Last night the board reviewed the administration’s recommendation to close the Obstetrics service line and heard from a number of community members and physicians asking the board to continue to keep the unit open. The room was full, testifying to the interest in this subject, and many speakers were understandably passionate about their desire to keep the birth center open. In the end, the decline in births at the Hospital and the mounting losses persuaded the board to approve the discontinuation of this service.
While acknowledging how difficult it is to discontinue any service, the board recognized that in order to continue providing the essential emergency services that this community needs and expects, we cannot continue to subsidize services that are declining in usage and losing money.
I might add that the meeting is the latest in a series of discussions questioning the viability of operating an obstetrics unit in the Sonoma Valley. Similar meetings were held in 2009, when the unit was modernized in an effort to attract families, and again in 2014.
The Hospital has made considerable effort in recent years to make Obstetrics financially sustainable. Obstetrics has experienced a dramatic decrease in births, down almost 50 percent since 2010, reflecting the continuing decline in births nationally. It now has an average of two births per week, which is not sustainable.
In addition, at the meeting the board heard more about the plan to transfer Home Health Care to a large and reputable local nonprofit in the coming year as an alternative to closing the service. The Hospital is currently in discussion with the nonprofit to conclude this agreement.
Skilled Nursing Facility Planning
Previously, the agenda for this meeting included discussion of potential closure of the Skilled Nursing Facility (SNF). CEO Kelly Mather and I decided to postpone the SNF discussion to allow time to collect more input from the staff, physicians and community, given the amount of questions and concerns we heard in the past week.
I plan to ask the board at next week’s meeting to convene a special task force, chaired by a board member and comprised of hospital staff, a physician representative, a Finance Committee representative, and a member of the community. This task force will be asked to return to the board within 60 days with recommendations for returning the SNF to profitability based on related costs, or for the closure of the unit. Following that, we will schedule a special board meeting, open to the public as usual, to hear and discuss those recommendations.
The administration deserves credit for approaching this process conscientiously and with deliberation, mindful of the impact that the closures will have on staff, physicians and our community. If you are interested in the details, the service line analyses and recommendations, they are in the board packet for this meeting, which is available online.
The combination of our previously announced initial investment in the Outpatient Diagnostic Services and this restructure of our core services demonstrates a focus on what our community wants and needs – emergency care and the critical services that support it. It also emphasizes that all other services at our Hospital must have high utilization rates and contribute to the bottom line.
Financially, the discontinuation of the Obstetrics service is critical as it had a loss of more than a half-million dollars in the fiscal year ending June 2018, with a similar loss projected for the coming year.
Unfortunately, we anticipate that 7.5 full-time equivalent positions, staffed by 12 individuals will be affected by the changes in OB. In addition, with the anticipated transfer of the Home Health Care service, 17.7 full-time equivalent positions, staffed by 27 individuals, will transition to the new organization. Employees affected by the Obstetrics closure will be considered for any open position currently posted for which they are qualified.
Reinventing The Hospital
The Hospital is undergoing a period of reinvention to prepare itself for a more sustainable role in the future, one responding to healthcare industry trends in a way that will lead to greater financial certainty. The vision emerging from these changes brings into clearer focus what SVH will look like in the future and how it will best serve Sonoma Valley. These changes reflect a long-term national trend for community hospitals of moving away from inpatient care and to outpatient services. Advances in medical care and technology, in addition to insurance mandates, are driving this trend.
These changes make it inevitable that our Hospital needs to emphasize emergency services and other healthcare services that don’t require overnight stay. As a result, our Hospital will be smaller in the future, but will operate with greater efficiency and be better able to provide for our community’s needs.
While reinvention and transitions can be very challenging, our board and our entire staff are committed to managing our Hospital effectively and efficiently. Our goal, as ever, is to provide our community with a high-quality emergency department and access to a range of convenient and important healthcare options. We hope that you understand the necessity of these changes and continue to support the important contribution we make to the community.
Our next regular District Board meeting will be held on Thursday, August 2 at 6 pm in the Community Meeting Room, 177 1st St. West in Sonoma. The public is welcome to attend, and public comment is always encouraged.
Sincerely,
Joshua,
Joshua Rymer
Chair of the SVHCD Board of Directors