As a candidate, I’ve responded to a number of endorsement surveys and questionnaires. Want to know where I stand on the issues? Please take a look below.
What are the biggest issues facing Salinas Valley Memorial Healthcare District in the next four years, and why are you the best candidate to address them?
There are four major issues facing SVMH District over the next four years.
- The first one is financial performance. The Covid pandemic with increased costs for personal protective equipment and longer patient lengths of stay has reduced net profits for most hospitals including SVMHS. The hospital is facing continuing pressures on revenue due to declining patient acuity (how sick the patients are which determines the amount paid) for Medicare and all payors, and a decline in number of commercial patients and payments. Also, SVMHS has a high percentage of MediCal patients. While they do well in with Managed Care MediCal, many of their inpatients are not in these programs which negatively impacts them financially.
- The second issue facing the District is the expansion of the Kaiser Health Plan into Monterey County. Kaiser is financially and programmatically supporting the new Pajaro Valley District Hospital. I have been through this before when Kaiser came to Modesto, California. I worked with Memorial Hospital’s CFO to write the first Kaiser contract with a non-Kaiser facility and became the liaison between the hospital, the medical groups and Kaiser. Kaiser will grow its business within Monterey County as they did in Stanislaus County until it has enough patients to support the building of new Kaiser Hospital. Eventually, Kaiser will suck revenue from the community and redirect it to other Kaiser facilities when they have their own hospital.
- The third issue facing the District Hospital is the need to improve the hospital’s quality rating from CMS (Center for Medicare and Medicaid Services), called the Overall Star rating. This is a public measure by CMS of all hospitals in the United States based on 50 measures of quality, efficiency and timeliness. SVMHS currently has a 3-star rating of a possible 5. No hospital is Monterey County has a 5-star rating. I orchestrated the improvement of my former hospital, El Camino Health in Mountain View, CA, from a 3- star rating to a 5-star rating in two years. Only 431 hospitals of a total of 4,489 hospitals in the U.S got a 5-star rating in July 2022. Wouldn’t you select a 5-star restaurant over a 3- star one when the cost is going to be the same?
- The fourth issue facing this District Hospital over the next four years is the seismic retrofit project which has been postponed by legislation over the last 20 years and still may be postponed again. This is related to the first issue of financial stability in that the hospital, supported by the SVMHS Foundation must plan for and secure the funds necessary to meet the retrofit requirements.
I am the best candidate to assist the hospital administration and the board to address these issues because of my experience in California hospitals with similar issues over my 40+ year career. I understand healthcare financing and have helped my organizations to be financially successful with Medicare, MediCal, Managed Care, fee-for-service and private payor contracts.
I have helped a community hospital successfully weather an intrusion from Kaiser by working with the CFO to write contracts that protected the hospital and the use of its services. I have expertise in analyzing the data and implementing the incremental changes needed to move a hospital from a 3-Star CMS rating to a 5-Star rating.
How often do you currently attend SVMHS board meetings? Do you think the current board is effective?
I chose not to attend the SVMHS Board meetings in person with the continuing Covid pandemic and because I was working remotely full time. As SVMHS is a District hospital, I am able to access all of the materials for the Board meetings and minutes from the hospital’s website. The Board Committees, especially the Finance and Quality Committees are very informative. These Committee packets provide reports and minutes that really help me to understand what is happening at the Board and Committee meetings without attending. The SVMHS Year End Balanced Scorecard provides a good overall view of the status of the hospital’s
Service, People, Quality & Safety Processes, Finance, Growth, and Community metrics.
I do not think the Board is as effective as it could be because none of the current Board members have any healthcare experience and as such do not know what questions to ask the administration and what issues should be delved deeper into. An example is the Balanced Scorecard, while adequate, it does not cover important quality metrics such as mortality, readmission, cesarean section rate, or morbidity for certain procedures or diagnosis which can be red flags for quality issues at the hospital.
How do you think SVMHS did at handling Covid-19? What policies should be in place going forward?
SVMHS did a good job of responding to the Covid pandemic and both the CDC and CDPH requirements to protect both patients and staff. The first year of the pandemic was chaotic and a constant learning experience with mitigation measures such as masking and distancing. Eventually that was mediated by the advance of vaccines and therapeutic measures. I think SVMHS did a great job of identifying issues and responding to them as reflected in programs initiated to promote resilience and wellness in the staff and physicians to address burnout and caregivers’ emotional health, such as Care for the Caregiver, and Healing our Healthcare Heroes. The extra physical exertion of just putting on and taking off PPE (personal protective equipment) and sweating through this gear while still trying to be heard by the patient was and is exhausting.
The pandemic has changed the healthcare system forever, in that we need to be
ready for the next unknown infectious agent with enough PPE on hand, and the capacity to quickly isolate groups of patient rooms or units. Covid patients are still coming to the hospital and the experiences over the last two years have helped the staff to be ready to deal with whatever comes next. The administration was governed by the requirements from the California Department of Public Health and the County Health Officer which they complied
Policies aimed at protecting patients, staff and physicians should remain in place going forward and these involve vaccinations and personal protective equipment.
Do you think SVMHS’ presence beyond the hospital is the right-sized footprint, or should there be more or less outpatient services?
The recent expansion of outpatient services to South County via the Mobile Clinic and the Taylor Farms Family Health & Wellness Center is moving SVMHS toward a “right-sized” footprint for the District, but it is not there yet. What is missing for South County are prenatal and maternity services which are services that are often needed immediately for the best outcomes for a pregnant woman and her baby. These outcomes are at risk if the family has to drive miles to an acute hospital.
