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Among the many benefits of living in our small town is quality customer service. That’s because when businesses and customers get to know each other as real people, mutually beneficial interactions result. We don’t have anonymous transactions here.

Think of the checkers at Safeway – Afton, Debbie, Jen and colleagues – they recognize us and say hello. The small favors they’ve done me are countless. In the wine and booze aisle at Sunshine, Matt Smith remembers what we like to drink and suggests new libations. If you buy a pair of pants from Nick at Mario’s, he’ll remember it the next time you walk in.

Then there are our restaurants, “where everybody knows your name,” as the title song from “Cheers” taught us long ago. The extra napkin, the glass of ice cubes, the quickly delivered iced tea — after a while, they become almost automatic.

That’s not to say that the inevitable bumps and hiccups that at times plague all service-oriented businesses don’t happen here.

When Jude Wilmoth, the proprietor of Cook and Cook Tavern, hears of a service problem at another establishment he responds with a classic line that extends beyond food and beverage purveyors: “It’s not your problem.”

What Jude means is that customers deserve and should expect first-class treatment, and that whatever the short-term or lingering problems at a business, they shouldn’t be visited upon the customer. His message to businesses is straightforward: don’t burden your customers with your problems — just fix them.

In terms of dollars spent, our largest consumer-oriented business here is St. Helena Hospital, traditionally known as the San and more recently as Adventist St. Helena. If it has bureaucratic good fortune, it will soon acquire yet another name – the Sacred Trust Network. We know many of their doctors and nurses as friends and neighbors; it’s another small town business – just the largest.

This Network will be the ambitious joint operating entity combining St. Helena and Queen of the Valley hospitals. In their application to the state for approval of this new venture, the two hospitals “believe there are significant opportunities to provide care closer to home for more patients by concentrating on centers of excellence, creating a broader and deeper value-based provider network, integrating clinically across systems, and collaborating on health information sharing and care management.”

That’s a mouthful and these aspirations won’t be achieved overnight. Not only because quality health care is an art as well as a science, but because it’s a ridiculously complicated financial structure that its customers find difficult to deal with. Among customer service problems in St. Helena that need fixing, the predominate one must be medical accounting.

My own recent medical adventure, previously recounted in this column, led to St. Helena Hospital submitting about $38,000 in claims to Medicare. The Hospital eventually received payments of nearly $8,000 plus a much smaller amount from my private supplemental insurance carrier.

To the customer (me) these numbers are absurd. To try to understand them, I chatted with Tim Kares, the relatively new CFO at the hospital. Kares comes to us with decades of experience at major health institutions around the country. His perspective on medical finances is based on that considerable body of work.

Kares acknowledges that “patient accounting as a service is one of the things patients get frustrated with. It gets more and more complex.” No kidding. In part because of this complexity, the hospital outsources its patient accounting staff. It hires the multi-billion dollar Cerner Corp. to do this work. I went to Cerner’s website, where it says things like “Track financial performance across your entire system.” But nowhere did I find any statements about patient access to comprehensible financial information.

Indeed, when I tried to talk to someone on the phone about my bill, I got entangled in an unfriendly phone tree. Eventually, I received a letter that states that “there are many factors that contribute to how a hospital determines the cost of charges for services … ”

I’ve found that at every St. Helena business I’ve entered downtown there’s always someone available to discuss a billing problem, and that person or a manager can resolve it. But evidently not so at our biggest business, the hospital. We should, however, recognize that patient accounting is by no means just a local concern; it’s a national disgrace that reflects the inefficiencies of our entire health care system.

When the San and the Queen implement their Sacred Trust Network, we, their customers, might hope that their use of the word “excellence” will also apply to medical financing and accounting. And then perhaps they could say to us, “It’s not your problem.”

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Mark G. Epstein moved to St. Helena from the East Coast early this century after a career in international business.

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