Programs and Services | Financing | New Governance and Management

Programs and Services

A. When will the District be able to discuss the long-range strategic plan with Hospital staff?

The Hospital will begin sharing its vision for the future during the first year following the transfer in 2010. Existing strategic planning reports from KSA are available here.

B. What programs and services will continue to be offered and what services will be discontinued? What services or specialties do you intend to close down at Marin General Hospital?

We have no intentions under present circumstances to reduce any health services or specialties at Marin General Hospital. In fact, we have a contract with the County to maintain all the healthcare services currently provided at the Hospital.

The only departments that we anticipate any changes in at the time of transfer are the IT and Business Office. The Settlement and Transfer Agreements require us to stand up a completely new IT system and Business Office for Marin General Hospital on the Transfer Date. We had to outsource these functions in order to comply with the agreements. Our vendor, ACS, will provide these services for Marin General Hospital much as Sutter Health has in the past. There will be IT people onsite at Marin General Hospital, a Business office in Marin, and an offsite support and data center much like Sutter Health provides from Sacramento now.

Employees working in these two departments now will have the option of applying to work for ACS, and we would encourage them to do so.

C. Is the District really going to be able to get a new Information Technology (IT) system up and running in time for the transfer?

The District signed a contract with one of the nation's largest IT providers, ACS, and they are already onsite making preparations to begin the installation. Because of their size and experience in the healthcare field, ACS has the ability to scale itself up for a project like this. ACS has put together an implementation schedule that fits the time frame for the transfer, will use industry best practices, and pre-configuration of certain applications, to ensure the time frames are met.

This new IT system will be fully integrated including patient care, financial, and quality data, which has been designed to work together, unlike many of the existing healthcare information systems that have been patched together over time. Marin General Hospital employees and medical staff will receive training on the new system in advance of the transfer. Once this state-of-the-art system is in place, we will have a solid foundation on which to add electronic medical records following the transfer.

D. With greater competition for private pay business, will Marin General Hospital become the "County Hospital" for Medi-Cal and indigent care?

With the continued support of the physicians and employees, we believe Marin General Hospital will continue to attract commercially insured patients while continuing to serve all residents of the county.

E. How do you make a hospital a Magnet nursing hospital?

You start by making it easier for nurses to do their jobs. We have to create an atmosphere of mutual respect between nurses, doctors, and other care providers. It involves creating an environment where people want to work, are supported and opinions are valued.

F. There are rumors that Marin General Hospital may partner in some way with another hospital system. How would that occur and when?

While the District has no plans to sell or lease Marin General Hospital, it may seek strategic alliances that will benefit the Hospital and its patients in the future. Specific alliances will be identified in the Hospital's strategic plan. No current contractual affiliations are being contemplated.

Financing

A. Does the new economic climate change the prospects for the economic viability of Marin General Hospital?

Our Hospital management consulting companies, The Camden Group and Kurt Salmon Associates, continue to forecast positive financial projections.

1. Healthcare is one of only three industries that has grown over the past year and Marin General Hospital has had a very favorable positive cash flow over the past year.
    
2. Marin General Hospital has no long term debt. Most hospitals in California have significant debt that must be serviced before any new projects or equipment can be funded. This lack of debt gives Marin General Hospital more flexibility in dealing with a soft economy.
    
3. Having access to public funds in a County like Marin that supports a top-notch Hospital, may actually be an advantage for the next several years. We have all read and heard news about the difficulty the larger healthcare companies, for profits and nonprofit alike, are having raising capital. Where there is private financing available for them, their costs to obtain it have risen; they can't borrow as much as the once could. This has caused the majority of larger healthcare systems to put many of their projects on hold indefinitely and outright cancel many others. Given the choice of having access to public funds, or private financing for our seismic work, public financing will be much more affordable but we will have to win back the public's confidence and have them share our vision for the Hospital's future.
    
4. This slow down won't last forever. We hope Marin General Hospital can use this time to reposition itself and be ready to take advantage of a stronger economy in the future.
    

