Health Care District Board candidate Jordan Battani
Health Care District Board candidate Jordan Battani
President, City of Alameda Healthcare District Board of Directors
I have served for the past six years on the City of Alameda Healthcare District Board, for most of that time I have been the Board President. I also have Masters Degrees in Business Administration (MBA) and Public Health (MPH), from the University of California at Berkeley.
I have lived in Alameda for more than ten years with my husband David Burton, an architect, our son Miles Burton, and our dog Kitzel. Like many Alamedans, I have family roots in the community – my maternal grandparents made their home in Alameda when they immigrated to the United States in 1927, and my mother was born at Alameda Hospital.
Professionally, I have more than 30 years of healthcare leadership experience in a variety of hospital, physician, health plan and consulting organizations. My current work is focused on the challenges and opportunities associated with the implementation of the health reform act, and on the strategic and tactical implications of innovations in accountable care, value-based purchasing and reimbursement to providers.
What is your vision for the health care district and what are the key steps you would take to implement it during your four-year term, if elected?
My priorities as a City of Alameda Healthcare District Board member are pretty straightforward – I’m all about the healthcare district, and I’m all about Alameda Hospital. My job, as I see it, is to balance two equally important objectives; ensure the continued availability of high quality, safe, patient care at Alameda Hospital and provide effective stewardship for the public funds that are used to support the hospital. During my tenure in office, Alameda Hospital has consistently received certifications and approvals from the agencies that oversee the quality and safety of patient and hospital care. We’ve had significant financial challenges, and as a result, we’ve become one of the most cost effective hospitals in the state. To overcome our current financial challenges, and ensure long term financial sustainability, we’ve embarked on a strategy of service and program diversification, launching healthcare initiatives that will meet community needs and generate the revenue required to sustain Alameda Hospital operations.
For the next four years, the District Board needs to ensure that we continue the progress we’ve made in quality and safety – and expand on our recent successes in program and service growth and diversification. My personal vision for Alameda Hospital is to launch and run new services and programs that generate revenue for the District (and hospital operations) and contribute in a meaningful way to the overall healthcare infrastructure of the larger regional community – by providing high quality, safe, patient services that meet the needs of the larger region as well.
We’ve had some significant successes; the achievement of Primary Stroke Center certification (in which we’ve partnered with the Stroke Program at Eden Hospital, and collaborated with Alameda County to promote stroke awareness and education) the opening of the Wound Care Center (which will generate revenue and provide a treatment modality that is in short supply in the region), the operational contract at Waters Edge skilled nursing facility (which will also generate revenue, and where we can provide a higher level of service for our most fragile elderly population – which is growing) and the launch of our new orthopedic service (which will bring orthopedic services to a region in which they are in short supply).
We have more initiatives like these in the planning stages, and I am anxious to be able to help guide them to completion. I’ll be able to do that if I’m re-elected.
What are the most significant challenges facing Alameda Hospital at this moment?
All hospitals in the country, and in California, face fundamentally the same challenges. The demand for healthcare services is growing, particularly as the population ages. The reimbursement for healthcare services is constantly shrinking, especially from government programs like Medicare (which is the payer of the majority of hospital healthcare bills). An extraordinary number of people don’t have access to adequate healthcare coverage – and do not have the personal financial resources to pay their bills. The technology and talent required to deliver high quality, safe, patient care is more and more costly and on top of all of that, the hospital industry is bombarded by unfunded regulatory mandates – some examples include seismic retrofitting requirements (in California) and meeting the requirements of “meaningful use” of electronic health records in order to qualify for Medicare payments.
Alameda Hospital is particularly challenged; because it is one of the last independent, basic, general acute care hospitals in the metropolitan San Francisco healthcare market. There’s a reason there aren’t many other hospitals like Alameda’s in our market. The industry pressures are enormous, and trying to meet that challenge as a very small player in a market characterized by fierce competition from bigger, more highly capitalized hospital systems is enormous.
With the help provided by the parcel tax, Alameda Hospital needs to do what other successful hospitals have done before us. We have to develop programs and services that are outside the basic set of hospital based services – and use the revenue and profit from those efforts to ensure that we are able to maintain and sustain those core hospital services – the surgical, inpatient and diagnostic services that are required to support the full service ER that Alamedans want to have available to them when they need it.
