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Bulletin, Progressive, Record, Reporter
Wednesday, Nov. 16, 2011 11B
COMMUNITY PERSPECTIVE
,@
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WHERE I STAND the contents seriously consid- addresses the impact of the economy and, most impor-
ered. proposed cuts and MediCal tantly, displace dozens of el-
JON KENNEDY I am a Plumas County su- beneficiaries' access to care. I derly residents who have giv-
DISTRICT 5 SUPERVISOR
PLUMAS COUNTY BOARD pervisor and represent a dis- feel no need to double up on en everything to finish their
OF SUPERVISORS trict that is served by Eastern" what they've already provid- lives in these facilities.
Plumas Health Care (EPHC), ed. I will, however, address One of the most traumatic
Dear Cindy Mann' a small rural hospital that my own personal concerns for circumstances affecting elder-
Director Centers for will ultimately suffer.severe the patients who call these fa- ly folks is to disrupt their
Medicaid and Medicare consequences as a result of cilities their home and the sanctity. Next to losing a
and SPA 11-010. EPHC has two employees who will loved one or close friend, this •
Gloria Nagle distinct-part skilled nursing ultimately be sent packing, can affect their wellbeing in
Associate Regional facilities (DP/SNF): One in What I've found most frus- multiple ways often leading to
Administrator, Region IX Plumas County with 27 beds trating about policies and pol- deterioration in their health
Centers for Medicare and and one in bordering Sierra icymakers is the belief that status, loss of association with
Medicaid Services, County with 39 beds for a"one size fits all,' decisions friends and loss of support
total of 66 beds. It is my under- are actually sensible. The SPA structure. While not tanta-
In an attempt to not barrage standing that approximately 11-010 is a clear example of mount to outright abuse,
you with additional multi- 93 percent of the patients in how a decision was made these elements severely im-
paged letters and complaints, these DP/SNFs are MediCalwithout regard to the conse- pact the emotional and physi-
I will try to limit my language patients, quences all parties may suf- cal wellbeing of seniors. Many
to select and pointed com- You have already received, fer. This SPA may very well of these seniors have recently
ments. Against my own ad- but obviously couldn't have be a sensible cost-cutting mea- experienced some of the most
vice that letter writing cam- taken into consideration, the sure that will have little or no severe "life stressors" in a
paigns do no good, I am going 31-page document from theeffect on many providers but short period of time.
to do it anyway. That being California Hospital Associa- it will devastate our small As they grow old, their
said, I write this letter under tion outlining their argument hospital; fmancially damage physical selves are no longer
the naive notion it will actual- that DHCS has yet to produce dozens of employees, further that agile and they are unable
ly be read in its entirety and an analysis that adequately affect our already negative to do jobs efficiently. This
alone puts a stress on their
mental selves. The loss of
spouses, friends and family
members as well as ailments
and financial constraints are
all contributors to stress lev-
els. Moving from the place
that has been called home for
an extended period of time is
particularly stressful. The
cuts proposed in SPA 11-010
will only exacerbate the
problems these seniors have
naturally.
The feds have regularly
generated exceptions under
Medicaid rules for circum-
stances that are unique, par-
ticularly as they apply to rur-
al areas. Some examples are
the Federally Qualified
Health Centers or FQHCs.
These are freestanding
clinics that serve medically
underserved areas and rural
areas where the cost of doing
business cannot take advan-
tages of things like economies
of scale. These clinics are
able to bill Medicaid for
actual visits rather than
reimbursement rates. EPHC
is a qualified Rural Health
Clinic that also receives
reimbursement in the same
fashion.
My point is: Although you
have approved the SPA
• 11-010, I believe further
analysis should be considered
and exceptions made for hos-
pitals like EPHC. I am quite
sure that we are not the only
DP/SNF, and our senior
residents are not the only
seniors who will suffer from
this poorly thought-out deci-
sion made by you and the
elected officials who represent
them. I am available to dis-
cuss this matter further
either by telephone or in
person. Have plane, will
travel. I will follow up with
you in a few days to make
sure you received my letter.
