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Previously Answered Questions

Q: This is not so much a question, as a thank you, and accolades for your Emergency Room staff. Wanted to put this thank you in the local newspaper, but could not find an email address for them. On June 29 at approx. 8:00 AM my wife, Betty Lichtenstern fell down the steps between the Model T Casino, and the Quality Inn Motel. The ambulance was called and the EMT's and the police officer were very proficient, secured her on a back board, and transported her to your facility. I was escorted by the police officer there, and arrived before the ambulance. The girl on the admissions desk was very kind, and effecient in getting all the paperwork done. When the ambulance arrived I was allowed in to the emergency room, and was blown away by the caring, kind, concerned service my wife received. We have a home in Sheridan, WY, and one in Vacaville, CA, and have experience both places emergency rooms, but I have to say as good as they are they do not hold a candle to you professionalism, and kindness. Thank the Lord and you all for taking such good care of my wife. --Richard J. Towns

A: Dear Richard, thank you for your thoughtfulness in sending such a kind note. We do have a wonderful ER staff. They are a very genuine, caring bunch. While we are sorry for your wife's adverse circumstances, we're grateful you were in a place where she could receive great, compassionate care. We hope your wife continues to recover quickly and well. Thank you again for your kindness in letting us know about your experience. Our best to the both of you, and we hope you'll visit our community again when you have the chance.



Q:
How can people access their medical records from Dr. Richard Ingle, now that he is no longer in the community? --Dee Holzel (on behalf of Silver Pinyon Journal readers)

A:
According to Jenny Setzer, who is handling the distribution of patients' medical records on behalf of Dr. Ingle, please send a written request to P.O. Box 2280, Winnemucca, Nevada 89446. Jenny also may be reached at (775) 625-4500 for further information.



Q:
Why does the ambulance crew take out the ambulance and leave it running and unlocked during lunch? I read somewhere from Mr Parish that it costs $850 everytime a ambulance is taken out.. so does the crew pay for taking it to lunch.. or do we? --Blanca Gilherrema

A:
Blanca, thank you for your question. When you see an ambulance in town, you are correct in assuming that EMS personnel are eating out, or are running errands on behalf of our service.

Due to the large amount of equipment that must maintain a charge, and the need to keep refrigerators cold, we require that ambulances remain running in order to maintain readiness.  Ambulances also need to maintain certain temperature ranges so they are ready to provide a proper environment to our patients. Ambulances are locked remotely and can be opened remotely so they can be left running.  

Our department is staffed by about 80 percent volunteers. Our volunteers make an enormous sacrifice on behalf of our community to provide around-the-clock emergency medical services to residents for very little recompense. While it may seem trivial, part of volunteer retention is allowing volunteers to choose to cook at the station or to eat meals out.  Considering the many duties they complete during their shifts as well as their rigorous call schedules and training obligations, we believe that allowing them to eat out is a small concession. Without our volunteers, the cost to provide full-time staffing would triple our expenses.

What exactly is the cost of running an ambulance? You are correct in noting that HGH CEO/Administrator Jim Parrish said it costs approximately $850 each time an ambulance leaves the station, but this is for emergency calls only, not for standby (readiness). That $850 figure represents wear and tear, fuel, supplies and the cost of personnel.  Cost is also based on the average number of transports we provide a year and the number of canceled calls we take care of.

In contrast, diesel trucks and buses use 0.75 to 1.2 gallons of fuel per hour of idling, depending on the size and type of engine. Based on current fuel costs ($4.383 per gallon), HGH EMS Rescue spends, on average, between $3.29 and $5.26 per hour to idle an ambulance.  If, for instance, our crews were to eat out three times a day, we would spend between $3,602 and $5,759 each year. That expense is covered by Humboldt General Hospital; however, we consider it a small price to pay for the retention of our volunteers.

Also, please keep in mind that when our crews are in the public our response time is usually reduced by approximately 20 percent. Also, as a side note, many ambulance services, like REMSA (the Regional Emergency Medical Services Authority) in Reno, do not have stations for ambulances. All ambulances are "posted" in strategic locations throughout the city, and their ambulances never shut off.


