Chairman of the Board, Albert Roork, opened the floor to those residents who had attended the meeting and were concerned about the grant.
"Our major concerns with the grant are: first, we don't know who is applying for it," said Yeneke Robinson. "We don't know if the hospital is applying for it, or if the city or the county is applying for it. We can't seem to find anyone who says, 'I'm going to sign the dotted line.' When we went to the Quorum Court last month, (Fulton County) Judge Charles Willett said that it was not their decision, but the decision of the hospital board, and that the quorum court does not deal with the hospital except for appointing the board members. We were led to believe that they are not involved with you at all. Yet, a little later, the court proceeded to approve a lease agreement between the hospital and several doctors from Mountain Home who rent office space in the hospital. So, why are they involved in a lease agreement?"
Chairman Roork responded that the county does in fact own the hospital building, and that is why they have to approve leases, but he made a point of stating that the Quorum Court does not govern the hospital.
Board member Jerry Estes then addressed the actual grant itself, and the monies that have been allotted for it.
"This grant started a year and a half ago," said Estes. "It's part of the recovery act. The Department of Energy allotted Arkansas a set number of dollars to spend. The Department of Energy addressed the large counties and the large cities. They sent the money directly to them. The Arkansas Energy Office has $5 million dollars to allocate, and you are correct, that this grant has to be applied for through a county or a city. There are 65 counties in Arkansas that are under that classification, and no one has applied for anything yet. The application is still in the works. There's $5 million available, there are 65 counties which have sent in their letter of intent to apply, and Fulton County is one of those. That $5 million is going to some of those counties. It's going to get spent. The Judge and I have talked about this, and he is progressive enough to know that if the money is out there we need to make the application for it."
Estes then went on to outline what the hospital would be applying for in the grant application.
"We are making an application for a new roof on two-thirds of the hospital," said Estes. "We put a new Energy Star roof on the back third using a USDA loan, and it has saved about $1,800 a month, and the payback on that will be 10 years, which is very good. We also are including in the grant new energy efficiency lighting and new HVAC systems. That part of the grant will pay back in 3.2 years, which is almost unheard of. Weatherization around the outside of the building and solar water heaters are also included in our application. One of the requirements of the grant is that it contains some type of renewable energy, so we are applying for five solar water heaters which will provide 70 percent of the hot water for the hospital. We have a good application. Most of these counties and cities will be applying for courthouses and city halls, and one of the big things they'll be looking for is job creation in these applications, or job retention. As everyone knows, dollars and cents right now are very important to this hospital, and we can put into our grant that we are retaining 127 full time positions. This will help the hospital on its overhead every month. One other thing is kitchen appliances. The hospital is still working with the 1960s appliances that were put in when it was built. One of the two things that we have been able to get done without any cost that I don't think any other county is going to be able to have, is we were able to get a commercial energy audit done that was paid for by Arkansas Electric, the wholesale power supplier. They figured out the payback on the lighting, the HVAC systems and on the kitchen appliances, so we have some things working for us that I don't think the other counties are going to have."
Estes went on to state that the county's commitment would involve some in-kind labor, and that North Arkansas Electric will be furnishing technical help when it comes to the solar water heaters and the lighting.
"Dollar commitment from this county and this hospital and anybody else is zero, and we're applying for over $400,000," said Estes.
Board member Danny Perryman then addressed Robinson. "What is your problem with the grant? Why do you care who signs for it? And what county would you rather see have it than this one, or where would you rather see it go than to this hospital?"
"I have no problem with the hospital getting the grant to upgrade the facility," said Robinson. "I have six children and we use the hospital all the time. I definitely want to see this hospital improve in its ability to provide service to the area. I don't want to lose this hospital, because I know that the nearest facility is going to be over 50 miles in any direction from me. My concern is the grant's open endedness."
Another resident then brought up the clause causing the concern. "I do not sign contracts when people leave out things," the resident said. "Here it says that, 'The grantee understands and acknowledges that the federal stimulus process is still evolving and that new requirements for American Recovery and Reinvestment Act (ARRA) compliance may still be forthcoming from the federal government and the State of Arkansas. Accordingly, grantee specifically agrees that both it and all sub-grantees will comply with all such requirements during the contract period.' Now, what are we complying with? We don't even know what we're signing the contract for."
Chairman Roork then briefed the audience on a meeting that had been held earlier in the day. "We talked to two of our healthcare attorneys this afternoon and we explained this clause to them, and their comment was that this is standard language with any kind of grant or federal contract with the federal government, has been for 40 years, and it wouldn't concern them at all," said Roork. "The bottom line is, it is a grant, it is a gift; they aren't going to try to take it back if we get it. They're going to audit us, which is normal and not a problem for us."
Another resident stated that they had copies of two grants the county applied for in 2009 which were not open-ended. "I doubt that any of you would personally sign a contract like this," the resident said. "If you read this, you will understand that no one would sign this personally. Over the course of this contract, anything can change."
"The bottom line is this is not a loan," said Roork. "It is a contract, and I've been involved in hundreds of thousands of dollars in grants from the federal government and I'm not the least bit afraid of it. And yes, I would sign it."
Board member Sue Hertzog then addressed the crowd.
"Would you have us just sit on our hands and let the other counties get it?" said Hertzog.
"Ma'am, if you all didn't waste the hospital's money, and would watch things here at the hospital, we could pay for it ourselves, and have the funds to get it, without grants," said the resident.