Should Alameda Hospital remain open? Why or why not?
The original ballot language that Alameda voters passed by a clear majority in 2002, is very straightforward. What the measure says is that the purpose of creating the healthcare district in 2002 was to keep Alameda Hospital open. More than two-thirds of those who voted in that election agreed – and that’s how the District was created.
A big part of that public discussion and decision to create the District in 2002, revolved around the importance of having a fully functional Emergency Room, supported by the diagnostic, surgical and inpatient services that are required to make it effective and safe, right here in Alameda, available within minutes from any location in the city. Fast access to emergency services, when they are needed, can make a critical difference in the outcome for the patient. Local access is particularly an issue in the event of a regional disaster (like an earthquake) when it might become impossible for Alamedans to reach an “off-island” hospital. That concern and need is as important today, as it was in 2002 – maybe more so, as the availability of emergency room services at nearby off-island facilities (like San Leandro) are under threat of closure.
The Emergency Room is an important asset to our local city, and to the larger community as well – but I think it’s important to recognize that our recent expansions into advanced care for non-healing wounds (at the new Wound Care Center), the launch of our orthopedic surgery service (and the recruitment of two new highly skilled orthopedic surgeons to the community) and our initiatives in long term care are important to the local and regional fabric of healthcare as well. These new initiatives make important contributions to local healthcare availability – and they also serve to generate revenue that’s critical to the long term health of the hospital.
With Alameda Hospital’s recent expansion into the operation of the Water’s Edge skilled nursing facility, we are becoming one of the major, local, providers of long term care locally. As a hospital provider of long term care services, both in Alameda Hospital (to patients who require sub acute care) and in our off campus locations at the South Shore and Waters Edge Facility, we are able to provide for the needs of patients with complex post-hospital conditions which make it impossible for them to return safely to their homes right after their hospital stay. This type of healthcare is in short supply regionally, and the need for it is growing as the population ages, and as major health payers (like Medicare) require patients to leave the hospital more and more quickly.
Beyond direct patient care, Alameda Hospital is an important institution in the city and for Alameda County on other dimensions. The hospital offers a wide variety of health education and wellness services that are free, or very low cost. We sponsor health fairs and community health screenings – and recently with our Stroke Education and Screening program, we’ve begun more formal collaboration efforts with the county health department. Finally, with over 500 employees, many of whom also live in Alameda, the hospital is one of the largest employers in the city.
If the hospital closed, what would you do with the parcel tax money the district collects and what if any services should the health care district continue to provide?
From my perspective, if there is ever a moment that Alameda Hospital needs to be closed the original reason for the creation of the Healthcare District will be gone, and with that, it will be time to reconsider the ongoing role and function of the City of Alameda Healthcare District as well. That conversation will have to include the citizen voters of the City of Alameda – and they should make the decision about how to move forward. What’s important to keep in mind is that the Board of the Healthcare District does not have the legal authority to dissolve the District, nor to restructure the parcel tax (other than to set the amount that should be collected each year). Dissolving the District or fundamentally changing anything about the parcel tax (like the method of calculating it, or who has to pay it) would have to be decided by the citizen voters of the City of Alameda, in a special or general election.
How would you fund seismic upgrades that are required under state law?
Seismic safety requirements are a great example of why it’s so very difficult for small, stand-alone hospitals to survive in the Bay Area, and in California in general. The requirements were enacted (and have been amended several times) – but the legislature made no provisions for ensuring that healthcare organizations would have the funds to comply with them. Most hospitals in California have found that a complete replacement of their buildings was required in order to meet the requirements – and with hospital construction costs averaging more than $2M per licensed bed, the cost projections are enormous. (For comparison purposes, replacing all of Alameda Hospital at current construction costs would be close to $250M.)
We don’t have any plans to replace all the hospital buildings. At those kinds of costs, it just wouldn’t be possible. Our current strategy, and one that I’ve supported and voted for has three main elements; work creatively with our engineers and the state officials to find ways to retrofit our existing facility (rather than doing a complete replacement), improve our financial outlook so we qualify for financing the needed improvements when we have to make them, and work with local and regional government to find partnerships and other sources of public funding to help us with this work.
The good news is, we have a very creative plan for retrofitting the existing facilities – that will cost a fraction of what a full replacement would cost, and that plan is in the final stages of approval from the state regulators.
