San Joaquin General Hospital reports operational strain and steps to curb overtime costs

Sam Harlan presented an update on San Joaquin General Hospital’s operational and financial position and described both volume increases and cost pressures.

Sam Harlan said the hospital showed an estimated $6 million loss for December but that first-quarter volumes — surgeries, emergency department visits and patient days — are above average. He told the committee that average occupancy is near 112%, producing overflow into hallways and complicating staffing and throughput.

"When the length of stay goes up, generally that eats into your cost and your revenue," Sam said, noting length of stay has risen to about 5.4 days versus a 5.1 budgeted target. He described social admits who may remain hospitalized for long periods as a key throughput challenge.

Sam outlined steps under consideration to address costs: targeted staffing augmentation, reassigning some administrative staff to clinical roles, re-bidding security and dietary contracts, and limiting capital purchases to emergent needs (he said about $8 million of a $15 million capital budget had been spent so far). Committee members and hospital leaders also discussed shifting minor procedures into a new procedural room funded by a health-plan grant, expanding operating-room capacity (the OR is up by roughly 800 cases this year) and pursuing efficiencies that would reduce overtime and ESPP (extra-shift premium) pay.

Sam reviewed major IT and revenue-cycle projects: Workday went live in February but data-loading challenges have delayed producing clean financials; implementation of a cost-accounting system (Strategize) is planned for an August go-live; the billing platform will move from Finthrive to SSI with a hoped-for June 2026 launch; computer-assisted coding integration with the Cerner system is targeted for June 2026 but faces technical hurdles; and a new employee time-clock rollout is expected in October after additional testing and a change to punch rounding policy.

Committee members pressed for clarity on premium-pay impacts, travelers and case-mix index (CMI); a committee speaker highlighted a move from a 1.37 CMI to about 2.1 and said that each decimal point change can represent millions of dollars in reimbursement.

No formal board action was taken; members requested continued follow-up on staffing plans, contract rebids and project timelines.