What to Expect if Adventist Health Comes to the Mendocino Coast

So the Adventist advance team has come to town and made a number of vague proposals. It's hard to know what to make of their pitch, isn't it? Having worked in their system for almost two decades I can offer a few observations and perhaps, predictions. I'm not going to tread softly, because I think religious based health organizations, with their secretiveness and unstated goals, are a bad fit for community based health care based on transparency and honest communication.

The effect of Adventist Health coming to your area will be mostly bad, but there will probably be some immediate benefits. Your health facility will be spiffed up. Adventist has deep pockets and can fund improvements in the physical plant far more easily than the local community. The hospital will look better and function better. Outwardly, it will reflect well on the community. You can also expect a surge in employment. (Adventist Health employs 15% of the labor force in inland Mendocino.) And many of these jobs will be good jobs. Over the years I saw many young people begin at entry level positions and advance to stable long term careers in health care. And, because it is well capitalized, many measures of health care will improve.

But what about those negatives?

Loss of Community Control. No matter what they say in their presentation, Adventist does not care about local communities. They think in larger terms. What they actually care about is their planned strategy to control rural health care in Northern California. Financial decisions are always made on a regional level. Your facility's budget will eventually be controlled by a distant corporate executive. If there's a major problem down the road, the local community leaders will never be able to communicate within the upper reaches of the Adventist hierarchy. Adventist will probably propose some plan for shared decision-making with the local community, but in the end it will be window-dressing - all decisions of financial consequence flow downward from corporate headquarters in Roseville. To step back, Adventists are a community to themselves. In their world people are divided into the Adventists, and the "worldly people.” When Adventists talk about doing things for the community, regardless of good intentions, they actually mean for "their" community. Ultimately their myopic decision-making process excludes non-members.

Greatly Increased Cost of Health Care. The Adventist's strategy historically has been to create small geographic monopolies and then jack up prices. For example in Ukiah the cost of diagnostic services are always at least double the price of similar tests done in Santa Rosa. Furthermore their aim is to drive consumers to more expensive care, such as elective surgeries, high tech imaging studies, and hospitalizations vs. preventive medicine and outpatient care. You only have to drive through Ukiah and look at their billboards to see their strategy. If Adventist comes to town you can expect to see a big jump in your health care costs, and the community will see a rise in medically related bankruptcies.

Profiteering. Why, you may ask, would a non-profit health organization try to grossly increase the cost of my community's health care? Because they are non-profit in name only, a huge amount of money goes to directly into the coffers of the larger Adventist organization. It's a corporate secret, but one estimate I heard from someone who would know is that 10% of gross revenue goes directly to the larger corporation. And then there's the matter of nepotism.

Nepotism. Local Adventist administrators make huge amounts of money. The last time I looked the top administrator of the Ukiah hospital was making over $800,000 per year and many others had salaries far in excess of those made by doctors or nurses. And (this is important) you have to be a member of the Church to occupy an upper tier administrative position. Non-Adventists need not apply - it's an explicit rule. In a way health care is their racket; where there is an Adventist community, there will be a health care facility that employs lots of Adventists in well paid white collar roles. Fundamentally Adventist Health is not an actual non-profit organization. What they call "administrative costs" I call a huge salary boondoggle paid for by the working class of the local community.

Incompetence. This is always the necessary corollary of nepotism. Many functionaries obtain their position based solely on their church status, particularly if they are related to other church members. For example, neither of my last two practice managers had any previous health care experience. The result is a laughably incompetent bureaucracy. As a provider I dealt constantly with untrained employees, unworkable communication systems, shortages of supplies, and many more problems caused by by blissfully obtuse management. From the consumer perspective you can expect consequences like poor communication, long wait times, and lots of mistakes in addition, of course, to increased costs.

Loss of choice. The name of the game in health care is "risk management.” That is, Adventist would like to create a large pool of consumers and control them through their insurance coverage, like employee-based insurances, MediCal (Partnership), and Medicare supplemental plans. Once Adventist is assigned care for x amount of patients they then contract with doctors to deliver that care. In this model the more you hold down cost, the higher the profit. And the best way to hold down cost is to limit care, either by outright refusal ("not a covered service"), or by restricting care to a single network, ie. Adventist Health. Thus in Mendocino you can expect to see only an Adventist approved doctor, receive only approved services at an Adventist lab, and receive specialty care in far away Adventist facilities like St. Helena or even Loma Linda. If your doctor isn't on their panel, you'll have to find a new doctor. And forget about going to Santa Rosa or UCF if you want a second opinion.

