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Hospital board members concerned over lack of budget
Nevada Daily Mail
Two Nevada Regional Medical Center board members voiced concern on the approval of hospital expenditures without a budget at the NRMC Board of Directors meeting Tuesday.
Board member Catherine Hissink asked Chief Financial Officer Greg Shaw if the board would see a new budget starting July 1.
"It won't start July 1 because I still have all these accounts and balance sheets to reconcile," Shaw said. "My concern is if I try to do a budget now, in a month it will already be blown apart because it's based on faulty assumptions and bad numbers."
Hissink stressed the need to decrease spending because the hospital lost "$5 million last year and $5 million this year."
"We were told months ago we had to decrease our spending," she said. "We have not done that. We have continued to approve more. Without knowing what that budget is going to look like, I'm very uncomfortable approving spending any more money. We also have to build into this next budget the cost of the hospitalist."
Board member Bill Denman said while everyone wants a budget, several years' worth of a financial mess isn't cleaned up with the wave of a wand.
"A budget that's not worth the paper it's written on is not going to change any of that," he said.
Hissink and Bob Beaver voted no on the 7-2 approval of a $25,000 contract providing 50 percent of the salary for a case worker to process Medicaid eligibility paperwork, a $97,000 contract for psychiatry call coverage by Mohammad Rasheed who will be paid per day and by volume of services, a $203,780 contract for 24 hours-a-week wound care services by Dwight Wagenknecht that includes a quarterly stipend for malpractice insurance coverage and a $353,793 hospital liability insurance renewal.
Hissink also voted against a $49,700 hematology analyzer and interface to replace the more than 9 years old machine, which had been down for repairs 16 days during the last 5 months.
"I'm not against these things, I'm just saying I would be more comfortable if I could see the budget," she said.
Glen Rogers, Steve Russ, Bill Denmen, Jenise Burch, Brad Copeland, Larry Bledsoe and Bill Turner voted yes to approve the items.
The board also approved a transfer of the funded depreciation account from Great Southern Bank to US Bank, a $2,750 engagement letter for risk management consulting services to conduct an insurance review and the $68,000 second anesthesia machine funded by NRMC Foundation and Auxiliary.
In the CEO report, Interim CEO Dave Hample commended Beaver on completing the Governance Excellence Certificate Program from the Missouri Hospital Association. Beaver was presented a certificate and watch during the meeting.
Hample announced Elena Sass, a psych-certified nurse practitioner, will start in July, James Connors, a radiologist, will start in September and Freeman will provide an orthopedic doctor for a two day clinic in the hospital with additional surgeries in that area.
"We continue to work with surrounding hospitals," he wrote in his report. "The agreement with Cedar County is in place for our surgeons to provide surgical services in El Dorado Springs. A surgeon from Cass County is assisting with our surgical call coverage. We are also partnering with Freeman to provide clinical education for our nursing staff."
In the Chief Nursing Officer report, Cory Vokoun said patient call back management and nurse patient rounding are two main efforts underway that significantly impact the nursing division.
"One thing that is critical is volumes," Vokoun said. "We had a 40 patient day on Saturday, which is busy. The average wait time for the ER is 13 minutes. I challenge you to go to any city in the nation and find an ER that has 13 minute wait times. Sometimes people don't wait 13 minutes. It's their expectation to be seen immediately. Our goal is to get them in as fast we can."
In the rural health clinic report, the NowCare clinic had an 8 percent decrease in total visits and 2 percent decrease in new patients, Rich Hill clinic had a decrease of 6 percent in overall visits and no decrease in new patients, Sheldon clinic had a decrease of 1 percent in overall visits with 14 percent in new patient visits.
"People say they can't tell that the clinics are open," clinic operations director Jama Bogart said. "In July, I'm going to purchase open signs for all the clinics. NowCare will have a computerized sign showing wait times so people can come in."
In the CFO report, Shaw attributed the hospital's net loss of $629,106 to an increase in contractual allowance percentage, three payrolls in May, payments on prior month's expenses, salary and benefit expenses and psychiatrist fees.
The contractual allowance percentage is the percentage of gross patient revenue discounted to third party payers, most commonly government programs. Shaw adjusted the hospital's contractual allowance percentage to 65.5 percent to prevent audit adjustments.
"Last year's audit hit us $2.2 million in additional contractual allowances and bad debt reserves because they were understated," he said. "I'm trying to show we have enough reserves out there, so we won't get stung by a bunch of audit adjustments this year. This affected us by about $222,000 in May."
Processing issues in accounts payable, money owed to creditors, led to payments that should have occurred last month coming through this month.
"Operationally, we reduced salaries and supplies by the same percentage we dropped in net revenues," he said.
In the long-term care report, administrative officer Steve Branstetter said Moore-Few and Barone Alzheimer's Care Center brought in a profit of $23,893 for May.
"We're at our highest census for the year," he said. "We're 78 at Moore-Few and 38 at Barone. Accounts receivable days (the average number of days it takes to collect the payments due) are 57.9, which is an increase of 1.72 days compared to April. One of our goals this next month is to get our statements out sooner. We did have some capital expenses; we bought a few scales."
Branstetter said bringing in a Certified Nurse Assistant manager would help with CNA turnover and quality at the facilities.
"Adding another Registered Nurse at Barone will help with staffing and serve as a backup," he said. "We are looking for a social services director at Barone; we have a couple of candidates."
He added Barone needs 21 new beds since the beds have not been replaced in 15 years, and Moore-Few needs a shower room repaired. The cost of the beds would be atround $40,000.