Lane changes

New CEO of Northern Inyo Hospital makes waves.

Healthcare in America is changing; from Obamacare to telemedicine and from Washington D.C, to the Eastern Sierra. But change can be difficult, even shunned.

Northern Inyo Hospital (NIH) is experiencing some growing pains, thanks to challenges in complying with new laws as well as making changes in its personnel policy, salaries and pricing

According to Northern Inyo Hospital’s Chief Executive Officer, Victoria Alexander-Lane these changes are necessary to keep the hospital thriving, now and in the future.

Lane and her boss, the publicly elected Board of Directors for the Northern Inyo Hospital District, have been both lauded and criticized for their efforts as they try to bring the hospital in line with state and federal standards while providing affordable, top-notch patient care.

Lane is proud that patient days, or number of days a person spends in the hospital, has risen by 50% on her watch.

The changes have also brought with them tension at the staff level. Chief of Staff, Dr. Thomas Boo quit, and some of the nurses have formed a union and are currently hashing out new contracts. Lane said there are “a very few, very vocal employees” who aren’t happy with the new policies. She wants people to be happy: “I have nothing to gain from unhappy employees,” she said.

Board President M.C. Hubbard said in a separate interview that she hates to see anybody not satisfied with their job. “Life is full of choices and we have to make the choices that make us happy,” Hubbard said, adding that sometimes change is difficult but it is needed to continue growing.

Lane said she’s not the bad guy or gal; she’s the messenger, the harbinger of change, and “absolutely no one likes change.” Her impetus for taking the job was to get the hospital out of debt and get costs down, she said. Lane has more than 25 years experience in the healthcare field, from nurse to CEO of three different hospitals.

Lane was chosen out of a pool of 12 candidates, explained of the recruitment process for a new CEO in 2013. Lane was chosen by a committee of doctors, board members and the public.

Hubbard explained Lane was the best qualified person to do what the hospital and the board needed. The hospital is not in terrible shape, in fact it’s in the black financially. It’s just that it’s future direcftion and viability appeared murky, Lane explained.

Hubbard added that Lane was not brought on just to make these changes. Lane is taking NIH in a direction healthcare needs to go, she said.

And there’s no lack of things to fix at NIH, according to Lane. “It’s unbelievable,” she said of the vast amount of things that are unnecessarily costing the hospital money.

The budget at NIH has risen from $50 million in 2003 to $100 million in 2013 but with no rise in productivity, Lane said. Prices were rising to pay for raises, she explained.

Hubbard said Lane illuminated the self-destructive business model, informed the board, and made the changes. Lane told the board the hospital was pricing itself out of business. Hubbard said Lane has a keen eye for discovering or uncovering financial waste at the hospital.

NIH ranks tops in California on many lists for having the highest prices for a number of procedures. Lane said she’s working on getting costs down for the benefit of the patients, the hospital and the larger healthcare picture.

Currently a “Cash Lab” has been set up offering substantial discounts on laboratory tests if the patient pays at the time of the visit in cash, debit or credit. Colonoscopies now cost $2,000, down from $4,000-$5,000 when she first arrived. She said these are also preventative procedures that could keep a patient out of hospital and save the patient and taxpayers money in the long run. She said she is committed to keeping prices at their current rate for the rest of the year. Keeping people healthy and out of the emergency rooms and hospital beds is also part of the larger preventative healthcare model of Obamacare.

In addtion, there has been a long-held expectation of NIH employees that salary was commeasurate with time served, according to Lane. With the new policies, employees will be evaluated on performance before receiving a raise. If refused a raise, an employee has three months (along with help and direction from administration) to try and remedy the issue, then they are reevaluated.

Lane said expected raises created complacency among some employees, with many not seeking training or furthering their education. Lane implemented a new tuition assistance program that offers $1,000 for continuing education for NIH employees to be spent locally at Cerro Coso Community College.

Pay scales have been modified and are now in line with those of other rural California hospitals. No one currently employed at NIH has had a pay scale cut, but new hires adhere to a new scale. This includes a current employee who is applying for another job within the hospital.

Lane said that policy has gotten some blowback, as some employees expect to at least keep their current wage, even if moving to another position.

There have been changes made to the personnel policy, specifically the

termination policies, as well. Before, NIH employees were allowed to address the board about their termination. Both Lane and Hubbard said they have never seen another hospital, or virtually any employer, allow employees to address a board over termination issues, as they don’t know the employees, their work habits, faults and strengths. Lane said it turns the matter into a political decision, which shouldn’t be a way to lose a job.

Hubbard said that in her eight years on the board she has seen two terminated employees come before it and believes some employees thought of the board as a recourse or “safety net.” She said she doesn’t know why employees are concerned over this particular change. If all the policies and procedures are followed correctly, an employee has nothing to worry about. “I totally trust the (termination) process,” Hubbard said.

Another change was made to on-call pay. When and if an on-call employee is called into work, the employee makes double time, plus, and this is the part Lane said she has never seen before at any hospital, the employee makes the on-call pay as well. Lane said the new policy will eliminate that third-tier pay.

These changes have spurred some employees to form a union, comprised mainly of nurses. Christine Hanley, committee spokesperson, said the union is busy working on negotiations and cannot speak regarding the ongoing process at this time.

Lane said she estimates the legal fees for forming the union will cost the hospital approximately $1 million. She called the whole issue a “waste of resources” that could be better served offering better health care.

Hubbard said she was unsure if the new union could get as good a benefit package with a new contract through a union. Lane provided figures for the cost of NIH employee salaries and their benefits. “Actual salary expense last year: $21,750,463.00, actual benefit expense: an additional $14,523,265.00 or 66% of the amount of salaries,” she stated in an email.

“Together salary and benefits amounted to $36,273,728.00 coming out of a net revenue of $71,882,158.00. Our TOTAL audited expenses were $65,768,378.00. Then we have to pay for everything else … ”

NIH has had a change of legal counsel as well, from Douglas Buchanan to Archer Norris. Lane said the hospital needed a firm that “understands healthcare.” She said that strict federal and state laws apply to any and all hospitals, but sometimes the isolated Eastern Sierra can make it seem like the rest of the world doesn’t exist. Archer Norris of Walnut Creek is the legal counsel for the majority of districts and hospitals in the state, Lane said.

The host of changes are coming rapidly, Lane explained, but that’s because the hospital is playing “catch up.”

Hubbard described the changes as a complete “180 degree turn” from how hospitals were run before the Affordable Care Act. The new federal mandates are for patient health and prevention, with less time spent in the hospital or going back to the hospital and even less time on an operating table. This is the opposite of the “fee for service” model and reimbursement methods of the past.

This hard and fast change is not easy to handle, Hubbard admitted. Hubbard said the changes are needed and challenging but they’re needed “so our neighbors can afford to go to the hospital.”

Lane said the rise in patient days will help bring prices down. “The number of patient days per year was around 2,000 until June, 2014. With the changes made by the current administration we increased our business by 50% to 3,000 per year,” she said. “This is on the rise so every month varies. The concept of this is simple, we reduce our costs, increase our productivity and then the community gets to have reasonably priced healthcare.”

She explained the hospitals that are going to survive are going to have to comply with new rules and regulations. She said she can understand the angst and frustration of change, but it’s a necessary evil if the hospital expects to survive.