By Jan Greene
Source: July/August 2007 issue of Trustee Magazine

Being a public hospital trustee is kind of like being Ginger Rogers. She performed all the dance moves that Fred Astaire did, only backward and in high heels. Similarly, public hospital trustees do all the things other trustees do, except they carry the responsibility of their community’s health care safety net and do their work in the public eye.

Given those extra factors, it takes a thick skin and a solid grounding in health care finance to survive as the public face of the local hospital. Just ask Richard Dennis. Back in 2000, when the Balanced Budget Act’s Medicare cuts were putting unprecedented pressure on hospitals, the board of Palo Pinto General Hospital in Mineral Wells, Texas, asked local citizens for a tax increase to keep the public hospital open. The idea was so upsetting to some in the community that they started a recall effort to oust the board of directors. “It was a public uprising,” Dennis remembers. “They got organized and got enough signatures to force a recall vote.” With help from a new hospital CEO who encouraged an aggressive response, hospital leaders, including the board, went out and spoke at every Lion’s Club meeting and town hall they could organize to explain the financial difficulties of running a small public hospital.

“We went out there and took our lumps and got yelled at, and then we told our story,” says Dennis, a nine-year member of the board. “We had to explain that being a nonprofit doesn’t mean you can lose money. We explained how we are reimbursed, what our charity care and bad debt take away from us. And how important it was to the community for us to stay here.” The hospital’s counter-campaign was a success, and the tax increase went into effect. That doesn’t mean the hospital’s problems were completely solved—it still struggles with typical public hospital troubles, such as inadequate reimbursement and a significant charity care commitment.

As the U.S. health care system’s problems become more entrenched—a growing population of uninsured, budget cuts for Medicare and Medicaid, a seemingly unending shortage of nurses and technicians—public hospitals feel the biggest brunt of it. As a group, public hospitals are consistently less profitable than the average American hospital—in 2002, members of the National Association of Public Hospitals and Health Systems had a negative margin of -0.3 percent, compared with an average margin of 4.5 percent for all hospitals nationwide.

With little relief in sight, many public hospitals are considering drastic restructuring options. A big urban medical center may seek a merger or switch to private nonprofit status. A small rural could look to hire outside management or sell out to a chain. Boards of trustees are the ones ultimately responsible for weighing the pros and cons of these fundamental changes.

Despite a stable financial situation, a well-respected administration and cohesive board, trustees at Palo Pinto have considered hiring outside management, in the face of an uncertain future. “We’ve talked about how we can survive the long haul,” Dennis says. “You know the best time to do something like that is when you are doing well. But we continue to feel we can do a much better job than an outside entity that might not have the community’s best interest as top priority.”

Restructuring is just one of the unique challenges that public hospital trustees deal with, along with charity care and bad debt, working the political process and strategizing in public.

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The most common side effects of breast cancer treatment are weight gain and fatigue – for which there are no medications or quick fixes. Center member Mercy Medical Center has developed a proactive way of helping cancer survivors deal with these side effects called Especially for Me. The free 12-week program consists of a guided exercise plan with a personal health coach, one-on-one consultations with a clinical dietician and occupational therapist as well as small group educational sessions with various members of the health care team.

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