The Fulton County Quorum Court met on Monday, March 8 and received a financial report from Fulton County Hospital Administrator, Joe Hammond.
Hammond reviewed the hospital's current financial situation, including the year to date fiscal loss of $979,000 that the hospital is facing. "Last year we lost a physician who produced 40 percent of the net volume at the hospital," said Hammond. "That particular type of physician, an internal medicine type of physician, relies heavily on imaging and laboratory testing in their practice; consequently our laboratory is down, in gross revenue, about $870,000 from this same period, July 1 to the end of January, of the previous fiscal year. Our inpatient service is down about $132,000 gross revenue. I emphasize gross revenue. Healthcare finance is different from normal finance. A dollar in healthcare is worth about 35 cents in the bank. If you were to take the gross revenue figures and multiply them by 35 percent, then you would have the amount of cash it actually is, which is called a contractual adjustment. About two or three months ago, I read an article where hospitals across the country are down in their gross revenue by about 61 percent and a lot of that has to do with the economy, with physician shortages. Our situation is wound all in there."
Court member Jack Haney asked point blank if the hospital could survive this kind of loss. "We are tightening up every way that we can, and as I've said to the Board and anyone who will listen, we're trying to do this very delicately," responded Hammond. "We have found opportunities to reduce costs by about $272,000 over the course of the year. Today, we found another $11,800 in a department over the course of the year. We are a business that relies on 24 hour a day, seven day a week, 365 days a year access to care and I can't jeopardize that in labor cut backs."
Discussion then moved to the new physician who will be coming to the hospital, Dr. Ahmad Saab, who recently accepted an offer to come to Salem. "He is somebody that ya'll would like very much," said Hammond. "It will probably be mid to late summer before he begins. The licensing process for an out-of-state physician through the Arkansas State Medical Board is very cumbersome and can last anywhere from three to six months." Hammond mentioned that the hospital is still searching for an internal medicine physician and will continue to conduct interviews for that position.
Questions were asked regarding average patient census at the hospital, and Hammond passed along averages of 9.6 in the in-patient wing and 4 in the swing bed hall. "An inpatient is someone who is having an acute episode, a need for an acute stay, meaning they are more critical requiring more critical care," said Hammond. "They can come through the emergency room or as a direct admit from any of the physicians serving the hospital. Typically, they are a three to four day stay. The revenue stream from inpatient patients is larger than what you see in swing bed patients. We have seven newly renovated rooms in the swing bed hall using the contingency fund left over from the new construction on the hospital. The patients absolutely love it."
A question was raised regarding the number of employees currently at the hospital, which Hammond estimated at between 128 and 130. "That's pretty much what it's going to take to maintain the services that we provide. If we cut more FTE's we'll have to cut services. For example, case managers are vital to maintaining the flow. If we cut that position, we would throw a boulder into the stream of patients. There are a number of positions like that. It takes a lot to run a hospital. We have people in billing, human resources, a finance manager, respiratory therapy, radiology, laboratory. They don't work all the time but we have to have coverage 24 hours a day, seven days a week."
The discussion again focused on the main concern of the court - can the hospital sustain this type of loss and for how long? Hammond's response - Yes, it can. "Right now we're about 40-45 days behind on our accounts payable, and this past week our Medicare and Medicaid payments were up," said Hammond. "I've also streamlined our business office to keep our revenue cycle management in tune to compress the days between the time the patient is discharged and when we can bill it. With these two new doctors coming on, with the one we have and the one more that we're pursuing, they will be the single most important weapons to thwart this loss. Most hospitals today live by their outpatient volumes, and we need that here. We need laboratory, radiology, physical therapy, and these new doctors will help do that. One of the most vicious weapons against a rumor is the truth. If you hear rumors and things out there in the community, or you get asked questions by your constituents, please don't hesitate to call me, because what you'll hear from me is the truth."
With that, the court members thanked Hammond for his time and moved on to the next order of business, delinquent county fines. "Last time I checked, we had around $700,000 in outstanding fines," said County Judge Charles Willett. "Erma Harris, managing editor of the paper came by and offered us space in the paper for no charge if we wanted to print our delinquent fines. She thought that might be the way to help us collect it, and just volunteered us the spot to help collect the money." The court members agreed that this was a good idea and passed a motion to do this.
Next up was the monthly sales tax appropriation for the hospital in the amount of $13,445.47. This was approved, and the judge brought up a new grant which the hospital is applying for to help make the older section of the hospital more energy efficient. "It is the American Recovery And Reinvestment act, and they're putting in for windows and new heat and air in the old section of the hospital," said Willett. "If it's approved, it has to be governed through the county, and we would appropriate it here. They have to bring all the bills by us here and we'll appropriate the money as needed." The court passed the motion for the hospital to proceed in applying for the energy block grant.
The court also reviewed a letter from the Arkansas Building Authority regarding the lease of the revenue office in town. "We lease the revenue office to them, and last year we raised it to $250 from $120," said Willett. "They want to renew for an additional two years. Do we want to keep the same price or ask for an increase?" The court voted for an increase to $275 to help cover the increase in the cost of utilities, which the county pays for.
Finally, the court discussed the recent article regarding K2, a new herbal compound that has recently been seen in the area and has left law enforcement officials in a quandary about ways to combat the use of this legal drug that is comprised of a similar chemical makeup as THC, the psychoactive ingredient in marijuana. Concerned members of the court asked if the county could in fact ban the substance, as some cities have done in both Missouri and Arkansas. Judge Willett said he would consult with County attorney Dewayne Plumlee on the matter and report back at the next meeting. With that, the court adjourned. The next meeting will be Monday, April 12 at the Fulton County Courthouse.