MediCal cuts would cause disrupti
ns, cl
WHERE I STAND
BILL WlCKMAN
CHAIRMAN, PLUMAS COL NTY
ECONOMIC RECOVERY COMMI'VI'EE
Dear Cindy Mann
Director Centers for
Medicaid and Medicare
and
Gloria Nagle
Associate Regional
Administrator, Region IX
Centers for Medicare and
Medicaid Services,
The Plumas County Eco-
nomic Recovery Committee
(PCERC) wishes to voice its
opposition to the California
Department of Health Care
Services (DHCS) submitted
State Plan Amendment (SPA)
11-010, which seeksauthoriza-
tion to reduce:MediCal
reimbursement rates for cer-
tain facilities, including
skilled nursing facilities
(SNFs) and sub-acute-care
units that are distinct parts of
hospitals, to 2008-09 rates less
10 percent. If approved by the
Centers for Medicare and
Medicaid Services (CMS), the
reduced rates will be effective
retroactively to June 1, 2011.
Plumas County, like most
small rural mountain coun-
ties, will most likely lose its
SNFs as well as see an addi-
tional financial impact to hos-
pitals. Our county has seen a
large shift in demographics
because of the regulatory
shifts in the management of
our public lands within the
county. Approximately 70 per-
cent of the county is public
lands and the loss pf .obs due
to these egut ii c- ange?
has led to a loss of our young
families. The age group of in-
dividuals moving to Plumas
County is now of retirement
age. This demographic shift
coupled with our existing ag-
ing population has led to a
higher percentage of families•
and individuals of Medicare
and MediCal age.
Plumas County does not
have alternative facilities that
current orfuture residents,
who need SNFs, can be moved
to or move into. To close our
doors on our existing SNFs
will mean those individuals
or couples will have to be
moved out of county. This
causes disruption in their
lives, as well as those of the
families who live nearby, as
well as causes families to trav-
el our dangerous highways to
visit these family members.
PCERC is concerned how
these cuts could affect the
overall hospital facilities •that
remain in the county. We
have already lost one of our
four area hospitals due to the
economic impacts associated
with the loss of jobs due to the
public land management
changes. It is highly likely
that we could/would lose one
of our three remaining hospi-
tals if these MediCal cuts are
approved.
Currently Eastern Plumas
Health Care (EPHC) would
face a 23 percent (by going
back to 2008 rates) MediCal
cut in payments to its hospital
skilled nursing facilities. In
addition, the cuts will be
retroactive, causing EPHC to
have to underwrite care it has
already given, back to June 1.
Since a'staggering 93 percent
of its SNF patients are on
MediCal, this amounts to a
$1.1 million hit per year-- an
unsustainable reduction in
revenue to a fragile hospital
system that has already
scaled back services and been
forced, continually, to do
more for less, while making
sure it meets shifting regula-
tions on every front.
EPHC is hit especially hard
by this ruling, because its
SNFs are a large part of its
business, with facilities in
both Loyalton and Portola,
and a total of 59 patients. Con-
trast this with its nine acute
beds, only three or four of
which usually are filled, and
you get a sense of the gravity
of the problem. Further, as
Chief Executive Officer Tom
Hayes has said repeatedly, the
hospitafhas "zero days of
cash on hand," which means
it can't ride these cuts for
long.
Because the hospital has
very little time to come up
with what amounts to $100,000
per month in cuts, everything
from wages, to cuts in staff,
cutting other programs that
MediCal-dependent residents
count on (but are operated at
a loss), as well as cutting oth-
er services are under consid-
eration.
Our small rural county
does not have the same op-
tions available that urban
communities and counties •
do. PCERC hopes that you
will consider these impacts
as well as what the loss of an-
other hospital would mean to
our overall social and eco-
nomic wellbeing. We urge
you to deny the SPA.
