City of Seward, Economics, Health

Council hears finance woes, upbeat medical news

By Heidi Zemach for Seward City News –

Providence Administrator Joe Fong, middle with white shirt, at City Council meeting. Attorneys from Brooking's law firm, front row. Heidi Zemach photo
Providence Administrator Joe Fong, middle with white shirt, at City Council meeting. Attorneys from Brooking’s law firm, front row. Heidi Zemach photo

The Seward City Council’s regular Monday meeting March 10th, was interesting in that we heard about the difficult working conditions in which the city finance department finds itself, without working software and lacking experienced staff. We also learned more about the latest finances of Providence Seward Medical & Care Center, and briefly met four of the other Anchorage-based attorneys from the firm of longtime city attorney Cheryl Brooking, who is leaving the city’s employ.

Brooking’s annual council review took place recently, in executive session. Eric E Wohlforth, the senior attorney and founding member of the firm back in 1967, will be looking after the city’s business, at least for a while. Meanwhile, several the other associates also have worked on Seward issues to some extent, so she expects a smooth transition, Brooking said.

The finance department has been under a lot of pressure lately, and its staff have been working long hours without overtime, said City Finance Director Kris Erchinger. They have been bravely putting the finishing touches on the current budget document, which none on the staff except for the director has ever done, and which came out Monday, later than ever before. And they’re now preparing for the upcoming audit of city finances in three weeks, for which the same is true. In addition, the department has taken on the additional task of helping get the new Seward Community Health Center up and running, providing services such as billing and hiring.

The CHC opened its doors Monday, March 10th in the hospital building with an entirely new staff at its front desk, and a temporary visiting provider seeing patients. It was a busy day, and many residents were seen, said Acting CHC Board and Clinic Executive Director Sharon Montanigno. They’re still looking for a full time MD, a mid-level clinician and an executive director.

Meanwhile, finance department has continued trying to work with, and ultimately replace its 25-year old, malfunctioning computer system software and hardware systems, with a newer one. The firm that was to have come to Seward to install the new system a few months ago suffered personnel setbacks of its own, with a staff member’s sudden illness and another suffering a death in the family. After patiently waiting for another appointment, the city finally hired a new firm, which will arrive to roll out the new software system on July 1st, Erchinger said.

The meeting’s  main order of business was a resolution amending the management and operating agreement between the City of Seward and Providence that dealt with removing the primary care clinic from Providence’s scope of work, modifying the space use of the facility, and proposing a future reduction in the annual fixed period fee that the city gives to Providence to manage the hospital and long term care center. That resolution passed unanimously.


The Seward CHC sign announces the new federally-qualified community health center. Heidi Zemach photo.
The Seward CHC sign announces the new federally-qualified community health center, which is now housed at the hospital. Heidi Zemach photo.

Administrator Joseph Fong also gave an upbeat 2013 year-end report on finances and other things at Seward Providence. In his Executive Summary, Fong said they had a strong year, highlighted by continued improvement in quality measures at both facilities, including significantly reducing the number of falls, bed sores and healthcare-acquired infections. Seward Mountain Haven sustained successful state licensing, and a federal safety regulatory survey, and sustained better overall patient satisfaction and improved employee engagement, as measured by two surveys.

Providence also was able to repay its deferred financial commitments with the City of Seward, due to money received by a recent settlement over differences in reimbursements with the State of Alaska. The city has begun receiving payments for only $6 of the $12 million it believes it was owed by the state in reimbursements after moving into the new Mountain Haven facility. But the settlement allowed the City and Providence to avoid up to eight years of legal wrangling, Erchinger said. The city also received federal reimbursement for the funds it had forward-funded to Providence to purchase EPIC, its digital health records-keeping system.

Providence’s financial performance census was therefore up in 2013, well above 2012 figures. Its net income was $4.8 million after total revenues of $20.9 million, and expenses of $16.7 million. In 2012, total revenues were $18 million, expenses were $16.3 million and it had a net income of $2.3 million. Its charity care and bad debt was up to $1.4 million in 2013, above .9 million in the previous year. Since Providence is a not-for-profit entity, any profits must go back into the hospital or the community. Providence provided almost $730,000 in charity care, including sliding fee benefits; approximately $64,000 in in-kind services and labor through Seward Wellness for All; and over $11,000 in on-demand (subsidized) lab work. Providence also donated to He Will Provide Food Bank.

Establishing the new CHC turned out to be more work than he had expected, but he still believes that doing so was in the best interest of Seward, Fong said.

Challenges for Seward Providence’s  future include filling “swing beds” at the hospital, which means returning patients who can do so to Seward hospital to complete their recovery here, and maintaining and improving population numbers at Seward Mountain Haven through referrals from other Providence facilities. As of Monday, the facility was 11 clients short of the goal of 40. Providence is also working to enhance its telemedicine services, such as eCare Mobile, looking at how they can expand services at the long-term care facility, and even service the Anchorage market, Fong said.

Providence also is still recruiting for two full time permanent physicians for the hospital. It has been using locum (or visiting) physicians to help the existing permanent physicians, Drs. Michelle Hensel, Rob Reeg (a married couple who are meant to work there part-time) and Amy Bukac, who staff the emergency room around the clock. Since Dr. Jerry Flynn, the former medical director moved from Seward, Providence has been working with Karen Mailer, MD, the medical director for Providence Extended Care in Anchorage. She provides regulatory oversight and to support to the physician assistants, nurse practitioners and other providers involved in elders’ care, from her office in Anchorage. She visits Seward at least once or twice a month, and elders also are seen by Providence’s PA.  Mountain Haven clients are occasionally transported to the ER when they need a physician’s care, but with Mailer’s assistance, that practice has decreased, Fong said.