Editor’s note: Lori Simpson helped organize this event but had no role in conducting the interviews or presentations.
It was standing room only at a Plumas District Hospital informational forum Nov. 10 sponsored by the League of Women Voters of Plumas County.
A panel of PDH leaders included JoDee Johnson, PDH chief executive officer; Darren Beatty, chief operation and government affairs officer; and Caleb Johnson (no relation to JoDee), chief financial officer. The panelists discussed a new skilled nursing facility, an alternative birth center and how cuts to Medicaid and the Affordable Care Act might affect operations at PDH. Moderated by LWV member Susan Christensen, the panel offered information and took questions on all three topics.
Alternative birthing center
California Senate Bill 669 created a pilot program for up to five critical access rural hospitals in California. Dubbed the Plumas Model, the program developed at PDH offers a model of delivery for low-risk pregnant women. PDH stopped delivering babies in 2023, said JoDee Johnson. Prenatal services have remained available in Plumas, but families were required to choose to give birth at home or travel to other facilities in Truckee, Susanville or Reno to give birth.
Maternity center closures are not uncommon, said Beatty. Many rural hospitals are having issues with maternity services, including Saint Mary’s in Reno. For PDH the issue wasn’t financial. It was an obstetrics nursing staffing issue, JoDee Johnson said.
Sixty babies were born at PDH in 2023, the last year services were offered. But the hospital had to be ready at all times. “Finding two nurses to work only OB shifts was not working,” she said. “We tried to use traveling nurses but that was not enough staff coverage.”
Under the new model, mothers at low risk for complications will be able to give birth in Plumas County at an alternative birthing center with midwives and standby medical staff at PDH. A site on Bell Lane is under consideration.
The Plumas Model allows hospitals to staff labor and delivery services on a standby basis, with medical teams available within 30 minutes and surgery services available around the clock, JoDee Johnson added. The pilot program is open to hospitals with 24/7 surgical services on standby, Beatty explained. Most hospitals that don’t offer obstetric services do not offer surgery either.
New skilled nursing facility
A skilled nursing facility has been a goal for PDH for many years. Both JoDee Johnson and Caleb Johnson recalled that when they began their jobs years ago, it was a top priority for then-Chief Executive Officer Dr. Jeff Kepple and the hospital’s board of directors. The former nursing facility closed in 2015. At the time Kepple hoped that PDH could take over the old site, but “arcane” regulations stated that long-term care facilities had to be within 250 yards of an acute care hospital to operate or to qualify for reimbursements from Medi-Cal, Johnson said.
The new facility, located opposite PDH on Bucks Lake Road, was built with a $32 million U.S. Department of Agriculture rural development loan. “There were many curveballs in the process,” Beatty said. For one: “We found out we were building in a wetland.”
The first patients are due to be admitted Dec. 1 to the facility, which houses 36 beds.
Caleb Johnson said that the facility is eligible for Medi-Cal long-term care benefit reimbursements. The daily rate at the facility is $850; MediCal will cover $771.25, he said. Those interested in Medi-Cal long-term care benefits can apply through the county. Beatty and Johnson advised that people who own homes or have $130,000 in assets can still qualify, but they should contact an estate attorney. Importantly, the facility is not designed for memory care.
The facility is organized into four nine-room “pods,” each with its own heating and cooling center, a feature designed to stop the spread of airborne viruses like COVID. PDH is in the process of hiring 28 new staff members, for a total of 300 across the organization.
“We wanted it to be home-like, create an environment of love and make people proud to have such a nice facility,” Beatty said.
The panel responded to numerous questions and comments from the audience, including the following:
Thirty-six beds doesn’t seem like a lot.
JoDee Johnson: PDH originally explored a 104-patient capacity. However, the swing beds — special rehabilitation beds — are a huge program.
Caleb Johnson: Financing was also a factor. The PDH loan is $32 million over 35 years. PDH revenue is $10 million per year. To determine the number of beds, PDH hired an outside firm to conduct a study. They recommended 20 beds, but PDH pushed for more. The current waiting list is over 70 to 100.