The seismic retrofit project has been years in the making and is finally moving forward, along with other construction. Is there anything you would change about the retrofit process or anything you would have done differently? If elected, what will you do to keep big construction projects moving forward and on budget?
Since the 1990s hospitals in California have lobbied through the California Hospital Association to postpone requirements to retrofit hospitals several times, now required by 2030. I am pleased that leadership at SVMHS has chosen to proceed with the seismic retrofit before it was required and in conjunction with the surgical expansion. With each year that passes the risk of another major earthquake increases. SVMHS will be well positioned to continue providing patient care in a safe environment and to continue its operation should another
earthquake occur and also be prepared to meet the growth anticipated in the community.
I would not have suggested anything differently, as most hospitals in the state are still waiting for another round of legislative relief.
Keeping construction projects on budget requires the Board to be attentive to the progress reports with open discussions on issues or problems that arise. This involves keeping the project on the Board’s agenda and giving the staff time to address it at every meeting.
Just a few years ago, the SVMH board was looking for a private buyer. What is your philosophy about whether SVMH should remain a standalone hospital into the future? What will you do to help keep the finances sustainable?
Of the 400 hospitals in California, SVMH is one of only 34 that are District Hospitals. I think SVMH should remain a standalone hospital and maximize any and all advantages of a District hospital. One of those is the California Medi-Cal QIP (quality improvement project) program. This program allows District hospitals to achieve additional revenue for their MediCal patients through improvements in selections from 50 measures. SVMHS is participating in this program.
In addition to maximizing the revenue from this program, I would assist SVMHS through investigation of other programs to maximize their revenue such as considering a clinical documentation improvement program to assist physicians to improve their documentation and thus the revenue for each patient, tightly manage inpatient length of stay when most patients are reimbursed by fixed payments such as Medicare DRGs, work with the medical staff to implement best practices and control excess utilization of services. In addition, investigate new clinical programs that are not in Monterey County and bring these with new physicians to the hospital. A good example is the excellent Structural Heart program at SVMHS.
Do you think the four hospitals in Monterey County work effectively together? What would you change, if anything, about the relationships between hospitals?
I think the four hospitals are only in the last few years beginning to work together and what I see is really SVMHS and CHOMP collaborating on the Blue Zone Project and the Monterey County Diabetes Collaborative. Natividad Medical Center and Mee Memorial Hospital are partnering with the other hospitals and the County Health Department on the countywide Health Assessment and Plan.
There is not an initiative that involves all four hospitals across the
county. I would try to initiate, through the board, a Collaborative that would involve all four hospitals and address a leading cause of death; sepsis and septic shock. Developing a Collaborative that would address sepsis across all of Monterey County would save lives and give each hospital the tools to identify sepsis early in their patients and initiate treatment.
This type of organization would give the opportunity for all four hospitals to learn to work together forthe betterment of patients across the county. The Santa Clara County Sepsis Collaborative is a local and successful example.
As a Registered Nurse and a Hospital Administrator, I have been on both sides of this issue. What is important is that both the staff and administration keep the patient as their focus so that their actions do not negatively impact their patients. This takes collaboration and developing a partnership in the delivery of patient care so that when negotiations begin, they begin from a partnership that needs to be nurtured and sustained. The achievement of Magnet status for Nursing has developed this partnership at SVMHS and I think it will be evident as the next union negotiations begin. I have met with the CNO and would also meet with the nursing union leaders to promote a focus on patient care to be sustained at all times.
Please rate the performance of the current president/CEO.
I met and have worked with the current president/CEO, Pete Delgado when he was the CEO of LA County/USC Health System and I was Vice President of Quality & Performance Improvement at the Hospital Association of Southern California. Mr. Delgado was one of the 30 CEO-member Board of Directors and I was staff to the Board and responsible for the Southern California Patient Safety Collaborative, with 105 hospital members, in which his hospital participated.
I think Mr. Delgado has done a great job of establishing a new beginning at SVMHS when he arrived in 2013 after much strife and an interim CEO. He embraced the Latino heritage of Salinas, and addressed the lack of access to care that was felt by much of the population in the community, through expanded clinics and outpatient services. This was recognized by Modern
Healthcare with a Diversity Award in 2021. He also supported Nursing in their quest for Magnet status, which they achieved in 2021. Under his leadership, the hospital has achieved several recognitions that are a significant reflection of the quality of care provided and demonstrate leadership in healthcare; WHO Baby-Friendly designation, Leapfrog Hospital Safety Score of A,
Cardiology Platinum Award for Chest Pain/MI Registry and many others.
Who are you supporting for the other open seats on the SVMHS board?
I have not met the candidates for the open seats in Zone 1 or Zone 5 and have only reviewed their candidate statements. Thus, I am reluctant to endorse a candidate from either Zone as I need to be unencumbered and able to develop a positive working relationship with the candidate who is elected by the voters in each Zone.
What is the proudest endorsement you have received?
Through this campaign process I have been interviewed by several groups, the Salinas Valley Chamber of Commerce, the Monterey Bay Labor Council, the Monterey County Democrats, and will engage with the California Nurses Association next week. As this is a non-partisan election, I am open to discuss my platform of patient safety and quality patient care with all groups
especially with the residents of Zone 4. I am pleased to have received the endorsement of the Monterey County Democrats.