Paul Raymond: The vote on South Peninsula hospital bond should send a message

By PAUL RAYMOND

A recent public vote on the $38.5 million South Peninsula Hospital bond proposal should send a message to those administrating and governing healthcare on the Lower Peninsula, and the message is that they are not truly representing their community. With official results now in, the bond went down in flames with 62% of voters rejecting the proposal.

Ryan Smith, the CEO of South Peninsula Hospital, stated on a local podcast that the bond had been vetted unanimously by 60 employed medical providers, the hospital operating board, the Kenai Borough Assembly, and the borough mayor. If that is the case, how can there be such a disconnect between the desires of the community and the direction hospital management has taken?

Smith also reported that the current net revenue of the hospital is $150 million and that they own or lease 32 properties in Homer. The hospital has 640 employees. The CEO and board have stated they have a master plan; however, when confronted while on the podcast as to what was the final goal, a definitive answer was not given. Is that goal $300 million revenue, $600 million revenue, or $900 million in revenue? No answer was given.

South Peninsula Hospital is a critical access hospital that is limited to 25 inpatient beds, yet the focus has not been on the quality of the services offered but instead the quantity of services offered.

The hospital has now recruited a plastic surgeon. Typically, it takes a population over 80,000 to support this service and how does this fit with the notion of a critical access facility? Is the end goal to have every service that is usually reserved for a secondary or tertiary facility? At what cost to the community is this rapid expansion of infrastructure and services?

The one answer that was given when asked was whether the cost of healthcare would be lowered by these expansions, Smith and the Borough Mayor answered, “No.”

The community has spoken loudly that they do not approve of proceeding with an open checkbook on what appears to be management that is more focused on revenue and monopolizing healthcare delivery than on the needs and desires of the community that they were established to serve.

This is not a problem that can be attributed solely to the CEO or the hospital board. This is primarily a systems problem. We are told that the process is transparent, but it far from it. The South Peninsula Hospital Operating Board is a self-appointed board made up of community members that have been recruited to serve. Although they may all be well meaning folks, the result is that there is no diversity of thought as the makeup of the board does not truly represent a cross section of the community. If a member of the public attempts to attend one of these meetings, they quickly learn that these meetings are much different than public meetings.

The board typically goes into executive session to discuss much of the business while you sit in the hall. When they come out of the executive session and you are allowed back into the meeting, motions are made and voted on and you are left with very little insight as to how the decision was made. Furthermore, if you review the minutes for last 15 years, an alarming pattern emerges. At no time is there a dissention in the vote.

The board always votes unanimously, further supporting the tenet that there is no diversity of thought on the board. Unfortunately, our borough assembly likewise has taken the board at their word and has almost always approved any request from SPH administration and board unanimously.

This recent vote should be interpreted by the CEO, the South Peninsula Hospital board, the borough Assembly, and the borough mayor that there is overwhelming disapproval of the direction this administrative body is managing our community healthcare dollars and services. Smith reported during the podcast that their surveys had demonstrated excellence in patient satisfaction; however, in the minutes from the September hospital operating board, the Press Ganey scores for satisfaction of their outpatient services was at the 13th percentile, while their rating for their SPH clinics was at the 44th percentile.

These are hardly numbers that back up that claim.

Smith also reported that none of the medical providers were paid based on their production. They were all paid at 75th to the 90th percentile of medical management group association provider compensation survey data. This model presumes all physicians are equally skilled, equally productive, and most importantly perhaps, equally motivated to work in the group’s best financial interest. That means “high producers” have little long-term incentive and low producers may be allowed to ride on the financial coattails of the more productive physicians. On what basis does South Peninsula Hospital determine if the provider is earning their salary and truly striving to serve the needs of the patient or the community?

It is my opinion that it has been a disservice to the residents of this community to employ and recruit providers from other facilities in the area to monopolize healthcare and alleviate options for the community. It has resulted in skyrocketing healthcare costs for the community and by their own published data has resulted in overall dissatisfaction with the outpatient care they are receiving.

It is time to revisit how healthcare is delivered locally. If the hospital administration and board truly desire to meet the needs of the community they serve, they will take the necessary steps to address these concerns. Unfortunately, I feel it is unlikely to change and the community will continue to watch private properties taken off the tax rolls, active suppression of competitive options, South Peninsula Hospital entering into non-healthcare businesses such as real estate and daycare, decreasing healthcare delivery choices, and further fueling the increasing costs of medical care to residents of the lower Kenai Peninsula.

Paul Raymond, M.D. is a resident of Homer.