‘A voice of rea­son’

Decades of ser­vice help keep hospi­tal in­de­pen­dent

Modern Healthcare - - SPECIAL FEATURE -

For 45 years, Rose­Marie Reno has sought to en­sure that Tri-City Med­i­cal Cen­ter in Oceanside, Calif., is a thriv­ing, in­de­pen­dent, pub­licly owned hospi­tal. Reno, 83, was the di­rec­tor of nurs­ing in the emer­gency de­part­ment from 1967 to 1974, help­ing shep­herd the ED’s ex­pan­sion from two beds and three gur­neys to 11 beds. Though she left the hospi­tal’s pay­roll in the mid-1970s, she never cut ties to the fa­cil­ity. As a pro­fes­sor of nurs­ing at Mi­raCosta Col­lege in Oceanside, she con­ducted hands-on clin­i­cal train­ing at Tri-City. And since 1984, the area’s vot­ers have re­peat­edly elected her to the hospi­tal’s seven-mem­ber board of direc­tors.

As a board mem­ber, she has backed numer­ous pro­pos­als to im­prove the hospi­tal’s clin­i­cal ca­pa­bil­i­ties, such as the ad­di­tion of a Level 3 neona­tal in­ten­sive-care unit and ex­pan­sion of the emer­gency de­part­ment, which now has 47 beds, in­clud­ing six re­served for fast-track pa­tients.

“She has been a voice of rea­son on the board,” says Vista, Calif., Mayor Judy Ritter. The hospi­tal, which has grown to 330 beds and has an­nual net rev­enue of about $400 mil­lion, serves north sub­ur­ban San Diego County, in­clud­ing Vista, Oceanside and Carls­bad.

For her ac­com­plish­ments, Reno has been se­lected as the Trustee of the Year for a large hospi­tal.

Reno’s com­mit­ment was put to the test in 2008 when the hospi­tal was be­set with prob­lems. Scripps Health pur­chased Sharp Mis­sion Park, a 65-physi­cian med­i­cal prac­tice, which rep­re­sented 30% of the hospi­tal’s pri­mary-care physi­cians. Mean­while, the in­ter­est rate on the hospi­tal’s $73.9 mil­lion bond debt, which was set at weekly auc­tion, soared as high as 18% af­ter the fi­nan­cial mar­kets col­lapsed that year, cost­ing the hospi­tal more than $1 mil­lion a month. In ad­di­tion, the hospi­tal had not com­plied with Cal­i­for­nia’s seis­mic safety stan­dards.

Given the sit­u­a­tion, some vo­cal mem­bers of the med­i­cal staff wanted the board to sell Tri-City to a pri­vate health sys­tem.

Not on Reno’s watch. At a meet­ing in De­cem­ber 2008, she con­vinced the board to put Tri-City’s eight-mem­ber ex­ec­u­tive team on ad­min­is­tra­tive leave and launch an in­ves­ti­ga­tion into the hospi­tal’s fi­nan­cial con­di­tion, Reno says.

“I felt that, by God, what have a got to lose? I am go­ing to stick my neck out there, and I am go­ing to pur­sue this to the end. I am go­ing to save this hospi­tal,” Reno re­calls.

In Jan­uary 2009, the board hired Larry An­der­son as in­terim CEO, mak­ing his po­si­tion per­ma­nent in July 2009. Mean­while, An­der­son—who for­merly was pres­i­dent and founder of In­te­grated Health­care Hold­ings, a four-hospi­tal chain in Santa Ana, Calif.— fired the pre­vi­ous ad­min­is­tra­tive team in April 2009. “There were ma­jor is­sues that should have been dealt with by the ex­ec­u­tive staff that were not dealt with,” An­der­son says.

An­der­son ad­dressed the prob­lems sys­tem­at­i­cally, which led to a $16 mil­lion profit, or ex­cess of rev­enue over ex­penses, in fis­cal 2011, ended June 30, and an $8 mil­lion profit in fis­cal 2012, up from a $5 mil­lion loss in 2009 and a $11.2 mil­lion loss in 2010.

The hospi­tal re­fi­nanced its debt and now has a $51 mil­lion term note, which is se­cured by an equal amount of cash, and equip­ment leases to­tal­ing about $6 mil­lion.

It also has im­proved or added clin­i­cal pro­grams to in­crease rev­enue. For ex­am­ple, the hospi­tal and North County Health Ser­vices, a fed­er­ally qual­i­fied health cen­ter with mul­ti­ple lo­ca­tions, launched a mid­wifery pro­gram to in­crease the num­ber of Med­i­caid births at the hospi­tal, en­abling it to qual­ify for Med­i­caid’s dis­pro­por­tion­ate-share pro­gram.

The hospi­tal also em­braced robotic surgery, pur­chas­ing four de­vices in­clud­ing two specif­i­cally de­signed for spinal pro­ce­dures.

While it still has not re­cruited nearly enough pri­mary-care physi­cians to re­place those it lost in 2008, the hospi­tal launched North Coast Med­i­cal Ac­count­able Care Or­ga­ni­za­tion, which is par­tic­i­pat­ing in Medi­care’s shared-sav­ings pro­gram.

Tri-City also ren­o­vated its lobby, ER en­trance and in­pa­tient rooms and has nearly com­pleted con­struc­tion of a new med­i­cal of­fice build­ing.

Reno, who was board chair off-and-on dur­ing this pe­riod, en­sured that board mem­bers were in­formed and in­volved in de­ci­sion­mak­ing. For ex­am­ple, Reno put to­gether a four-inch-thick binder packed with back­ground in­for­ma­tion.

“She sits down with new board mem­bers and goes through it,” An­der­son says. “I have never seen a trustee do the amount of work that she does. She loves the hospi­tal. It is her life.”

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