The Fulton County Hospital Board of Governors met on Monday, March 22, and hospital administrator, Joe Hammond, had some bad news on the financial front.
"Our year to date loss, as I knew it would be for this month, has crested a million dollars to $1.2 million," said Hammond. "You'll see that compared to the prior year to date, we are down $2,444,000 in patient revenue. Net collections are down compared to prior year to date $392,491."
But it wasn't all bad news in the financials for February. "Our losses are not uniformly shared across all departments. I talk often about Physical Therapy and how well they are doing. Physical Therapy's gross revenue year to date is $346,870, with a net profit margin of $120,000, so they are doing really well."
The hospital's CPA firm, Hughes, Welch and Milligan, have also written to the Centers for Medicare & Medicaid Services (CMS), to request a Medicare reimbursement rate increase and retroactive receivable.
"With the reduction in volumes and amount of investment that we've put into the facility, both with the new furniture and some of the renovations, the way the cost basis of this reimbursement goes, is that when your volumes go down, as ours did, and expenses for all intents and purposes remain relatively flat, then your cost per patient day goes up significantly, and that is how the CMS calculates their payment to us as a critical care access hospital," said Hammond. "The higher the cost per day, the higher the payment. Bill Couch has estimated that we have approximately a $612,385 receivable from CMS, and he is asking for us to be paid 80 percent of that, or $490,000, and in addition to that, he has also proposed increases in our Medicare reimbursement rates, not the rates that we charge at the hospital. Our current Medicare inpatient reimbursement rate is $840 a day, and he is proposing an increase to $1,000 a day. Swing bed currently is $700 a day and he is proposing an increase to $950 a day. Plus, we are currently being reimbursed 47 percent of Medicare allowable for outpatient services and he is proposing that figure be raised to 50 percent."
An influx of close to half a million dollars would undoubtedly assist the hospital, but as Hammond pointed out, there is a balancing act involved in keeping the reimbursement rates stable.
"Now, the thing we will have to watch is that if we continue to ratchet down expenses, and should our volume swing back up again, what we could be looking at is having to give a significant portion of this reimbursement back. So we have to watch that balance, watch those ratios and we will, very carefully."
Hammond told the board he is looking into specialized software that would allow the hospital to create a cost report model that would allow them to keep close tabs on the reimbursement balance.
In recruiting news, all of the forms for incoming physician Dr. Ahmed Saab have been mailed in to the state medical board, which has a scheduled meeting the first week in June.
"We hope to present his application to the board at that time," said Hammond. "I'm very encouraged, though we have nothing official from the board, but the individual with whom we've been working spoke very favorably about the application and that things are looking good. It's still a board decision, and there are 13 individuals on it, each with a mind of their own, so we'll have to see how that all turns out."
Hammond then presented the board members with the resume of a new physician candidate, Dr. Russell Huq of Houston, Mo., whom the hospital received through their recruiting firm.
"He is a family practice physician at a clinic in Licking, Mo.," said Hammond "He's married and has a young child. He did his medical school at the American University of the Caribbean School of Medicine in St. Maarten, Netherlands, Antilles. We recently had another physician scheduled to come in who graduated from a school on the Arkansas State Medical Board disapproved list, so we had to cancel that one. Because of that, I called the medical board and asked them both about Huq's medical school and then also about his post graduate year I, II and III. Any international graduate is required to have three years of post graduate work from an American school and he does meet those basic requirements, so he would be eligible to apply for an Arkansas license."
The board members discussed various items within Huq's resume, including his many certifications.
"He is ACLS, PALS and ATLS certified, and we're coming to the point where that will be a requirement to work in the emergency room," said Chairman Al Roork.
Hammond explained that as soon as a date could be set for a visit, he would arrange for the board members to meet Dr. Huq.
The board then turned to hospital's continued efforts to reduce expenses.
"I've had several department come to me and volunteer to reduce their hours," said Hammond. "Billing and admissions, which is now one department, has reduced their hours to the tune of about $11,500 a year savings in labor, and in human resources, they have reduced their week's work by four hours which equals around another $6,000 over the course of a year. As I mentioned earlier, one thing that we have to watch very closely is not letting the expenses plummet so low that we change that balance with our cost based reimbursement. It's working in our favor to maintain our level of expenses. If our volumes go way up again, then we're going to have to let those expenses come back up, responsibly, with them; otherwise, we'll get into a pay back situation."
Next up was the Chief of Staff report presented by Dr. Griffin Arnold.
"We had several physicians and personnel from Ozarks Medical Center (OMC) come over and give the medical staff the beginnings of some sort of a fast track for Fulton County Hospital and OMC, and I'm hoping that turns into something that is beneficial for both," said Arnold.
Several physicians from OMC in West Plains came and gave a presentation to the medical staff and spoke about the options available for the two facilities to assist each other.