Administrator Hammond immediately addressed the crowd following that statement.
"I beg to differ with you," said Hammond. "80 percent of our revenue stream comes from federal programs. Congressman Waxman says in one of the articles I passed out here tonight that over the coming years, healthcare reform will continue to evolve and congress will continue to change it. We have to have that federal support."
One of the people in the meeting asked Hammond if the hospital had planned to make all of these improvements before the grant became available.
"No, because obviously we didn't have the revenue streams to do it, nor was I going to obligate or suggest obligating the hospital to an additional USDA loan, which we could have applied for and very likely would have gotten," said Hammond. "But I did not want to obligate the hospital to another large monthly payment. This grant is an opportunity for us to receive funds to complete projects that we have wanted to do for a long time, and this is an opportunity that comes along rarely. We're going to continue to see people, to treat people, and to see this hospital prosper in the days, months and years ahead, despite the unknowns."
"The money is allocated," said Estes. "It's already there. It's going to go to Fulton County or it's going to go to another county. The money is going to be spent. It will go out over 65 counties. We're either going to get a part of it, or we're not. We will be applying for it, but that does not mean that we're going to get it. We've done some things to make our application, I feel, pretty good. This is not going to cost anybody anything more than it already has."
"I've got to tell you that if this board takes any action that disrupts this grant, I am not sure that we are going to be able to come to town tomorrow morning, because we are going to be literally tarred and feathered by the people of this community," said Roork. "Because to me, it is insane to turn down this grant. I was put in the position that I am in for the betterment of this facility. I am totally dedicated to it. I lay awake at night worried about this hospital on several occasions and each time we've always worked through it, and things are looking up for it, and I just think it would be very irrational and a bad decision to think about not doing this."
At this point, Sue Hertzog motioned that the board continue with the grant process. The motion was seconded and passed unanimously.
With that, the board moved on to other agenda items, beginning with the hospital's financial outlook.
"You may remember last month that we posted a loss of $1,027,862," said Hammond. "This month we have reduced that loss to $710,899. For the month of March, we showed a positive balance of $316,963, due in large part to the interim cost adjustment that we filed, and we received a significant retro adjustment back to July 1, and seven days out of the month of March we operated and were reimbursed based on our new payment rates. If we can hold onto some of our patient volumes, I believe we have turned a very significant corner."
Hammond then went on to praise the efforts of the hospital's billing and collections department.
"We have revenue days in accounts receivable for Medicare, Medicaid, Blue Cross and commercial that averages out to 42.82, and for a small facility like us, that's really pretty fantastic, as 60 is considered acceptable, so they're operating quite efficiently. We've been running a good census, both in March and so far into April. One of the numbers that we watch quite closely is the Critical Access Care Hospital Length of Stay average, and for this year to date it's at 3.82. That has to stay at 4.0 or lower. Swing Beds are running at 12.64 and that more closely approximates an average swing bed stay which is around 14 days, sometimes a little more, sometimes a little less. We're getting that up to where it needs to be, and I'm excited about our reimbursement rates and our volumes coming up to where they need to be."
Hammond then moved on to the issue of licensure for Dr. Saab.
"We have engaged Mike Mitchell, former attorney for the Arkansas State Medical Board, to help us shepherd Dr. Saab's licensure application and paperwork through the State Medical Board approval process," said Hammond. "Jennifer Perryman and I believe that we have most of this information covered. We have one form that was not completely filled out, and unfortunately it comes from the American University of Beirut, so it's not like just running down the street and getting someone to sign it, but we hope to have that information complete by May 4 to be on the agenda for the June 3 board meeting."
On April 30, Dr. Madhulika Krish came to visit the hospital on a recruitment meeting. She currently has a family practice in DeQueen, Ark. and is actively licensed in the state of Arkansas. Dr. Krish is single, and would be moving to Salem with her elderly mother. At a special Board Meeting held on May 3, the board voted to extend an offer to Dr. Krish to join the Fulton County Hospital staff and further word on her response was pending. It was noted that remodeling of the clinic building on hospital property would need to be completed before both Dr. Krish and Dr. Saab would be comfortable moving to the area. The Board agreed to investigate grants with the county to help cover the costs of the remodeling work.
Administrator Joe Hammond then passed out some items of interest for the board members to review at their leisure, featuring an overview of what the healthcare reform legislation would look like for small rural hospitals.
At this point, Administrator Hammond then asked the board to agree to revise the office leases that they approved last month to a fair market value price, as required by the various laws that govern healthcare. The board agreed to Hammond's revisions.
"We have two providers that were brought into the medical staff and need to be credentialed," said Hammond. "Dr. Alan Winberry to renew his dental service credentials and Dr. Mark Heymire who has been covering the emergency room and we would like to get him credentialed as consulting staff. These recommendations come from the medical staff."
The board approved the credentialing of both doctors.
Hammond then reviewed the quarterly Quality Assurance report and stated that all departments have continued to progress towards their goals set in the past quarter. Hammond also noted that the new laboratory director, Tim Killian, is doing an excellent job there.
In other business, Hammond requested that the board agree to allow him to be added to the signatures on the Volunteer Bank account which was created last month to handle the cash flow from the volunteer-run Gift Shop. "It's been suggested that I should have my signature on there as well, since I'm here most of the time and occasionally those two who are currently on the account with signing privileges are not."
The board agreed and then a motion was made to go into executive session.
Upon returning from executive session, no action was taken and the board adjourned.