Mariposa Democratic Club Meeting Minutes
Saturday, April 13, 2013

Speaker - David Hill, CEO of John C Fremont District

Discussed how even with the Medi-Cal expansion, the state is still trying to cut Medi-Cal cuts by 1.7 billion this year.

Ewing Wing – there is a 10% cut to the skilled nursing facilities – but that cut is based on 2008 reimbursement rates; compared to 2011 reimbursement rates, it’s a 30% cut. Injunction has been lifted so state can implement the cuts as well as ask for reimbursement of the overpayment back to mid-2011.

A bill, AB900, has been introduced that rescinds the cuts for 88 hospital-based skilling nursing facilities (which includes the Ewing Wing). The various hospital organizations also plan to sue again to try to stop the cuts.

Pre-cuts: Ewing Wing costs $394/day/patient; the current payment is $325/day/patient, which ends up as an annual loss of $493,000 which has been covered by various tax measures and other income.

Post-Cuts: payment will be $237/day/patient which would mean a loss of about $964,000 annually. The recovery back to mid-2011 will cost about $1.1 million. Board doesn’t want to close Ewing, so need to increase revenue and/or decrease expenses. They are performing a district-wide operations assessment to see where can cut. Also looking at revenue. Expense cuts may include labor cuts; a lot of employees are part-time/on-call. Another area to look at is that some nursing home patients are actually mixed in with hospital patients, which leads to a higher cost of care; if they can move them back with the other nursing home patients, that will cut costs.

In general, hospital-based nursing home are more expensive than standalone due to acute care needs. A standalone nursing home will send acute care patients to the hospital; a hospital-based nursing home keeps them.

Ewing Wing currently has 23 people; it’s licensed for 16, but the hospital beds (18) give it room to expand to more than 16.

Medicare pays a little – but generally people use up their lifetime nursing home care (100 days) pretty quickly.

Mr. Hill discussed the funding changes for hospitals and that it looks like after the changes are in place the hospital wll get $240,000 less from the state. But this funding change hasn’t been approved yet.

John C Fremont is a “critical access” hospital – essential services to underserved area. The three clinics have special federal designation as “rural health clinics” so get a preferred reimbursement rate. With Medi-Cal moving to the state, the state is promising to honor the higher rate, but there is no guarantee.

Mr. Hill then discussed Medi-Cal Managed Care – will be provided by Anthem and Blue Cross. Initially planned for June 1, postponed to Sept.

New clinic in Italian Acres – by Horizons; will take Medi-Cal. People will need to pick their “home clinic”. Expecting number of patients to grow from 2,000 to about 3,300.
California is 47th in nation in terms of putting dollars into Medi-Cal; lot of doctors won’t take Medi-Cal patients because revenue isn’t worth the paperwork. When doctors come to Clinic 2, they have to take Medi-Cal patients.

Treasurer’s report -  will be on website

Spring Fling – Club will have table at El Portal’s Spring Fling on April 27; passed around sign-up sheet for tablers

Fair booth/Labor Day Weekend Float -  Discussed float and fair booth; passed around signup sheets for committees

Flea Market – We will be participating in the October Flea Market again! Please save your stuff!

Jefferson Award – Winner has been selected; awards ceremony is May 8, 6:00, at the high school

Membership – Continuing to look for names of people to become members!

Announcements -  Town Hall meeting in Fresno on MediCare and Social Security cuts proposed by Pres. Obama. Tues, 4/23
The Garden Club will be at the Butterfly Days festival May 5 with a big plant sale – funds go to scholarships

Meeting adjourned 11:00 a.m.
Submitted by Anne Brock, Secretary, Mariposa Democratic Club