Duplicity. This is a highly personal issue for me, and I cannot say to what degree it applies in a wider sense. But I remember leaving a meeting with an Adventist exec and thinking "he just lied to me!" It's been my experience that for sanctimonious people, dishonesty employed for a "higher good" is not wrong. Expect that no matter what assurances and promises are given to your local leaders, no matter what it says on a signed piece of paper, your agreement with Adventist will mutate into something you didn't anticipate, and over time, become increasingly favorable to Adventist aims.

Physician flight. Since my arrival in Ukiah two decades ago, the number of practicing physicians has been cut by more than half. Why? First of all, lack of replacement. Adventist Health is regarded as a third tier organization by many young doctors, who choose to work for more competent systems like Kaiser. And more immediately, Adventist drove many practicing doctors from the area by heavy-handed methods like forcing the community hospital (Ukiah General) out of business, and more recently, insisting that local doctors become Adventist employees. If Adventist comes to town, expect a greater than 50/50 likelihood that your doctor will retire or leave town.

AdventHealth headquarters, Altamonte Springs, Florida

If AH really decides to come to the coast, you probably can't stop them. They have been employing a successful takeover strategy in small towns all over Northern California for more than twenty years. But before putting their signature on anything, your leaders should talk to community leaders in places like Ukiah and Lodi and Hanford and Feather River and see what really happens when Adventist Health come to town.

—Michael Turner, MD (retired)

11 Responses to "What to Expect if Adventist Health Comes to the Mendocino Coast"

  1. Jeff Fox   July 17, 2019 at 1:05 pm

    Thanks for the great article detailing the lesser known aspects of an Adventist takeover. Having just retired from MCDH after 23 years I had plenty of opportunity to interact with the Adventist people, and personally know several employees that left MCDH to work for Adventist, and vice versa.

    It’s not widely known how deeply the religious aspect is ingrained in the organization. Even though lower level managers are not required to be Adventists, one I know personally has told me they are subjected to giving prayer before managerial meetings. It’s also little known that Adventists are basically a doomsday cult, holding the belief and hoping for a God-induced global apocalypse that will destroy all unbelievers and leave only Adventists as survivors.

    I’m not expressing an opinion one way or the other as to whether MCDH should or should not affiliate with Adventist. There are definitely issues at MCDH that an affiliation would fix. But it’s important that the community be aware that much of what they are used to, such as services Adventist deems “unprofitable” will disappear without the opportunity for public input. Affiliation will leave the publicly elected MCDH board with practically zero influence over direction of the hospital. Those who have become accustomed to attending public Board meetings and expressing their views on important issues such as the closing of the Labor and Delivery unit are in for a rude surprise. Dr. Turner’s comments on profiteering are consistent with my own experiences both as a patient and as a department manager who interacted with them in my capacity at MCDH. In my opinion, should Adventist take over the hospital, the chances of keeping the L&D unit open is virtually nil. Additionally, expect the town to lose the jobs currently held by the billing, medical records, and the majority of I.T. staff. My off-the-cuff estimate this that we’ll say adios to around 25 benefited, living wage jobs in those three departments alone. Off to Roseville they’ll go (or Santa Rosa for the billing jobs).

    Reply
  2. Joan Hansen   July 18, 2019 at 9:35 am

    If not Adventist then who? Some of the current problems at MCDH are bankruptcy , resulting in the inability to bring the physical building up to earthquake or just visible maintenance standards . Are there other candidates to take over the management? I feel stressed to read the description of Adventist above. What do we do and where do we go from here? Many years have passed with poor management and loss of revenue to result in the poor condition of the hospital now. Those of us who are elderly and have lived here many years need this hospital, but it is not a consideration. If there is a better alternative, great, if not where do we get help?

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  3. MD, NOS   July 18, 2019 at 5:30 pm

    As a currently practicing MD in Mendocino County, I can honestly say that my experience mirrors Dr. Turner’s. Sadly, Ms. Hansen is right as well. We will have to make do with what we have and try to improve it as much as we are able.

