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 efficient 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
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.
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)
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.
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 every time a ambulance is taken out.. so does the crew pay for taking
it to lunch.. or do we? --Blanca Gilherrema
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
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
- 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
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.
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.
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.
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.
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
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.
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
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.
Why has our billing dept been outsourced and how many jobs were cut for
that? --Jeannie Sykes
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.
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
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.