L E T T E R S T 0 E E D I T 0 R
Best sale candidates chose to write a
We started the Quincy li-statement of qualifications.
brary book sale with a large No info in the newspaper Until
goal of $1,500, not knowing if the last week where I learned
we would get it. The goodthat one of the candidates no
news is that we beat that total, longer lives or works in
We want to thank all the Plumas County.
people in the community who Now maybe these five can-
donated books, helped us set didates did not advertise be-
up the sale (a tremendous el- cause they did not have the
fort made easy by a large$250 to be included in the vot-
amount of volunteers), be- er pamphlet, maybe they did
came members of the Friends not have the time to write a
of the Library, bought books, blurb about their qualifica-
made donations, brought their tions (I hope they had some),
friends to the sale, helped us or maybe they just didn't feel
keep the books in order dur- like it. Or maybe they all
ing the sale and helped us put thought everyone in the dis-
away the books in our storage trict knew who they were,
area after the sale (another how they would vote on the
tremendous effort with the upcoming controversial is-
help of even more volunteers), sues, how they would spend
We made a total of $1,610.88 district monies, and whether
that we will use toward the or not they would vote to have
purchase of new books, audio yet another treatment plant
materials, children's services gracing our beautiful Ameri-
and the garden renovation, can Valley.
This is the largest amount I almost didn't vote, but, I
we've made at a quarterlyalways vote; so that was not
book sale since I've been keep- the answer. Besides, not vot-
ing records, ing is the worst response. So, I
Mary McMonegal did vote by process of elimina-
Treasurer tion. It is probably not the
Quincy Friends of the Library right vote and I may regret
Who knew?" my uneducated decision, but
it is the best I could do.
Having been in market- So, to the two of you that did
ing/advertising for years, it not get elected, I'm sorry. You
always amazes me how some-
may be the best for the job,
one can have a product and but who knew!?
think everyone knows about
it. Or maybe that product has Shirley Leschinsky
been available for years in the Quincy
same store in the same loca- Please consider
tion and it is just assumed I would like to remind
that everyone knows on sch0ol board members of your
which shelf to find it. No ad- duty to act as advocates for
vertising is like planning a the entire district, in the best
party and forgetting to invite interest of every student. I
the people; for instance and strongly believe that closing
most recently, the East Quin- schools is neither in the best
cy Services District election, interest of the district, nor its
Yes, candidates, you were the students. I am asking you to
product and oops, you forgot please be more forward-think-
to advertise, ing and consider the long-
Five candidates, vote for term effects of school clo-
three ... which three? Of those sures, rather than just focus-
five, I know one, my neighbor, ing on the short-term bottom
However, I know nothing of line.
his thoughts on how to run a School closures will result
Very controversial EQSD. Lots in larger, more crowded
going on in that district. But, schools, fewer students at-
in reviewing the voter infor- tending neighborhood
mation pamphlet, I learned schools, more transportation
nothing because not one of the issues and more parents
choosing to leave the school Not so super great one don't do away
district altogether. If we con- It is unbelievable that in with it!
tinue on this trajectory, it is one fell swoop, the (not-so-su- VirginiaKylberg
likely that we will be in this per) congressional committee Clio
same position a few yearscould completely do away
from now. How many schools with a wonderful facility in Study in bitterness
The protesters at Wall
will close before you begin to the heart of a rural communi-
Street are using their iPads
take a real look at other op- ty that depends so much on
tions? Please consider the con- their skilled nursing facility and laptops at Starbucks, they
sequences for the community to provide care for those who are upset because of the $100K
debt they created in order to
before you make your final de- cannot be cared for at home.
get their degree in "bitterness
cisions. (In many cases, there is no
With just a little research, I home!) These fragile people studies." They expected a six-
figure job, a car and full bene-
have found substantial evi- may have to be taken from a
dence to support the following place they call home. to anoth- fits at an organic farm collec-
ideas: Smaller schools are bet- er facility far away fromtive. These precious
ter for students and teachers; friends and family, snowflakes are all about in-
gratitude, entitlements, with
students are negatively im- The so-called "super com-
pacted by transitions from mittee" is cutting over $1 mil- an utter lack of perspective;
one school to another; stu- lion from the SNF at EPHC, reality can be ugly, bloody
dents perform better academi- which will endanger the facili- and horrible.