Q: Humboldt General, I am a pre-nursing college student and I was wondering if Humboldt General Hospital offers and scholarships or intern programs? I am a freshmen in college and eager to learn. Thank You. --Tiffany Bressem

A: Hi  Tiffany. Your question regarding nursing scholarships and "intern" programs was forwarded to me. We appreciate your question and interest in the hospital. Humboldt General Hospital offers two scholarships for nursing students.  Both scholarships require the applicant to be enrolled in an accredited nursing program prior to applying for the scholarships. 
  • Humboldt Hospital Auxiliary Scholarship (sponsored by our volunteer organization).  Qualifications include being a resident of Humboldt County for one year, acceptance into an accredited nursing program in Nevada, transcript of grades and letter of recommendation from the college attended and an interview with the nursing scholarship committee. This scholarship  is for $2,000.00 ($1,000 per semester).  There is no requirement of repayment with this scholarship.
  • Ed and Molly Hanssen Scholarship (sponsored by Humboldt General Hospital).  Qualifications include being a resident of Humboldt County for one year, primary candidates are employees of Humboldt General Hospital, acceptance into an accredited school of nursing, letter of reference, an interview with the nursing management team and the expectation that the recipient of the scholarship will return to Humboldt County to work. Failure to return to Winnemucca to practice requires the repayment of the scholarship funds awarded. This scholarship is for $2500.00 ($1,250 per semester).

The nursing department also sponsors the Nurse Apprentice Program.  This program is overseen by the Nevada State Board of Nursing.  It provides the opportunity for nursing students that have completed at least one year of clinical experience to practice the skills they have learned in the hospital setting. HGH typically hires two to four apprentice nurses during the summer.  This program requires an application for employment, an interview with the nursing management team and is limited to those nursing students that will return to Humboldt General Hospital to work upon graduation. You can obtain more information on this program at the Nevada State Board of Nursing website. Please feel free to contact me if you have further questions.  I wish you success in your pursuit of a career in nursing. Thanks. --Darlene Bryan, R.N., Chief Nursing Officer


Q: How does the process of reporting how many patients become ill, septic or infected with illnesses such as hospital acquired MRSA work? Before I have a procedure in any facility I like to know these stats. Rumor has it that these instances are self-reported, meaning that the hospital would only have the stats if the physician reported on themselves. Does infection control follow-up with post-surgery patients and report to Quality Assurance? A recent call to your Quality Assurance department was not productive as I was told it was his job to protect the hospital from the public having this type of knowledge. Please provide me an explanation on how these things are reported so I many consider future use of our beautiful facility. --Katarina Nance

A: Dear Katarina: Thank you for your email of March 6. I hope the following information will assist you in feeling comfortable receiving care at Humboldt General Hospital. The Infection Control Preventionist at Humboldt General Hospital tracks and monitors trends of infectious patients admitted to the hospital, and HGH's staff is skilled in how to care for infectious patients of varying types. You asked regarding the process the hospital uses to report how many patients become ill with hospital-acquired infections (HAIs). This stat is calculated on a monthly basis and reported at the monthly Medical Staff meeting which physicians and administrative personnel attend. To let you know, lab cultures done in the hospital are reviewed by the Infection Control Preventionist on a weekly basis, who then determines if an infection is HAI or a community-acquired infection (CAI).   If transmission-based precautions need to be put in place, this is done proactively by placing a suspected patient on precautions until the results of cultures are known.  If results are negative, the patient is taken off the transmission precautions; however, if the results are positive, then appropriate measures are already in place to protect other patients as well as hospital employees. As part of this process of monitoring cultures, post-op infections are investigated as well. This is due in part to the fact that the Infection Control Preventionist follows all surgeries done in the facility on a monthly basis. Consequently, if a patient returns to the facility or has lab cultures done, Infection Control is aware.  The Infection Control Preventionist also becomes aware of post-operative infections through monthly reporting by surgeons.  This is accomplished by sending a letter to each surgeon with a list of all patients and completed surgeries. Surgeons are specifically queried regarding any post-op infections on their patients.  They are to report the date of infection, site of infection, and if a culture was done or not.  Accordingly, as you mentioned in your email, part of our monitoring process includes self-reporting.    We are careful to follow the recommendations and guidelines from the Centers for Disease Control (CDC) for our infection control program. Thank you again for your inquiry regarding our infection control practices. Please let us know if you have additional questions. We welcome the chance to earn your trust and provide you with an exceptional care experience.