"This was one of the most friendly, informative meetings that I've gone to in a long time on two facilities that used to be against one another," said Arnold. "I was very encouraged by that meeting and there's going to be some fast track ideas developed where, if a patient comes into our facility that we cannot handle, if it's appropriate, we can quickly transport them to OMC where they can help them. Many of the patients we talked about, are patients that Baxter Regional Medical Center cannot handle, so that's why it was such an important meeting. This is something that Baxter cannot offer us, that OMC can, and we're geographically close and we'll see what comes to pass in the weeks ahead."
Updating the billing and charting situation, Dr. Arnold noted that the advances in previous weeks have been slowed down due to the workload that the current physicians are faced with.
"Recently Dr. Phillips has been put back into the rotation of getting unassigned patients, which should help us with sharing some of the load," said Arnold. "Let me tell you what the procedure is right now. What happens is that a person gets admitted to a physician, and that physician comes in that morning and has two things they have to do for that patient: They have to have a history and physical and they have to have a discharge summary, if they're stabilized and ready to go home. Each of those takes about eight minutes to dictate, and another eight minutes in preparation to dictate it. Right now, Dr. Bozeman and myself have to do the weekends and our paperwork during the week. We used to have weekends off, but that hasn't been the case for the last three months. It all comes back to this: We need emergency room physicians and we need admitting physicians."
In other business, the hospital received the annual audit engagement letter from Hughes, Welch and Milligan for completing the hospital's yearly financial audit.
"The cost of the audit fees are estimated to be $15,000 and $7,800 for the preparation of the cost report, and that is only a slight increase from last year," said Hammond.
Chairman Al Roork felt that due to the estimated cost, the hospital would be best served by placing a public bid for the audit. "I think we're going to have to bid that," said Roork. "I don't think that the cost is out of line, but I would think that because of the amount of that we should bid that."
The rest of the board agreed, and Hammond said he would have the bid placed in the upcoming week's paper.
The annual credentialing of physicians was brought to the medical staff and they were approved and recommended to be brought to the Governors as follows:
For active medical staff status, they presented Griffin Arnold, Jim Bozeman, Michael Moody, Rebecca Phillips and Jeff Summerhill.
Presented for consulting privileges were Philip Ferguson, Richard Jennings, William Landrum, Stephen Locke, Matthew McAllister, Anupama Schultz, Joe Tullis, Otis Warr, Matthew Wilson, Adam Wozniak and Michael Camp.
Presented for courtesy privileges were William Dyer, Peter Mackercher, Charles McKnight, Charles Tucker and Tamara Ward.
All were approved by the board members.
Department Directors appointed by the medical staff on Feb. 25 are as follows:
Chief of Staff -- Griffin Arnold; Vice Chief of Staff -- Rebecca Phillips; Ambulance -- Griffin Arnold; Blood, Gas & Medical Laboratory -- Duke Jennings; Cardiac Rehab -- Jeff Summerhill; Emergency Room -- Jim Bozeman; Infection Control -- Duke Jennings; Medical Records -- Griffin Arnold; Operations/Procedures -- Jim Bozeman; Pharmacy -- Michael Moody; Co-Chairman of Pharmacy -- Rebecca Phillips; Physical Therapy -- Michael Moody; Radiology -- Ronald McCann; Respiratory -- Griffin Arnold; Safety/Disaster -- Rebecca Phillips; Swing Bed -- Rebecca Phillips; and Quality Assurance -- Griffin Arnold.
All department directors were approved by the Board of Governors.
Hospital Administrator Joe Hammond also presented renewal lease agreements regarding clinic space within the hospital for several physicians for the Board to approve. "This is a compliance matter, to remain legal and compliant with CMS. We can't just give them office space because that is what's called inurement, which is enticing a physician to come and produce revenue for our hospital by giving them a place to practice."
The board agreed to the lease agreements and talk moved on to the hospital's new Volunteer Gift Shop.
"If ya'll haven't seen that, it's right across from the cafeteria," said Roork. "They've done a great job on it and it looks very nice."
According to Hammond, the gift shop needed to open a bank account which the board needed to approve.
"As they have prepared that business and are watching every dime and penny very closely, they have opened a bank account called the Fulton County Hospital Volunteer account, and anything that has the name of the hospital on it has to be approved by the board," said Hammond. "This will be a separate account from the hospital, even though it will appear on our ledger."
The board members agreed to the account, and it was mentioned that the ribbon cutting for the gift shop will occur on Monday, March 29.
Before going into executive session to discuss personnel issues, Chairman Roork reminded the board members of the upcoming Political Rally being presented by the Fulton County Hospital Foundation on April 1, and asked that members consider attending the event.
Upon returning from executive session, the board took no action and adjourned.