San Joaquin County extends another $4.5M to improve care at SJ General Hospital

San Joaquin County taxpayers will continue to pay for managerial and administrative changes made within the General Hospital in French Camp.

The Board of Supervisors unanimously voted on Oct. 24 to spend another $4.5 million to extend a Management Services Agreement partnership with Dignity Health, according to a county press release.

Millions of dollars have already gone into making San Joaquin General Hospital (SJGH) more efficient since 2022.

Last year, the county partnered with Dignity Health to boost SJGH’s financial and quality performance, Board of Supervisors Chair Robert Rickman said in the release. The sprawling Dignity Health hospital chain has owned St. Joseph’s Medical Center in Stockton since 1996.

The board vote confirms its previous plans for 10-year initial period option for the Management Services Agreement. The new agreement will expire on June 30, 2025.

Since the services agreement began, Richard Castro was appointed as CEO of San Joaquin General Hospital, through CommonSpirit Health (a partnership between Dignity Health and Catholic Health Initiatives). Castro held a similar leadership position for another Dignity Health facility in Arroyo Grande.

The CommonSpirit Group was instrumental to achieving pharmacy and supply savings during the first phase of the services agreement, according to county documents.

Abe Nuñez was hired as chief financial officer in December 2022, the hospital told CVJC in a statement.

Many of the financial improvements noted by the county involve optimizing how the facility bills its patients. These revamped practices have since saved the hospital an estimated $30 million.

For example, SJGH contracted with an outside vendor to pursue small balance accounts that were neglected in the past, the hospital said in an email statement.

The hospital also began using the 3M CodeAssist tool that examines physician reports to assign more accurate codes for billing, according to the press release.

“3M CodeAssist will save the hospital money,” SJGH told CVJC. “In addition to a revenue lift, SJGH expects to realize productivity improvements by leveraging the 3M computer-assisted coding technology.”

The release lists eight “Quality Improvement Items,” including the hiring of a new deputy director of nursing. Zainab Wardak was appointed to the position, SJGH wrote in a statement.

The county reported a significant decrease in “all SJGH-acquired infections” as one of the hospital’s improvements.

“The Standards and Compliance department, which includes Infection Control, Quality and Risk Management, are responsible for these improved results, as are the nursing unit managers and staff who implemented clinical best practices,” SJGH told CVJC in an email statement.

Catheter-associated urinary tract infections dropped from 10 to a single infection over the course of a year, the hospital said. Thirteen central line associated bloodstream infections were tallied in 2022; so far this year, only six have been noted. Surgical site infections lowered from 53 to 27 since last year.

Looking forward

During the management transitions, SJGH implemented a hospital-wide quality reporting system, MIDAS.

“Staff are adjusting to the transition with the new MIDAS reporting system. As with any new system, staff are on a learning curve and adjusting to the changes,” the hospital told CVJC in an email statement. MIDAS deals with Ongoing Professional Practice Evaluation (OPPE) and Focus Professional Practice Evaluation (FPPE).

“All core measures reported to the Centers for Medicare and Medicaid Services (CMS) are also now performed through MIDAS,” the hospital wrote. SJGH will keep old OPPE/FPPE reviews on paper, and utilize a shared drive for core measures, along with the new system.

San Joaquin General Hospital’s quality improvement is measured through a series of surveys, according to the county. Most notably, the CMS LeapFrog Hospital Survey rating is expected to “improve to an ‘A’ by the end of calendar year 2024, breaking the seven-year ‘F’ rating,” the release said.

Today, the SJGH has a “high C” score, the hospital told CVJC.

LeapFrog currently ranks SJGH high in most of the 12 categories surveyed, such as Maternity Care and Medication Safety. The public hospital has low rankings in the Pediatric and Patient-Centered Care categories.

SJGH in French Camp’s Billing Ethics rank low in LeapFrog’s Patient-Centered Care survey, because the hospital has been found to sue its patients.

In 2020, the San Joaquin County General Hospital filed two civil cases against patients represented by Health Care Services Corporation' and Blue Cross/ Blue Shield for lack of payments of over $100,000, according to court documents. The Health Care Services Corporation case was moved to a federal court in August 2022, and the other was dismissed.

“San Joaquin County is not aware of any pending lawsuit (sic) filed by Health Care Services Corporation or any San Joaquin General Hospital (SJGH) related litigation that is pending in Federal court,” the hospital wrote in a statement to CVJC.

SJGH was established in 1857, and its post-graduate residency has trained over 3,000 physicians since 1932. The facility and its related clinics are the basis of San Joaquin County’s safety-net health care system, according to the press release. Eighty-percent of SJGH patients rely on Medicare or Medi-Cal.

Vivienne Aguilaris the health equity reporter for the Central Valley Journalism Collaborative, a nonprofit newsroom based in Merced, in collaboration with the California Health Care Foundation (CHCF).

Zhaozhou Dai, data reporter with The Center for Public Integrity & Central Valley Journalism Collaborative, contributed to this report. 

This article originally appeared on The Record: San Joaquin County extends another $4.5M to improve care at SJ General Hospital