Beatty: Forty percent of the applicants need memory care and this facility is not made for that. PDH is currently working on a project to address that need.
What is the collaboration of five local rural hospitals?
JoDee Johnson: Five hospitals — Plumas District Hospital, Eastern Plumas Health Care, Seneca Healthcare District, Mayes Memorial in Fall River Mills and Modoc Medical Center in Alturas — are all collaborating and meeting quarterly to continue offering imaging services.
Beatty: These hospitals’ previous MRI imaging vendor cancelled all contracts, saying agreements were no longer profitable. Heritage, a new vendor, now provides MRI services four to five days per month at PDH. PDH us working to provide breast imaging. The five hospitals have agreed to each purchase their own unit MRI equipment and work jointly together over equipment breakdowns.
The effects of cuts to Medicaid and affordable health care
Finally, discussion turned to the effects of proposed cuts to health care stemming from the Trump administration’s Big Beautiful Bill. “We still don’t know how these cuts will affect our Senior Life Solutions and other outpatient programs,” said JoDee Johnson. “We will live within our means and work with our hospital advocacy groups.”
Beatty called the cuts “sticky topics.” “People will lose their insurance if the cuts go through,” he said. Premiums have been getting expensive and will cause people to have no insurance. The individual mandate, which requires insurance, in the Affordable Care Act was appealed to the Supreme Court and is no longer in place, he noted. Hospitals do better when people have insurance, Beatty added. “The last 10 years of medical debt <at PDH> was at 1.7%.”
The loss of the supplemental payment program expansion will have an impact on smaller hospitals. But, Beatty said, “Our financials are stronger than ever.” The cuts in the Big Beautiful Bill don’t kick in until 2028. By then, Beatty said, he hopes exceptions can be added for rural hospitals, which support far smaller volumes of patients than large urban hospitals.
The Save America’s Rural Hospitals Act, which would restore financial ability for rural hospitals, has been stuck in committee since June, said Beatty. “We need to get everyone behind it and get it passed or we will immediately lose money,” he said.
Caleb Johnson said that the bill’s Medi-Cal cuts could be particularly devastating for PDH. “It’s hard to put words together in my mind on the impact,” he said.
Medi-Cal is “a quiet but tremendous way” of financing supplemental payments, he added. If the Big Beautiful Bill Act curtails some of the financing that has been available in the past, “we can’t continue to grow the cash like it has been,” Caleb Johnson said. “The future is not so rosy because of the increase of supplemental payments in a couple years — a $2 million to $3 million loss by 2028,” he said.
PDH has other funding changes to consider. One is declining Medi-Cal enrollment due to new work requirements. That will increase bad debt with the uninsured, Caleb Johnson said. “We at PDH will always treat you and provide care whether you have insurance or not. But there will be no money for PDH to recover,” he added.
Caleb Johnson said that Medicare is PDH’s largest payer at 45% of revenue.
Questions included the following.
How many patients are on Affordable Care Act insurance? Premiums are doubling.
Beatty: Nationally, ACA services 25% commercial businesses and employees. ACA subsidies are a big problem if not renewed. Health care CEOs make 23% profit year after year.
Doesn’t the Big Beautiful Bill have $50 billion allocated for rural hospitals?
Beatty: Yes. California has an application with 49 other states for funding through Centers for Medicaid/Medicare, run by Dr. Mehmet Oz.
Is there any state level support to tap into in the future?
Beatty: California does subsidize health care, but the $100 billion rainy day fund is almost gone. Sen. Megan Dahle sponsored a Medi-Cal cost reimbursement bill both in the Assembly and Senate but the governor vetoed it. The 100% Medicare fee schedule is way below cost.
What about the seismic building requirements for the old hospital?
Beatty: SB 93 was enacted after the 1994 Northridge earthquake and has a 2030 deadline. PDH has grant funding to provide 80% structure compliance. It is seeking bids. The hospital was built in 1959 with heating, ventilation and air conditioning equipment from the 1980s.
In closing, Beatty said, “We will continue to serve the community and we will be in a strong position financially. <These> will be difficult times. With our critical access hospital, decisions need to be made close to home.” More information about Plumas District Hospital is available on its website.