Clashes between police and protesters in Bangkok

first_imgThe BBC’s Jonathan Head was at the protest Police in Thailand have used tear gas and water cannon against pro-democracy protesters outside the country’s parliament.Protesters protected themselves with inflatable rubber ducks which they had planned to float along the river behind parliament whilst inside MPs discussed reform.- Advertisement – – Advertisement –last_img

Democrats have to answer questions

first_imgI’m tired about hearing about Russia. Anyone with any intelligence already know who they were going to vote for. I never got an email from Russia saying who to vote for. Why would anyone with any sense listen to another country’s opinion anyway? I don’t understand how Russia could influence we Americans. We’re not that stupid.I’m a Republican and I vote for the candidate I think is best for the job, whether Democrat or Republican. They have been investigating Hillary Clinton, and just reopened another investigation. Why isn’t the FBI investigating Hillary about her using her own server, which was illegal?No matter who President Trump nominates for a position in government, the Democrats won’t accept it, no matter how much he or she would be fit for the job. They just want a Democrat so they can control the country. Just how many of those accusing President Trump are Democrats? How come Sen. Kirsten Gillibrand and rest of the Democrats didn’t ask Bill Clinton to resign for his behavior in the White House with Monica Lewinski?James MaxfieldScotiaMore from The Daily Gazette:Foss: Should main downtown branch of the Schenectady County Public Library reopen?EDITORIAL: Beware of voter intimidationEDITORIAL: Urgent: Today is the last day to complete the censusSchenectady teens accused of Scotia auto theft, chase; Ended in Clifton Park crash, Saratoga Sheriff…EDITORIAL: Thruway tax unfair to working motorists Categories: Letters to the Editor, Opinionlast_img read more

The 3-year-commitment: Hernandez discusses the plight and the future ahead for SRMC

first_imgby Tracy McCue, Sumner Newscow — To put things in perspective, the amount of money the Wellington City Council gave Sumner Regional Medical Center last week, $880,476 out of its contingency fund, is more money than what the half-cent sales tax generated in a year. A half-cent sales tax usually brings in $50,000 a month revenue to the hospital or about $600,000 annually.But SRMC Administrator Leonard Hernandez is optimistic that it is a one time event. The hospital is in a state of flux and a lot of it is about timing. He is convinced the potential is there for better days ahead.Leonard HernandezWe sat down with Hernandez for a one-on-one interview outlining the current state of finances at SRMC and what the future may be for the premier health clinic in Sumner County. Sumner Newscow: What has caused SRMC to be in such a dire financial situation as of late?Hernandez:  Everyone is aware we lost (Wellington Family Practice) clinic at the end of May in 2013 and Dr. Janelle Yutzie (a former SRMC surgeon) a couple years ago. With those people in place the hospital was generating $88,000 a day in revenue. That number dropped to the mid-60s when they all left and that is where it has stayed. Last year. we had to get a surgeon and we did that with the hiring of Mr. (Gregg) Shore.The trouble is he hasn’t gotten all of his credentialing with the various healthcare agencies completed and some of that can take 30 to 90 days. Once he gets his full credentialing intact, he will be go full steam ahead.SN: What did that $880,000 pay for?Hernandez: I’m not going to get into a lot of specifics where the money went. There were some issues we had been talking with the city for a couple months and these were the best places that we felt needed taking care of immediately.SN: Can you at least tell us what that money was going toward?Hernandez: One is KPERS. Another are the various accounts payable that have been due past 60 days. Cerner, our software company is a monthly payment program. Impact (Bank) was part of a loan repayment agreement and we needed to pay the initial $135,000 for a line of credit in 2013.SN: Does this put you back to where you need to be with your creditors?Hernandez: It puts us back on a 30-day payment schedule. SN: You lost a quarter-cent sales tax (which sunset in April). How has that affected the hospital?Hernandez: We lost around $25,000 a month. That’s why we are talking to the city about an additional half-cent sales tax referendum because we feel that will keep us going.SN: Do you think that is going to be a tough sell?Hernandez: Yes, it will be a tough sell. But if we can present it outlining our long-term strategies and convince them it is affordable to the public, I believe the community will listen.SN: How would you define SRMC’s financial state if it was a corporation? Would you invest in its stock?Hernandez: That’s an interesting question. Right now we are operating at a $60,972 profit (see income statement here: SRMC income statement April 2014. However, we received a $834,000 incentive payment in March for electronic records reimbursements which is a program through Medicare. If you took that out we would be losing $160,000 a month. We have a couple of more payments on our electronic records and that will dry up. SN: It sounds to me like you are in desperate need of another source of funding. Do you have anything down the pike?Hernandez: Well I’m glad you asked. I’ve been told since coming here that