B. How do you expect to be able to get a bond passed in an area with so many Kaiser members?dt>

There are a number of reasons why we feel we will be able to pass a bond measure here. First there were a number of hospital tax/bond measures passed in the Bay Area during recent elections in areas with similar, or higher Kaiser membership. Those include Sonoma Valley, San Francisco General, Santa Clara Valley, El Camino Hospital, West Contra Costa County, and Fremont Washington Township. Many passed with more then 80% approval of voters.

Next, there are a number of reasons why the public may see tax/bond measure as a good investment. Marin General Hospital is the destination for most Marin residents in a medical crisis or trauma. They recognize and appreciate the value that a top-notch hospital emergency department brings to a community. Beyond the value of saving lives, a top hospital tends to raise property values, just the way good schools do. Hospitals tend to mirror the community that they serve, so why shouldn't Marin have a first-rate hospital?

Finally Marin General Hospital is one of our regions largest employers. Businesses recognize that beyond the value of delivering quality healthcare, the Hospital provides outstanding employment opportunities that benefit the community as a whole. Marin General Hospital plans to be a model of green management, from facilities construction, to green principles in healthcare operations.

C. Given the downturn in the economy, wouldn't it be better to have Sutter Health stay longer?

We see no reason to delay the transfer because the Marin Healthcare District is on schedule and executing a very thorough Transfer Plan developed with the assistance of top strategic and financial planning consulting firms. While we understand some concerns about Marin General Hospitals returning to community control, we are convinced that it will continue to be successful, even in difficult financial times.

The longer we delay this transfer, the more expensive it becomes. The sooner Marin Healthcare District gets the Hospital back, the sooner we can deploy Hospital resources toward rebuilding our Hospital and the sooner we can provide medical staff and employees with the tools they need to provide excellent healthcare.

E. How is the District going to pay for the seismic compliance expenses? Will the District be able to acquire the necessary financing to pay for the cost of capital, personnel expense, Medical Staff Development, and management of the Hospital?

The District plans to finance transfer expenses through two complementary approaches. The set-up, testing, and training for IT systems prior to the transfer will be funded by the selected IT vendor. Other transition expenses such as seismic related architectural and engineering services, physician development and recruitment, managed care contract negotiations, and other human resources, finance and administrative expenses are likely to be funded by the existing $1.3 million annual transition funding and a line of credit provided by Marin County.

F. Can the Hospital be financially solvent as a stand-alone facility that is not part of a large Health enterprise?

Marin General Hospital's financial results are strong, producing substantial excess cash flow (over $40-million in 2007) after covering all operating (salaries, benefits, supplies, drugs) and capital (new equipment and technology) expenses. We expect the performance to continue to be strong and plan to maintain such financial performance after a transfer of ownership. Between 2005 and 2007, the Marin Healthcare District engaged two nationally recognized top-tier healthcare policy and management firms, the Lewin Group and Kurt Salmon Associates, to evaluate the Hospital, its market, and to assist with its strategic planning. Both firms concluded that Marin General Hospital should be a viable freestanding hospital.

G. What is the likelihood that Marin Healthcare District will be able to get Federal Stimulus money for Marin General Hospital?

Right now, the details surrounding future stimulus dollars are not available. However, we have met with Congresswoman Woolsey and her staff, and plan on meeting with our Senators in the very near future.

Several of our vendors are working hard on our behalf to get more information on future stimulus program details as soon as they become available. Given the types of projects we have planned for Marin General Hospital, we remain optimistic that we will be in line for our fair share of stimulus moneys. This is another situation where it may be a benefit to be a freestanding District hospital then to be part of a larger healthcare organization that may not qualify for this type of assistance.

H. When will the District place a bond measure on the ballot or a parcel tax?

The District will place a bond measure on the ballot, likely in late 2010 or 2011; after the change in ownership that is expected to take place on or before June 30, 2010.

I. If the voters do not support the hospital with tax dollars, what is the back-up plan?

The Marin Healthcare District is presently identifying other well-funded hospital operators who are interested in partnering with Marin General Hospital.

