospital status after a failed integrated delivery system that almost broke the hospital was a needed shot in the arm. But, as some physicians might say, this patient is not yet stabilized.
In 1957, residents in Mountain View, Los Altos, Los Altos Hills and portions of Sunnyvale, Cupertino, and Palo Alto voted to establish the El Camino Hospital District.
The hospital opened in 1961. Management established a successful track record that had a 31-year run. An excellent nursing staff and a local climate conducive to the incubation of cutting edge medicine attracted top physicians.
Health care management trends changed in the 1980s. There were fewer and shorter patient stays. Insurance companies began penny-pinching reimbursements. In 1992, in an effort to remain competitive, the publicly elected district board turned hospital management and assets over to Camino Healthcare, a non-profit, public benefit (read: private) corporation.
In 1994, Sunnyvale and Shoreline physicians merged to create the Camino Medical Group, which formed a partnership with Camino Healthcare. The partnership between physicians and hospital formed an integrated delivery system; but profits disappeared. Building and equipment maintenance was neglected. Morale dropped.
In 1995, concerned with the quality of patient care and financial losses, the district board sued Camino Healthcare. Under a settlement agreement in 1996, the district board regained control of El Camino Hospital, returning it to public hands. Camino Healthcare management resigned. The district board appointed a new CEO, Richard Warren. Camino Medical Group reverted to an independent medical group. The board voted to change the name of Camino Healthcare to El Camino Hospital, although it remained a separate legal entity as a 501(c)(3) corporation. In 1997, under Warren's tutelage, the hospital showed an immediate profit.
The last two years have been agonizing, but productive ones. "We stopped the hemorrhage," said Dominick Curatola, district board president. Warren favorably resolved a nurses' strike. A benefits and compensation plan put salaries on par with the local market. Moral improved. An influenza epidemic increased patient days. Management opened a sub-acute nursing unit for long-term patients, bought new patient monitoring systems and beds, imaging equipment and installed Y2K compliant software. Overdue renovations and improvements to buildings and grounds cost $12 million and required detail work such as upgrades to infant, pharmacy, security and fire alarm systems, a remote paging system for nurses even the replacement of inefficient light bulbs and the sanitation of smelly bathrooms. The turnabout has taken its toll. Having fought back to a break-even bottom line, the district board and hospital management now face a projected $12 million deficit in 2000.
Snapshot: Where We Stand Now
With the shakedown of the hospital's infrastructure well in hand, both board and management are focused on constructing a plan to guide them through an uncertain future. Formal strategic planning is in process, said Owen Aurelio, chief operating officer . Working with consultants from Deloitte and Touche, management will be looking at the mission statement, the market, revenue programs and physician relations.
The hospital's Y2K Project Manager, Jim Rusnak, is working toward Y2K compliance, "The message is the fact that we're prepared." Staff aggressively monitors hospital systems that include PCs, RISC boxes, system terminals, patient monitors and radiology equipment. The PCs alone number 800.
Hospital Emergency Prepared Plans and contingency plans continue to evolve. In the event of a system failure, the hospital, said Rusnak, is self-contained with emergency power systems and a well for an independent water source.
The man in charge of literally shoring up the hospital is Ken King, vice president of facility services. The assessment needed to meet the state's earthquake standards 2001 deadline has been completed. An assembled team of architects and engineers are looking at retrofit options to meet the next deadline in 2002. Structural engineers are using computers to simulate earthquakes on a graphic rendering of the hospital. The questions are, is a retrofit possible, and, what can be done if it's impossible?
King ponders the possible complications. Which components will need work? The foundation? The frame? The sheer wall construction? A structural upgrade means that the skin gets ripped off the building. Once the structure has been strengthened the architecture must be replaced. And all work must be brought up to current California construction codes. A lot of code has been written since the building went up thirty-eight years ago. Handicapped accessibility requirements alone would add 30 percent more building area. In the event that a retrofit is impossible, King and his staff are thinking about site planning. They will present their findings to management in the next four to six weeks. The race to find solutions before the financial crunch becomes a killing force continues.
Crystal Ball: Where we go from here
So, what does the next five years look like? The man who didn't laugh at the question was CEO Dick Warren. Yes, there are serious problems, he said, but nothing about this roller coaster ride, it seems, has shaken his basic management philosophy or horse sense, "When people get terribly frustrated, they always go back to what's good. Good solid quality care, locally controlled, that's the best thing you can ever have."
Aurelio said that staffing and acuity standards are in place and El Camino compares favorably against other local hospitals. Staffing standards are good; but that standard must be maintained in order to hold on to the patient base.
"A hospital cannot stay open in this area, providing the high level of care (that we do), and attract the best and not pay them," said Paul Hoar, district board director.
The quality of nursing care is one reason Curatola works at El Camino. In his opinion, there will be, "No cutting nursing staff, no cutting quality."
What will it take to remain solvent? Two weeks ago at the last district board meeting, Aurelio announced the termination of three insurance plans that paid set patient fees that did not cover actual costs. This may be a first step in an ongoing push-back against insurance companies. Warren said that, "HMOs are last year's product." Hoar believes that it will be up to hospital management and patients to choose insurance companies that will take less profit.
The determining factor may be local residents. The board seeks public input. In a call for community involvement, Hoar said, "This hospital is a valuable community asset, and the public must determine how much they're willing to pay for services rendered." District Board Member Mark O'Connor echoed the sentiment. "People should be at the meetings and take an active role. Politics and medicine should be all local. We can't depend on those people in Washington, D.C."
The future holds, said Warren, "a whole different milieu of treatment patterns." Hospitals will chose their approach. Some may stick with insurance companies; some may pick fee-for-service; and as happens now with some laser and cosmetic surgery, he said, some will opt for the boutique approach by only accepting cash. With El Camino, only time may tell but public input may certainly play a strong hand in its fate.