this hospital could not be a Sole Community Provider which is a Medicare designation or a critical access hospital because of our location. We are part of the Wichita MSA – Metropolitan Statistical Area which the county joined on when that was offered years ago. Because of that status we have not been able to join those programs.But I was doing some research last weekend (this interview was conducted on Friday), and I think we could prove we could become a Sole Community Provider. In order for that to happen, we need to get some designation from a state or a national group that says we are “rural.” If we are able to opt out of the MSA, then that makes us eligible to becoming a Sole Community Provider. Then we can apply. It would be a two-prong process.SN: Do we have a chance of getting that done?Hernandez: I was looking and in a 2013 report by the Kansas Department of Health and Environment on medicine, Sumner County is listed as a densely populated “rural” county. Because the “rural” designation is there, the people I’ve been talking with, like auditors, feel that will be enough to apply and opt out of the MSA. If we can find others, who can call us rural, this will help our cause even further.SN: So what do they have us designated now?Hernandez: We are urban.SN: So what would happen next if we were declared a “rural” county?Hernandez: Our goal is to have this in place by October 1, so we can be a sole community hospital before the federal fiscal year. If that happens, we would then be able to get higher reimbursements for in-patient care and cost-based reimbursements on our labs. That would be huge for us.You are talking literally $100,000s of dollars. I started working on it on Monday and talked to a lot of people in the know and they think we have a good shot.I was an administrator in Elkhart and that hospital was a Sole Community Provider and I can’t imagine that we don’t meet the same criteria as that hospital out there (in western Kansas).SN: You have worked at both Elkhart and Wellington. Do you think the hospitals are comparable?Hernandez: They are now. You can go to all the western Kansas hospital towns and they are having the same discussions as we are.Hospitals are going to their cities and counties asking for more money. You see that up and down the map. There are not many independent hospitals left. The problem is small-town hospitals have to compete with the big boys, like Wesleys and the Via Christis, and that is impossible to do.SN: So are these hospitals going to survive?Hernandez: Well, they are doing what they have to do and a lot of them are increasing taxes. A lot of them are talking about being something less than a hospital like a federally qualified health center. Those decisions are tough to make and the change is going to be very big.People want their hospitals. If you had one you don’t want to lose one.SN: It’s hard for a town to grow without a hospital.Hernandez: Absolutely.SN: Do you think the financial situation is worse in Wellington than other hospitals in Kansas?Hernandez: I don’t think it is any worse. Many hospitals across the state are having the same financial problems that we are having. A lot of those hospitals are critical access hospitals and are getting 101 percent reimbursements on medicare costs which constitutes 70 to 80 percent of their volume. And yet they are still not able to fully fund themselves and be self sufficient without tax money.The financial assistance we have had in the past with the half cent sales tax is considerably less than those rural hospitals receive on an annual basis as a critical access hospital. We are not eligible for that program because of our proximity to Wichita. But again we have a chance by being a Sole Community Provider.SN: Does SRMC have to redefine what a hospital is?Hernandez: No I don’t think so. What I think we will have to do is enhance the services that we are good at.When I came here we had 143 FTEs (full time employees). I think we have 128 now. We made some tough decisions. On the other side of the coin we have added two highly paid positions: the CRNA (nurse anesthetist) and a surgeon.We may have dropped our salary level on one side, but now we have two additional salaries on the other and it doesn’t reflect a change in the financial statements.But we needed a surgeon and that was the best shot we have with turning the hospital around.SN: Is losing these employees affecting the quality of care at the hospital?Hernandez: We have been surveyed by Medicare on the hospital side, the lab side, the radiology side, the skilled nursing side, and we had just one deficiency cited. There isn’t another hospital in the area maybe in the state that can make that claim.When people want to talk about quality, I feel very confident with the quality of the services and care we provide.Now would we like to be busier? Of course, we do.SN: Do we have less patients than we have had in the past at SRMC?Hernandez: If you look at the statistics (see here: SRMC inpatient admissions.) and the average number of patience we take in a year at our hospital, nothing has changed. Even with all the the major things that have happened in the community with the doctors and the surgeon, we haven’t had any major changes in the volume of patients at the hospital.Where you do see the big change is in the out-patient services.SN: And how do you fix that?Hernandez: We do very well with BHU (Behavior Health Unit), skilled nursing and residential services. The BHU has been