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  4. michael turner   July 18, 2019 at 6:31 pm

    Jeff, I forgot about the outsourcing. Someone who went to business school decided that Adventist would apply economies of scale to the Ukiah clinics. The first move was removing all receptionists to a central facility located a mile from the clinics. So that when patients (generally sick or frail people) called the office they would learn to their consternation that they weren’t actually talking to people in the office. My number one complaint was from people who tried to call me or my nurse and never got through, or tried to leave a message that was never received, or were stuck on hold, or transferred here and there. In the old model when old Mr. Jones called and got frustrated or confused, there would be an experienced office person who knew him and could help out. No more. And worse, billing was transferred to a central facility in Santa Rosa. And it’s a mess, I was constantly hearing from patients about billing errors, and frustrating to them, no easy way to sort them out. So it’s not just local jobs being lost, it’s a whole layer of communication being wiped out purely to save a buck.

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  5. Cass   July 20, 2019 at 6:46 am

    Apparently there isn’t another option. The Coast Hospital has been on the verge of closing its doors for years. No one else, no other health organization would take it on. I’m thinking this solution is better than not having medical care at all on the coast

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  6. William Self   July 20, 2019 at 8:08 am

    Re: The Coast Hospital and the Adventist’s strategy to create small geographic monopolies and then jack up prices. (from article: “For example in Ukiah the cost of diagnostic services are always at least double the price of similar tests done in Santa Rosa. … If Adventist comes to town you can expect to see a big jump in your health care costs, and the community will see a rise in medically related bankruptcies.”

    I have heard this is true. I believe that is true. I have personally had problems with “Adventist’s billing practices” (thankfully small/ though gross to me) that would lead me to choose a non Adventist related Medical Facility if I had a choice. Seeing a rise in medically related bankruptcies would not be good for common folks the Coast Hospital serves.

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  7. dr. michael h turner   July 20, 2019 at 12:48 pm

    The key acquisition for them would be to gain control the Rural Health license – the outpatient piece. I think the license is currently controlled by the Mendocino Coast Clinic. That license is the elixir that transmutes low paying Medicare insurance into lucrative fee for service via the State of California’s Partnership Health Plan. They will probably offer the clinic some sweets, like a brand new building across from the hospital, in exchange for “sharing” that license. In what will seem like a win-win situation they will “save” the community money by taking over management of billing, contracting, human resources, maintenance, etc.. Once they gain administrative control, community input will wither away, and ultimately all the outpatient money will go to Adventist. A ripe fruit there for the picking.

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  8. dr. michael h turner   July 20, 2019 at 6:11 pm

    Not sure what you mean by “separate”. Yes rural health clinics can be independent, but they are often part of a larger umbrella organization. In the case of the latter, the larger organization bills, collects, and distributes the money.

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    • Jeff Fox   July 21, 2019 at 11:30 am

      To clarify, MCC is an independent (not affiliated with MCDH) clinic designated as a Federally Qualified Health Clinic (FQHC). FQHCs are a different license with different requirements. For the most part, FQHCs are independent entities because their reimbursement scheme would be incompatible with that of a critical access hospital. Susie, this is probably what was meant when you were told that they had to be separate.

      The RHC license is held by North Coast Family Health Center, which is not a separate entity, but a department of MCDH. Because of this, under Medicare the reimbursement is cost-based, not fee for service based. Medi-Cal patients are managed under Partnership Health Plan, which operates like an HMO. It uses a fee for service model with extra money incentives for meeting certain “quality” measures such as referrals for colorectal screening. (This varies from clinic to clinic.) Adventist would definitely inherit the RHC license as a department of MCDH.

      Reply
  9. Michael turner   July 21, 2019 at 1:46 pm

    Thanks Jeff, so Adventist has a big incentive to come in, Partnership is lucrative in itself but would also serve as a feeder to their larger system.

    Reply
  10. Taurusballzhoff   July 27, 2019 at 11:58 am

    And remember:

    Not only are the leaders at AH incompetent, uncaring and duplicitous, they LIE about everything!

    Jason Wells is a LIAR! Beware…

    AH trains their managers to tell lies, abuse staff, and to gas-light. AH allows staff members to physically assault and to harass each other.

    AH staffs with a skeleton crew, runs an abusive and random schedule, and will use every trick to get you to work for free and to avoid overtime…

    AH is not a nice company, and it does not care about your community.

    AH will bust your union!

    Reply

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