What kind of medical services do you believe Alamedans need on-Island?
I think the concern about having a full service Emergency Room services available on island is a real and legitimate. I know that having a full service Emergency Room requires having a certain amount of basic hospital service to “back it up” – things like radiology and laboratory and surgery.
Maybe more important, I don’t think it’s just a question of what Alamedans need on-island, Alameda Hospital is an important part of the overall healthcare infrastructure in the county as well and it will become more and more important as other hospitals are threatened with closure.
What do you think is the role of the board in overseeing the hospital? What would you improve about how the board carries out its work and/or works together with hospital leaders?
The Healthcare District Board is responsible for all the things that a regular community hospital board is responsible for – and in shorthand legal terms that means the Board is ultimately responsible for every single thing that happens in the hospital from patient care and services to financial matters. In addition, as public officials we’re responsible for ensuring that the public funds in our trust are used in accordance with the ballot measure that created them and that we are operating according to the transparency and accessibility laws that apply to public institutions.
It’s not the job of Board members to micromanage and attempt to run the hospital – it’s our job to hire the best staff we can find, make sure they have the resources and tools to do their jobs well, and then monitor and evaluate how well they achieve the goals that we set for them. If they fail – then it’s our job to make adjustments. During my tenure on the Board we’ve established formal processes for establishing and monitoring our goals – on a five year and annual time horizon. We’ve reinforced and refined our budget development process so it aligns with those plans, and we set annual performance goals for the organization and for the executive staff, so we can tell whether or not they are doing their jobs. We also now conduct an annual evaluation of the CEO’s performance which the Board performs as a group using detailed input from each Board member, and from various members of the management team and key business and community partners.
One thing I’d like to be able to do is to have a formal education process for new board members. There’s a steep learning curve each time we add a new board member – even those with a healthcare background generally require a significant amount of orientation to the nuances of hospital operations and the regulatory environment that we operate under. Combined with that, I’d like to implement a formal process of reviewing the performance of Board members – perhaps something similar to what’s done at other community hospitals. Finally, I’d like to see less mid-term turnover in Board positions – it’s disruptive and creates the need for time-consuming leadership transitions that take time away from other important Board activities.
How would you advise the hospital’s leadership to improve operations, financial stability, and patient satisfaction at the hospital?
I can’t emphasize enough the importance of the planning, evaluation and adjustment processes that we’ve put in place to oversee the activities of the hospital and the team in these areas. We’ve made significant operational improvements and must hold a steady course on cost reduction and cost containment efforts. Patient satisfaction is a critical success factor for us – right up there with quality of care and safety of care. Staff and leadership monitor these factors on an immediate and real time basis and must continue to make course corrections and adjustments as issues and problems are uncovered. Finally, I believe that our service and program development and growth initiatives are the keys to our financial future. Hospital leadership must maintain a laser-like focus on making the newest ones successful and on identifying and launching as many additional ones as make sense and we can manage.
What are the near- and long-term implications of the Affordable Health Care for America Act (“Obamacare”) for reimbursements and revenues at Alameda Hospital? What changes (if any) will be needed for the hospital to adapt to this law?
The Patient Protection and Affordable Care Act contains a number of healthcare payment reform measures for the Medicare program that are already having an impact on Alameda Hospital and will continue to be felt long into the future. There are several different reforms at work as well as systematic reductions in payment levels. The most important common theme, however, is that the Medicare program is changing the rules for payment to hospitals, and finding ways to pay more to hospitals that provide high quality, safe patient care. Alameda Hospital is well positioned to take advantage of this trend – because our cost reduction efforts have made our operations very very efficient, and because our quality improvement and safety programs operate on an immediate and real-time basis for our patients. One of the major reforms from Medicare is aimed at reducing hospital readmissions – which is the term for what happens when a patient leaves the hospital and has to return in a very short time for the same problem. This is unfortunately very common, particularly among the elderly, because Medicare also requires very short hospital stays and that sometimes means that patients go home before they are really ready to take care of themselves after an illness. Our expansion into long term care at the South Shore and Waters Edge skilled nursing facilities puts Alameda Hospital in a great position to be successful under the new Medicare rules, because we are more able than most hospitals to carefully coordinate patient care in the hospital and then in the nursing home too – to ensure that when they go home, they are really ready.