asking for additional beds. So we started thinking about increasing the size of the BHU unit from 10 to 14 beds by moving them to the main floor (it is currently upstairs). The jump in beds would generate an additional $150,000 net a year for the hospital.What that will do is free up more rooms upstairs for residential housing. Those rooms generate about $5,200 a month – all cash. We currently have had to turn people away on residential housing because there is such a big demand for it. We can do this without affecting the number of beds available for acute care.This won’t happen immediately. It will be a long term process, and take up to five years. Barring some major changes in acute admissions this will be additional revenue for the hospital.Those expansions with BHU and residential along with having a surgeon are keys to making this hospital financially viable for the long-term.SN: You and the city council had four-hour of executive session before the city allocated $880,000. Are you going to have to do that again?Hernandez: I don’t think we will have to. Let’s give the city council a lot of credit for the decision they had to make. They knew the viability of the hospital was at stake. They want to see the hospital succeed. But they want us to do as much as we can on our own.That is why these designations and these other proposals are so important.SN: How about the Affordable Healthcare Act, aka Obamacare? How is that going to affect the hospital?Hernandez: The biggest thing that hurts us are uninsured people coming into the hospital. Part of that is the state not accepting the Medicaid money provided through Obamacare.There are an estimated 200,000 people that could have been covered by that Medicaid. Those are the same people who come into our E.R. several times a month.By not getting Medicaid payment, it is estimated by several groups like KHA (Kansas Hospital Association) that it costs us $200,000 to $300,000 a year that would have come to us if the state accepted that money.SN: Are there other areas where we can get additional funding?Hernandez: We knew we had to enhance our coding (the billing process). So we outsourced our coding in March.Since March, the outsource company has generated $5.2 million in accounts receivable for the hospital which is a huge difference than what we had a year ago. The goal is to bill our patients in a more timely manner, 60 days or less. Right now, our billing process is at 78 days. If we have accounts over 70, there is a blunder in the system. If we get under 60 days, that is a big gain and a huge potential for additional cash.For every bill we send out we expect 42 cents to 60 cents in return. I know when you bill you expect full payment. But for hospitals that is not the way of the world. That’s why we have to increase reimbursement with that rural designation. It’s huge for us.SN: Sounds like you have lots of opportunities. Are you optimistic about the hospital?Hernandez: Absolutely. We have done our best to keep the staff informed. We are all in this together. We need it to work. I’ve been here a year-and-a-half now but I knew walking in it would be a three-year project. Now we have some things to grab onto and be the hospital we can be.Does that mean we will be self sufficient? Probably not. But it means we will be the best model we can be after three years. It will take that long.Follow us on Twitter. Close Forgot password? Please put in your email: Send me my password! Close message Login This blog post All blog posts Subscribe to this blog post’s comments through… RSS Feed Subscribe via email Subscribe Subscribe to this blog’s comments through… RSS Feed Subscribe via email Subscribe Follow the discussion Comments (17) Logging you in… Close Login to IntenseDebate Or create an account Username or Email: Password: Forgot login? Cancel Login Close Username or Email: Password: Lost your password? Cancel Login Dashboard | Edit profile | Logout Logged in as Admin Options Disable comments for this page Save Settings Sort by: Date Rating Last Activity Loading comments… You are about to flag this comment as being inappropriate. Please explain why you are flagging this comment in the text box below and submit your report. The blog admin will be notified. Thank you for your input. +16 Vote up Vote down No one special · 322 weeks ago Interesting, everyone has something to say now….. Nothing. Thank you Mr. Hernandez for enlightening us with the above information. The community needed this as well as the employees. Let’s all take this and go forward hopeful for the future. Report Reply 0 replies · active 322 weeks ago +7 Vote up Vote down CueballSumnernewscow 94p · 322 weeks ago No one special, it reminds me of that old saying, “My mind is made up. Don’t confuse me with facts.” Report Reply 1 reply · active 322 weeks ago +13 Vote up Vote down Chad · 322 weeks ago Very good information, Mr. Hernandez doesn’t try to cover anything in sugar. It’s up to us whether we want a hospital or not. Report Reply 0 replies · active 322 weeks ago +1 Vote up Vote down Leadership · 322 weeks ago What struck me with this interview is that the hospital appears to be in the right hands with Hernandez. With the current situation, it’s absolutely necessary to have strong leadership and vision in place, and he appears to have both. You can’t hide from the problems, you have to work to overcome them, and he provided at least 4 examples of plans to do exaclty that. Hope is on the horizon, though it will not be easy. Report