Q: I notice the new helicopter pad is, or is near completion. When patients are arriving by or being transported away by helicopter, how will she/he be moved to the pad? By ambulance or with a gurney and staff members? I'm just thinking of potential traffic problems that may come up with a helicopter, flashing lights, police (for traffic control), people, etc. --Tim Vaughn

A: Hi Tim. Thanks for a very good question. We appreciate your concern for patients' safety as well as for that of the public. When a patient at Humboldt General Hospital needs to be transported by helicopter to a larger medical center located to the west or east of Winnemucca, members of HGH EMS Rescue will transport the patient from the hospital's ER to the helipad via ambulance. The operation of the helipad will be more efficient and safer than the previous hospital-based operation. The pilot will control the landing pad lights from the air and will be able to land safely without the police department surrounding the site as before. The new relocated port was specifically designed for its purpose. Approach is limited to south, southwest and west approach paths. The port is fenced, and there is a specially designed load ramp for the ambulance. The entire area has been landscaped and is sufficiently distant from Haskell Street that, beyond the casual interest of passersby, operations should not pose a safety hazard to the traffic on Haskell Street. The former pad was simply the parking lot on Harmony Road between hospital buildings with approach over power lines and occupied buildings. That's why the former pad required mobilization of the police department to cordon off the area. Now, HGH has separated the new port into the railroad corridor, automated the operation and added 50 new, much-needed parking spaces as a productive buffer. All safety issues have been discussed with officials from the City of Winnemucca and should concerns arise, they will be addressed immediately.



Q: Why are your accounts receivable being done in Spokane? This takes at least two good jobs away from Winnemucca and we need the jobs here. Thanks for your time & service!! --Bryan Mahoney

A: Hi Bryan. Thank you for your question. Humboldt General Hospital's patient billing has been outsourced to a private company in Spokane, Washington. That decision was made after we had explored every possible solution to what was becoming an overwhelming problem. In all honestly, we simply had to come to terms with the fact that we could not get our billing into a manageable situation without outside help. Medical billing is a highly specialized field. It is extremely expensive and difficult to train billers and we could not effectively process our 10,000 bills a month in-house. At one point, our billing department was 154 days out from the time care was provided to the time a bill was issued. Through the absolute hard work and tenacity of our billing office staff, we were able to reduce those days out to 70 days, which was an unbelievable drop at unbelievable sacrifice on the part of our staff members. But we never could get below that. We should be somewhere between 52 and 55 days. If we go much above that, our patients have to deal with a multitude of insurance and other headaches. Plus, if one of our billers was gone for a few days due to sickness, vacation or training time, our days out immediately started inching back up; it was a miserable battle and one that I think our billing office was glad to hand over to a national company that specializes in such practices. You noted in your question that this move to outsource took two good jobs away from our community. When we decided to outsource, there were six staff members in the former billing office. Two of those employees were reassigned to other areas of the hospital, one found employment elsewhere and three remain in the business office to provide local billing support. It wasn't the ideal solution, but it's one we know most hospitals have had to make, both rural and urban. That being said, we share your concern about job creation and retention. While our business office now shares some of its work with an outsourcer, HGH has created approximately 10 new positions over the past 18 months in other departments, including a physician recruiter, an accounts analyst, a case manager, an additional position in our purchasing department and many others. The bottom line is that just like other businesses, we must make those decisions which will allow us to provide our community with the best care possible-whether that's medical care or billing care. Sometimes we transfer patients to larger institutions where they can get the care they need. Sometimes in the non-medical aspects of our organization we have to transfer work to larger organizations that can give us the care we need. Still, we are very grateful that most of the time we can do a great job in-house. Thanks again for a thoughtful question. Take care.



