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NRMC board members Denman and Bledsoe leave with years of experience
Bill Denman of Bowman Title Company and Larry Bledsoe, a local certified public accountant, will retire from the board of directors of Nevada Regional Medical Center at the end of this year. Together they possess almost two decades of experience and on Thursday, took time for a conversation that revealed not only their respect for one another, but their deep appreciation for NRMC, its people and services.
"I began serving in 2007," said Bill Denman.
"I began in 2012, filling the unexpired term of Wayne Pruitt," said Larry Bledsoe. "I've always had an interest in the welfare of the hospital and I had served for six years on the board in the late 80s to early 90s."
A term on NRMC's board is for three years with a consecutive limit of three terms. A slate of candidates for open board positions is prepared by the board itself with final approval coming from the Nevada City Council.
Reflecting on the past, Bledsoe said, "When I first served, we didn't have managed care. But we did and still do have a good hospital. I think Bill and I have the same interest at heart: we want the hospital to be successful. We want everyone in the area to use it and not go elsewhere. But every time we turn around, there's something new coming down the pike."
"I was wondering about that," said Denman. "Is the pace of change quickening or is this the end of a series of events so that we're nearing some sort of tipping point?," asked Denman.
"I think the pace is quickening and we're at the end of a lot of changes, Obamacare and all that," responded Bledsoe. "If we were proactive enough we'd be in a better position but none of us has a crystal ball. But I think you're right, Bill, and the younger generation -- the millennials -- they don't hesitate to drive to the city for a better deal on a toothbrush, let alone some medical service or hospital care."
"Look at all the things coming down the pike," continued Bledsoe. "There's ICD-10, Medicaid expansion issues and the consequences of this state not being a part of that and then we're looking at the ACA and ACOs. All those have been in the last five years and they really affect what we are doing and how hospitals are getting paid."
ICD-10 is the tenth revision of the international classification of diseases, which is the world standard for the coding of diagnoses used by public and private insurance entities. ACA is the Affordable Care Act also known as Obamacare. Presently, most hospitals are paid for each service rendered but an ACO -- Accountable Care Organization -- pays them to manage the use of medical services among those who often have a higher use of medical services such as those with diabetes, heart disease or lung problems.
"When I first came on and sat through an audit presentation, and they went over the cost report it showed that for each Medicare and Medicaid patient we were treating, we were losing money," said Denman.
"Years ago, it used to be that a doctor or hospital provided a service, billed for a dollar, got 70 cents and everything worked," said Bledsoe "But now a doctor gets 20-25 cents and so they have to see four times the number of patients to make ends meet."
"That cost report was a real eye opener to me," said Denman. "And I said, 'What is this telling us here?' I mean, the cost report is a mysterious black box."
Bledsoe laughed at this saying, "It is. I used to do those for nursing homes, trying to determine the reimbursement rate for each category of patient."
"Bill, you've brought this up many times," said Bledsoe. "We'd look at Medicare, Medicaid and BHU and say if we brought in this many new patients we'd break even. But, as you'd point out, if we're losing money on every one of them why do we go after all these high dollar people if they're really not going to bring anything to the bottom line. We're going to keep people busy but financially, we're not going to make money. Maybe that's a loss leader but I'm not sure it really brings in that many more acute care patients which is where hospitals traditionally make money."
"And you have to watch it so there's no quick readmission, otherwise the government penalizes you, said Denman.
"And that's another whole issue now," said Bledsoe.
"A person has COPD, gets treated at our hospital and goes home," said Bledsoe.
"But if he goes out to smoke and that brings on another attack which brings him back the next day or so, then the hospital is penalized," said Denman.
"The Affordable Care Act has really changed things around here," said Bledsoe. "So many people in this area now have pretty high premiums and when you couple that with high deductibles, folks are not using their insurance as much as they used to."
"Now that isn't all bad," added Denman. "Some folks were abusing the system and now they understand what the real costs are. But for our hospital, I think it's really cut down not only elective procedures but needed things as well. People just can't afford it anymore."
Asked about the hospital's strengths, Denman said, "I'd put up our MRI unit -- and our people -- against any you'd name in Joplin or Kansas City," said Denman. "It's state of the art."
"Our wound care clinic is very strong, and for an area with a high number of diabetics, that's crucial," added Bledsoe.
"I'd also have to add the OB unit," said Denman. "Our youngest was born there and they did a fine job managing the care of my wife and our child."
"I get asked why the hospital board spends so much," said Bledsoe. "People want facilities and equipment that are state of the art. An analysis of the hospital said that, on average, our facilities and equipment are in the mid-life range of eight to 12 years in age so we need to watch this carefully."
That led Denman to make an important observation about the financial position of the hospital. "Money is not so much a problem as it is a symptom; it's a measuring stick of our overall performance."
"That's so right, Bill," said Bledsoe. "If we can get patients into the door, have doctors, nurses and all the others needed to deliver the services and then properly code, bill and collect on those services in a timely fashion, the money will take care of itself."
"But at various times we've had troubles with each of those areas and on top of that, you add the headwinds of so many changes and requirements," said Denman. "Really, it's a tribute to the leadership, providers and our dedicated personnel that hundreds of people receive quality care each month in our facilities."