Reply 0 replies · active 322 weeks ago +7 Vote up Vote down Jim Miller · 322 weeks ago I hope we can get the change to RURAL as we are a very rural community. By no means do I consider Wellington surburban and the fact they placed the casino up north should attest to it. Report Reply 0 replies · active 322 weeks ago -2 Vote up Vote down guest2 · 322 weeks ago yes, Mr Hernandez was in Elkhart. We could not become a critical access hospital because we had too many beds, an ICU unit and 1 mile too close to another critical access hospital. There was a time when we could have been grandfathered in, but Mr. Hernandez did not see fit to make Elkhart a critical access rural hospital, which we could have had increased reimbursments from Medicare and possibly from medicaide. Now there is talk with “Obama Care” that they will do away with the critical access rural designation thus lowering the payments a facility will get. So is it worth the monetary output to obtain this designation? As for Mr Hernandez not covering up the hospital situation, take a good hard look at the financial situation in Elkhart. It did not happen overnite and has been in the making for a number of years. Having been a former employee of the old St. Lukes, it saddens my heart to hear of the ongoing problems. I still have family in Wellington and was hoping to retire and return home. If there is not a viable hospital, it could change my plans. Report Reply 0 replies · active 322 weeks ago -3 Vote up Vote down guest2 · 322 weeks ago cont. from previous: Has your administration been reading and understanding the changes in health care laws? They are staggering, but necessary to how to manage the flow of exams and what is allowed and not allowed. The worse part for the patients anymore is the neccessity for precertification of exams, what cna be done on the same day and what exams are required to be done on another seperate day. I am not familiar with your behavior unit, but at Elkhart we had a geriatric psych unit. While Mr. Hernandez was there, we(employees) were told that this was a money generating unit. Recently our psychologist retired. In reviewing the financials to keep this unit open it was discovered that it was losing $450,000-500,000 a year. In 2007 there was a change in medicare regulations that was ignored or not noted. Yes, this happened during the time that Mr. Hernandez was CEO at Elkhart. I feel that before the BHU is expanded, maybe an independent audit of the monetary income this unit generates should be done and studied. I hope and pry that the finances can eventually improve and have a healthy hospital as I still have friends that are employed here. Report Reply 0 replies · active 322 weeks ago +11 Vote up Vote down Leonard R Hernandez · 322 weeks ago I would like to share the facts about the comments mentioned above. First of all, I never ignored an opportunity to change the designation from Sole Community Hospital to Critical Access Hospital status. From 2003 to 2005 volume kept us from applying for CAH status. This was verified annually by BKD our auditing firm. After January 1,2006 the state’s authority to grant the 35 mile distance waiver expired and has never been available again ! As for changing regulations effecting the reimbursement of the Gero psych unit everyone , Board Administration and Staff were all aware that the cost based reimbursement was being phased out over 4 years. Decisions were made by all involved to continue to fund and staff the unit according to patient acuity and need because our psychiatrist and our entire unit staff were well known for the quality care. This unit was also always seen as a feeder to the entire health system, including the hospital, clinic ,nursing home, special care unit and the assisted living complex. I pride myself of staying abreast of current and changing regulations. Report Reply 0 replies · active 322 weeks ago +6 Vote up Vote down Chad · 322 weeks ago Keep moving forward Mr. Hernandez. It won’t be an easy road but as stated above you have a plan and undoubtedly will have to be adjusted as things change moving forward. It appears you are in a no win situation but your leadership and experience have the best chance to keep SRMC going. Report Reply 0 replies · active 322 weeks ago +9 Vote up Vote down Citizen · 322 weeks ago The Board needs to do everything in its power to retain the current CEO. His contract is only a 3 year term, as far as I understand. He understands what it’s going to take for SRMC’s survival, if that’s what the community wants. Report Reply 0 replies · active 322 weeks ago 12Next » Post a new comment Enter text right here! Comment as a Guest, or login: Login to IntenseDebate Login to Login to Twitter Go back Tweet this comment Connected as (Logout) Email (optional) Not displayed publicly. Name Email Website (optional) Displayed next to your comments. Not displayed publicly. If you have a website, link to it here. Posting anonymously. Tweet this comment Submit Comment Subscribe to None Replies All new comments Comments by IntenseDebate Enter text right here! Reply as a Guest, or login: Login to IntenseDebate Login to Login to Twitter Go back Tweet this comment Connected as (Logout) Email (optional) Not displayed publicly. Name Email Website (optional) Displayed next to your comments. Not displayed publicly. If you have a website, link to it here. Posting anonymously. Tweet this comment Cancel Submit Comment Subscribe to None Replies All new commentslast_img read more