Hospital board adopts Long Term Care budget

Kevin Leeper, chief executive officer for Nevada Regional Medical Center and Mike Harbor, chief financial officer, were interviewed Tuesday morning on the state of the hospital.

The old television show, “Dragnet” featured a character, Sgt. Joe Friday, who was noted for saying, “All we want are the facts, ma’am.”

From Monday’s meeting of the finance committee at Nevada Regional Medical Center, a Tuesday morning interview with two hospital leaders and Tuesday evening’s meeting of its board of directors, here are the facts.

For the month of April, the Long Term Care Unit made money, the hospital lost money, the board adopted the fiscal year 2018 budget for the Long Term Care Unit, the board heard a report from Quorum Health Resources and two members of the hospital’s leadership team commented on hospital matters.

For the month of April, the level of profit made by Barone Alzheimer Care Center was $14,926 while for Moore-Few Care Center it was $22,132.

During the same period, NRMC had a loss of $422,604.

Asked about the monthly losses which continue to drain cash, chief financial officer, Mike Harbor said, “It is definitely a matter of concern and we are watching it very closely.”

April’s financial report showed a “bond days cash on hand” level of 12.8 and a “days cash on hand level of 17.1.

Harbor pointed out there is an important difference in what defines “bond days cash on hand” and “days cash on hand” which is reflected in their current levels.

“Days cash on hand” is the number of days in which an organization can meet operating expenses without receiving new income.

The trustee for those holding the hospital’s bonds require’s the hospital to maintain cash reserves equal to 70 days cash on hand. This requirement helps to define the “bond days cash on hand.”

Harbor said, “The hospital is still very sound. We are paying our bills on time, meeting payroll, and still have funds to do what needs to be done.”

Towards the close of an interview Tuesday morning, chief executive officer, Kevin Leeper added, “While there may be a few naysayers about this hospital, just look at what is going on. Even though the season for flu and pneumonia has passed, the volumes we are seeing in patients remains very high, even in May. People need and want the services we provide.”

One of the first items on any agenda at NRMC is called, “celebration of good things.”

“One of the financial highlights for us was settling a two-year account. The family had been making small but regular payments and was waiting for an estate to settle and a house to be sold and when it did, last month they came in and paid the balance, which was $84,000,” said Steve Branstetter, director, Long Term Care Unit.

In reviewing the budget for Moore-Few and Barone, the combined Long Term Care Unit net operating revenues were budgeted at $7,499,040 in 2017 while they are projected actually to come in at $7,751,809.

“Over the years I’ve learned that it’s best to lowball your revenues and overestimate expenditures,” said Branstetter.

For fiscal year 2018, he projects revenues at $7,620,632.

On the expense side, $7461,081 was budgeted in 2017 with the actual expenses projected to be $7,504,983. For fiscal year 2018, the budget calls for expenditures of $7,522,460.

After factoring in non-operating income, the 2017 budget profit was set at $46,587 but is projected to come in at $255,571. Branstetter conservatively projects a profit of $106,800.

“Right now, one of the biggest unknowns out there is the size in the cut in state Medicaid reimbursement rate for nursing home patients in the new state budget,” said Branstetter.

Originally, the Missouri state house adopted legislation with a 3.5 percent cut in Medicaid funds to state nursing facilities. The state senate adopted legislation which lowers that cut to 1.75 percent. This means nursing homes will receive a cut of $2.46 per patient, per day.

When asked, Branstetter said, “I budgeted at the lower level of cuts. The governor has until the middle of July to decide whether to go with the lower or higher level of cuts.”

Associate vice-president with Quorum Health Resources, Herb Winters, provided a brief report highlighting a fiscal evaluation performed periodically by a separate unit of Quorum.

“We do not perform an audit but we look at fiscal policies, procedures and practices and look to see whether these can be strengthened,” said Winters. “This is based off an 18-page template which is filled out by people here and then we come on site to verify things and then write up a report with suggestions to Mike Harbor, to be shared with his staff.”

Winters summed up by saying, “Your financial reports are trustworthy.”

Marci Hardin, director of information technology services at NRMC led off the meeting, assisted by Tim Fowler, network administrator.

“For the fiscal year 2018 budget we had wanted to upgrade our cloud protection as a means of providing a level of security against internet and cyber threats,” said Hardin. “But with the recent “Wanna cry” attack, Tim and I felt we honestly would not be performing our jobs if we waited till July to get our network protected.”

Hardin and Fowler asked the board to authorize her to enter into a contract for the purchase of the Cisco umbrella cloud protection system. Spread out over three years, the cost would be $4,125 per quarter.

Following discussion on the types of threats it would stop, how it worked, and a comparison with other systems and options, Hardin was authorized to proceed.

Holly Bush, chief quality officer, led the board through a review of various quality measures on the services delivered at the hospital.

Among the data was a comparison of NRMC with Missouri statewide averages in 17 areas.

“Several of the most difficult infections to combat are contracted in hospitals … but not in ours,” said Bush.

She noted the rate of infections in NRMC patients following surgery, those with a urine tube placed during a hospital stay, bloodstream infections, rate of Clostridium Difficile (C.Diff) and other antibiotic resistant forms of staph infection.

Said Bush, “Over the past year, in those categories and all 17 listed here, the rate of infection is zero. None of our patients had any. We take infection prevention and the health of our patients seriously and these facts show it.”