J. Will the District be able to maintain managed care contracts that provide comparable levels of reimbursement as Sutter Health has?

Sutter Health has been able to negotiate favorable managed care contracts for its system and we expect to be able to do so as well. While Sutter's size can work in its favor, health plans also want to offer favorable contracts to community hospitals and safety-net facilities.

As the only full-service hospital, serving our 200,000 residents, Marin General Hospital is in a strong position to gain favorable rates from the health plans. The Hospital is geographically isolated and is the only provider in Marin County for many of its services. This combined with the high level of care our doctors, nurses and staff deliver, makes our hospital a very desirable provider for health plans

New Governance and Management

A. Who will be the Governing Body for Marin General Hospital?

The Marin Healthcare District will replace Sutter Health as the parent company of the existing not-for-profit hospital corporation, Marin General Hospital. The existing Hospital Board will be restructured to include both new and existing members. The membership will include business, community, and physician leaders much like the current Hospital Board. The Hospital bylaws will be updated to reflect the change in ownership.

B. Will the District Govern the Hospital?

The hospital will be governed by a new Marin General Hospital Board with oversight from the Marin Healthcare District Board.

C. Not all Marin Healthcare District Board members in the past have supported the proposed new governance structure. How will you prevent a future Board from trying to take back control of Marin General Hospital from the Hospital Board you are putting in place now?

All members of the present Marin Healthcare District board have supported this new structure and present governance planning is to develop a parent/subsidiary relationship, carefully delineating the roles of the District parent and existing Marin General Hospital corporate subsidiary, so that these roles are well established and stable into the future. Changes in this relationship in the future would be subject to carefully established limitations in order to preserve stability.

D. Will the District Lease Marin General Hospital to another corporation or sell it?

The District will continue the existing lease of the land and buildings to Marin General Hospital. The District does not have plans to lease or sell the Hospital to a third party.

E. When will the new executive team be announced?

An executive leadership team will be developed during the year prior to transfer and announced at least thirty (30) days prior to the transfer of ownership. This team will likely include permanent, as well as transitional executives supplied by our management-consulting firm and possibly members from Marin General Hospital's leadership team should they desire to stay with the Hospital. Ultimately, the executive team will be selected and employed by Marin General Hospital.

F. When will the District have a post-transfer Business Plan available to share with us?

We are currently working with our investment bankers and financial consultants to prepare a 3-year business plan with financial projections for Marin General Hospital. We are encouraged by early projections as we work on a final draft.

There are a number of scenarios we are working on to rebuild our Hospital, invest in technology, and recruit new physicians and partners in the coming years. This will help us expand the scope of services at Marin General Hospital, and in our community. We expect to be able to share our business plan and financial projections within the next 4-5 months.

G. I have heard it is better for a hospital to be a part of a large health care system. Can Marin General Hospital be successful as an independent hospital?

As a freestanding independent hospital, Marin General Hospital will not have to compete with other Sutter Health hospitals for scarce system resources. In fact, Sutter Health recently announced a significant cutback of capital expenditures for Epic (electronic medical records), new IT, and major construction projects system wide. Under District control we will be able to focus all our time and energy on Marin General Hospital and its efforts to serve the healthcare needs of Marin County.

The community should also consider that many of the state's top hospitals are either stand-alone independent hospitals, or the "anchor facility" of their system. Sharp Memorial Hospital (San Diego), Scripps Memorial Hospital (La Jolla), Cedars Sinai (Beverly Hills), John Muir Hospital (Walnut Creek), Hoag Hospital (Newport Beach), California Pacific Medical Center (San Francisco) and El Camino Hospital (Silicon Valley).

We believe Marin County's population shares many of the same qualities of the communities where these top hospitals are located. Over the years these communities have shown their willingness to support first-class hospital facilities and medical programs and we believe that given the chance, Marin will too.

Are you a Marin General Hospital employee? More FAQs about the transfer.