cally in smaller classrooms, ty and possibly the hospital. Unfortunately, throughout
Please consider the research Did I mention that this is also their entire lives they were
before you make your final de- retroactive to 2008? Is this le- told as children that there
cision, gal? How can you do that?were no loserS. They were
The board has not ad- Why only rural hospitals? I born into prosperity, never
hungry, never cold, never
dressed many issues that am sure that if you really
identify a quality school or a tried, you could find $1 mil- without TV or air condition-
quality school district. These lion from any number of ing in a car, always a video
include: student participation wasteful spending that is ram- game console and a laptop,
and no one ever finished in
in extracurricular activities; pant in this government. Be-
last place.
students' sense of belonging; lieve me, our SNF has no
community involvement; staff wasteful spending, and it also Well, there are people out
relations and collaboration; has aheart! there that do unpleasant
student performance; and the I know the good people atthings to make your Xbox,
level of staff interest in stu- the hospital well, both resi- iPad and smartphone work.
dent success. At smaller dents and staff, as my hus- They feed you, purify your
water and provide you the
schools where communities band is one of the residents at
electricity you use. They do
already exist, these qualities the SNF at Eastern Plumasall the dirty things that you
are more than evident. When Health Care Center. One day never see and you should
communities are broken up he went from being the acting thank them.
and students are disrupted, director of the dental clinic at These groups of people are
these qualities are lost. Please EPHC, to having a debilitat- making your life easier and
consider the consequences for ing stroke. His needs were so have for years. They are
students and staff before you great, I could not care for him called corporations. They do
make your final decision, at home without 24-hour help. the things for you that you are
You have a• community of We were very fortunate that unwilling to do; they drill for
people, voters who elected he was able to acquire a room the energy (Shell, BP), grow
you, who are willing to stand at the SNF in Portola. Relo- the food (Kraft, Green Giant)
behind you and support you cating him will not he an op- and kill the animals you eat
in thinking outside the box. tion he needs me near for(farmers, ranchers).
We can come together to make companionship, therapy and The protesters need to grow
this work, rather than fight- advocacy. I could not visit up and realize there js a real
ing against each other. We all him every day, as I do now, world that the rest of us live
have the same ultimate goals, were he to reside in Su- in. Your current government
a benchmark school district sanville, Truckee or Chico, has failed you, you failed you.
and a quality education for particularly in the winter Do you realize that only 97.7
each and every student, months, percent of America's poor
Please consider that as your For most of the residents, own a TV? Your moral betters
bottom line before you make there are no real choices. In in the mainstream media will
your final decisions! urban California, if you had a never tell you this but a
Alicia Hammerich stroke, you would have many "poor" American is about 10
Parent choices. In rural California, years behind the average
Taylorsville Elementary. School we have only one and it is a American.
It's about resentment and
envy, us versus them, as they
stand next to you in the Cost-
co checkout fine.
Dr. Trent Saxton
Lake Davis
A little respect
From time to time a group
of people are demonstrating at
Dame Shirley Park. I have no
idea what the pros and cons
are and I really don't care. I do
believe that the group has the
right to express their griev-
ances, that is, freedom to as-
semble, freedom of speech and
every other constitutional
right. I am not aware that the
president has signed an execu-
tive order prohibiting your ac-
tions.
I do believe that you need to
find an alternative area to do
your deeds. There is a memor-
ial on the corner of Main
Street and Court Street. Sever-
al names are engraved on the
monument. Those people gave
the ultimate sacr'ffice to guar-
antee you that you would
have the ability to keep your
freedoms.
I would like to see you dis-
play respect and appreciation
for their sacrifices. Find an-
other location, like the court-
house, and show a little re-
spect.
Thank you for your consid-
eration.
Jan Klement
Quincy
Fair share
It is time that government
employees pay their fair
share of retirement programs
and health care benefits.
Those on Social Security have
always paid their fair share.
'Most employees and employ-
ers in the private sector strug-
gle over health care benefits.
Gov. Brown is delivering on
his campaign promise with a
plan to reform pensions. It is a
bold political move. We need
to support the action for gov-
ernment reforms that cut
deficits and still deliver vital
See Letters, page 12B