The Cook County North Shore Hospital & Care Center board continues to pursue the possibility of remodeling and upgrading the facility. On August 22, 2013, Administrator Kimber Wraalstad told the board about a study that showed that finances had improved for critical access hospitals after undergoing facility upgrades. Revenue outpaced interest and depreciation, the number of staff per patient decreased, and quality outcomes were higher.
Wraalstad said she had been soliciting input and suggestions from department heads regarding the proposed remodeling of the hospital and care center.
Wraalstad showed the board a slide of the general floor plan she was proposing. It had a central entrance for visitors, outpatients, and emergency room patients facing the original hospital parking lot between the hospital and the care center. It also included an operating room and the infrastructure necessary to provide chemotherapy.
Some services, such as cataract surgery, could be offered quarterly, Wraalstad said. A general surgeon had called her, offering to work at the hospital part-time, she said, but she could not take him up on his offer because the present facility does not have a required scrub room next to what could be an operating room.
Board member Tom Spence said the proposed floor plan, which makes use of the current building footprint while also including an addition, looked “chopped up” like the facility is already. He said he thinks they are dealing with “a dinosaur.” He suggested that an architect be employed to start them in the right direction.
Architecture and engineering firms looking at requests for proposals (RFPs) require a master plan and budget to already be in place before they put in a bid, Wraalstad said. An architect would create the specific drawings that would be needed, she said.
Whatever they decide to do would be a plan for the next 20 years, John Strange said.
Spence also said he would like to see all employees—not just department heads— have input into the proposed building plan.
Wraalstad said she would involve all employees when it was time to plan the design of individual rooms rather than soliciting input from everyone on where departments should be located. She and Maintenance Director Rory Smith indicated that they had received input from the staff along the way.
Last time architectural changes were made, accountant Kelly Swearingen said, employees felt they weren’t included. On the other hand, she said soliciting input from employees at this stage in the process would be “too much.”
Employees might feel it was too late to offer input after the architectural work was already done, Spence said. He said he was “very concerned” about getting input from employees and the Sawtooth Mountain Clinic.
The board gave Administrator Wraalstad the go-ahead to send out RFPs. Wraalstad indicated that the design would need to be one that Medicare would be willing to reimburse for depreciation.
Health insurance
Administrator Wraalstad said she continues to contend with Blue Cross Blue Shield of Minnesota (BCBS) about the more complex billing system they are demanding of the state’s critical access hospitals by next year.
Wraalstad said BCBS is trying to set itself up for survival under the Affordable Care Act health insurance exchange just around the corner. Some helicopter companies are no longer going to be BCBS providers, including Lifelink III out of Hibbing, one of the companies North Shore Hospital has been using.
St. Luke’s President John Strange said none of the critical access hospitals are willing to go with the billing system BCBS is demanding. In regard to the new health insurance exchange, he said many people will end up with really high insurance deductibles that they cannot afford to pay. While people will be insured, he said, no one is asking whether they will be under-insured.
Levy request
Without this year’s levy of $800,000, the hospital would be facing a year-to-date loss of $638,559, and slow months are coming up. The board deliberated over how high to set the preliminary levy that will be submitted to the county. Administrator Wraalstad recommended that they not request an amount they were unwilling to actually levy.
Board member Howard Abrahamson said it’s hard to know how the Affordable Care Act will affect their finances. “It’s such an unknown year,” he said.
“My crystal ball is not worth a darn,” Wraalstad said.
Kelly Swearingen said expenses keep going up, but Administrator Wraalstad said some revenues would be increasing.
To reduce costs, Abrahamson said, they could either reduce services or reduce their net worth and use money that has been set aside for facility maintenance and improvement. That would be “a downward spiral,” said John Strange.
The board voted unanimously to set the preliminary levy at $1.5 million. This could be reduced when the final budget is set in December.
Dress code
In response to a concern from board member Sharon Bloomquist regarding a need for more professional attire by staff, Administrator Wraalstad gave the board copies of an employee dress code she has been working on. The dress code policy is not something the board would ordinarily deal with.
“Clothing should portray a professional image and be of an appropriate length and fit to facilitate movement and protect modesty,” the draft states. “Clothing should be in good taste, neat, clean, in good repair and adequately pressed.” While sweat pants are not allowed except on casual days or while on call, T-shirts and sweatshirts are allowed.
“Hair must be clean, well-groomed, of a safe length and be of a color in good taste, avoiding extremes in color and/or style,” the document states. In addition, it says, “Undergarments are required at all times and should not be visible in normal working conditions.”
“Who determines what is in good taste?” board member Kay Olson said.
“I do!” Sharon Bloomquist said.
“I do!” Wraalstad said. “I don’t really want to be the fashion police. I don’t want to be the underwear police, either.”
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