Hospital CEO’s first board meeting

Tuesday evening saw the first meeting of the Nevada Regional Medical Center’s Board of Directors under its new Chief Executive Officer Steve Branstetter.

In his report, he reiterated what he said in his written report to the board. “The key will be working as a team to turn this around. This will not be a quick turnaround, but a rebuild that will take some time.”

Besides his report, the board heard a summary of items covered by the Finance Committee in its meeting prior to the board meeting, reviewed compliance and quality outcome reports and review two capital purchase items.

Financially, the hospital posted a net operating loss in February of $75,741 which is considerably less than the January loss of $176,239 but over $20,000 more in losses than budgeted for eighth month of the fiscal year.

Expenses for the month were $2.98 million which is below the budgeted $3.15 million.

However, billed charges were $1.01 million lower than budget and except for surgeries and deliveries; the number of patients in every other area in the hospital and clinics was down for the month.

While acute inpatient admissions were 81 but budgeted at 83 while behavioral health admissions totaled 85 compared to 117 the same time last year.

The net patient revenue of $2.72 million was $311,621 less than budget.

Interim Chief Financial Officer Steve Graddy’s report notes “NRMC has successfully reduced expenses, but continues to be challenged by lower volumes.”

The hospital’s unrestricted cash balance as of Feb. 28 stood at $1.06 million while the number of bond days cash on hand stands at 8.9. Under terms of the covenant with the trustee for the bond holders, NRMC is to maintain 70 bond cash days which is equivalent to $8.3 million.

NRMC has never missed a bond payment which, this year, amounts to $123,539 per month or $1,482,468 per year.

Many times, the packet of materials relayed to the board in preparation for the monthly meetings includes one or more educational pieces and this month was no exception. The March newsletter from the Missouri Hospital Association contains an article written by its board chair, Steven Edwards, President and CEO of CoxHealth.

Edwards writes, “Recent data estimates that 31 or our 64 rural hospitals are operating at a loss, and about one-third of the total hospitals in Missouri are considered financially distressed.”

In his first written report to the board, Branstetter listed five “key focus areas” for what he termed the hospital rebuild. These include planning, people, financial strength, quality and community.

While in the longer term he wants to do strategic planning with the board and Freeman, in the near term he is meeting with all department heads and doing a lot of listening and asking questions.

In terms of people the hospital CEO wants department heads to take ownership of solving problems and let staff have a voice and create buy-in.

A mantra from Branstetter’s previous leadership posts is “grown our own,” meaning to identify and train people to serve as back-ups for key positions and eventual promotion. Further, he noted the need for cross-training in the revenue cycle (billing and collections) and that recent hires and promotions mean there are people who need training, resources and support.

NRMC Controller Dana White reported a total of $650,000 will be coming from the Long Term Care unit (Moore-Few and Barone Alzheimer’s Care Centers) with $350,000 having arrived on Tuesday with three further payments of $100,000 each in April, May and June.

“The first payment will allow us to catch up on our bills,” said White. “We're not behind but we have stretched a few out and it's time to pay them.”

“To have financial strength we need to have excellent quality care,” wrote Branstetter. “We have to do the basics right every day which means the patient experience has to be a success story in order for our community reputation to be rebuilt.”

He also relayed to the board his plans to visit businesses in Nevada to open communication.

Chief Quality and Compliance Officer Holly Bush reviewed executive summaries of these two important areas.

NRMC’s triennial hospital accreditation is performed via an in-person survey conducted by the Center for Improvement in Healthcare (CIHQ).

“We have successfully completed the survey process for this three year cycle,” said Bush, meaning the hospital has been reaccredited for three years.

In the past quarter there have been no hotline reports.

Since most of NRMC’s computers run on Windows 7 and support for that platform is scheduled to end on Jan. 20, 2020. Bush said these will need to be replaced due to the threat of breaching the hospital’s computer firewall.

Speaking of an incident which occurred in the Emergency Department in February, Bush reported, “Based on an anonymous complaint that was unsubstantiated, we received a three day EMTALA (Emergency Medical Treatment and Labor Act) Survey.”

Through the survey process she said “we have found a phenomenally increased pediatric mental health crisis in our community which is stressing our current resources both in the hospital and in the community and across the state in order to ensure that these patients are safe.”

In capital expenditures, the finance committee approved the purchase of a new hood in the pharmacy to comply with new regulations; the cost is $6,226 and is part of a larger $400,000 government required pharmacy remodel.