Q: At this week's joint City/County meeting, we heard about budget shortfalls at the State level. These funding reductions may result in unfunded mandates at the local government level. Are there any funding shortfalls coming down the line for HGH? If so, what are the plans for addressing this issue? Will it be necessary to dip into reserves and increase billings or will there be program reductions or service/quality curtailments? Thank you in advance for your thoughts on this issue. --John Siegfried

A: John, thank you for your question. Although the information we have right now is very preliminary, it appears that Humboldt General Hospital is not going to be immune from funding shortfalls and spending cutbacks at the state level. For instance, it is very likely that Humboldt General Hospital's State of Nevada licensing fee will increase by $10,000 each year. The state also is considering a severe reduction in its allocation of Medicaid match dollars for long-term care. If that indeed is the case, that would mean that 18 of the residents at Harmony Manor, Humboldt General Hospital's long-term care facility, would then not be eligible for funding. At a $1.3 million loss, that would put HGH in the position of having to discharge those residents or provide for their care free of charge. Additionally, the government is considering a 10 percent rollback in Medicaid reimbursement, which would amount to a hit of about $700,000 to Humboldt General Hospital. All told, with just what we know so far, this hospital could be looking at over $2 million in additional expense/lost revenue beginning with the next fiscal year. Of course, these are only the ideas that legislators and the governor have mentioned so far. With the Nevada Legislature convening on February 7, there will no doubt be other suggestions that will come forth over the following 120 days. That being said, we surely don't want to sow fear about our ability to provide care regardless of what the government's final decisions are. One of the reasons we have been so watchful about our bottom line is so that we will have a reserve during adverse economic times-a reserve that will help us care for our community at the same levels we now enjoy. As such, we do not anticipate that cuts at the state level will translate into increased costs to our patients, nor do we anticipate that we will see any reductions to our programs or services. We probably will not have any definitive answers as to how budget shortfalls at the state level will affect us until the beginning of the next fiscal year July 1. Until then, however, we will share any new information with the community as it becomes available. Thanks for a great question.



Q: Why has our billing dept been outsourced and how many jobs were cut for that? --Jeannie Sykes

A: HGH outsourced its billing to a private company in December 2009. As a fiscally responsible organization, HGH had to acknowledge that it needed help to get its billing into a more manageable situation, so we followed on the heels of most hospitals across the nation, both rural and urban (like St. Mary's in Reno), who have taken the same route. Why? Medical billing is a highly specialized field. It is extremely expensive and difficult to train billers and we simply could not effectively process our accounts receivable in-house. We process about 10,000 bills a month. At one point, our billing department was 154 days out from the time care was provided to the time a bill was issued. Through the absolute hard work and tenacity of our billing office staff, we were able to reduce those days out to 70 days, which was an unbelievable drop at unbelievable sacrifice on the part of our staff members. But we never could get below that. We should be somewhere between 52 and 55 days. If we go much above that, our patients have to deal with a multitude of insurance and other headaches. Plus, if one of our billers was gone for a few days due to sickness, vacation or training time, our days out immediately started inching back up; it was a miserable battle and one that I think our billing office was glad to hand over to a national company that specializes in such practices. We are still working on getting the kinks out of that system, but at least we know we are on the right track. With regard to your question about how many jobs were cut, there were six staff members in the former billing office. Two of those employees were reassigned to other areas of the hospital, one found employment elsewhere and three remain in the business office to provide local billing support. 



Q: I know HGH has and is making great strides to bring more physicians to Winnemucca. Has any consideration been given to having a visiting neurologist serve our town? My spouse suffers from epilepsy. We've been forced to make many trips to Reno for specialist care. Many epileptics are unable to drive (like my wife). Our trips have required significant amounts of time off from work; which, in effect, drives our medical costs even higher. Thank you for your consideration. --Name Withheld

A: Thanks for your question, and thanks for acknowledging that HGH is working hard to bring more physicians to Winnemucca. That goes for visiting physicians as well, but unfortunately at this time, we don't have a neurologist who is scheduled to visit Winnemucca. We are sorry about that and feel badly that your wife cannot receive the care she needs in Winnemucca. The good news, though, is that we are open to any physician who would like to come to Winnemucca and, on your behalf and that of others who also have neurology issues, we will send out some inquiries to neurology groups in the Reno/Carson area right away to see if any are interested in scheduling a monthly or even quarterly visit to Winnemucca. Our current medical office expansion will free up many physician office spaces, especially in the 130 E. Haskell Street building, and we hope to fill those with visiting physicians of every specialty, including (hopefully) neurology. Thanks again for your question and best of luck to you and your wife. She's lucky to have your support.