The Fulton County Hospital Board of Governors met in regular session on Monday, June 28 and welcomed the CEO of Ozarks Medical Center, Dave Zechman.
"I wanted to introduce myself to you and give you a quick update of what we're doing at OMC and our relationship with Fulton County Hospital, which we're very pleased about and excited to be working with you on," said Zechman. "We're really pleased to be working with you and look forward to helping you in any way that we can. (CEO) Joe Hammond has been really good to work with -- we share a lot of the same vision, of taking care of our patients and our communities while supporting each other and developing a seamless environment of patient care between our two facilities."
Zechman also noted that OMC now has 24-7 cardiovascular coverage, 24-7 orthopaedic surgery coverage and their new 16 bed emergency room will open on July 20 with an open house on July 18 at 2 p.m.
"Dave and I started working on this relationship in July of last year, and its turned out to not only be a good professional relationship but also a good friendship has developed out of it," said Hammond.
Moving on to the hospital's financial report, Hammond noted that the facility had reported a loss of $244,529 for the month of May.
"Our patient days were down significantly during the month of May, as they have been so far during the month of June," said Hammond. "In May, patient days for Medicare were at 130 versus 155 days in April. The same thing happened with Swing Bed. In May we had 99 days and in April we had 133 days."
The hospital's year to date financial loss is currently at $791,092, but Hammond reminded the board to take all avenues of revenue into account.
"Obviously, I'd like to have a positive bottom line every month, but we have to remember that all of this settles out on the cost report," said Hammond. "One of the ways that Medicare settles a cost report is increasing our reimbursement per patient day and then a retroactive adjustment or pay back, depending on where we fall on that adjustment. Now Medicaid settles up once a year. This typically comes in to the hospital in December."
Following discussion on the financial situation, Hammond updated the board on the two incoming physicians, Dr. Krish and Dr. Saab.
"Dr. Krish has purchased a home and also rented a home until the purchased home will be available to her and renovated to her liking," said Hammond. "She is anxiously awaiting being able to come here and get started. She will be available for emergency room work until she starts in the clinic and we are targeting July 19 as the start date for the clinic. Dr. Saab has also purchased a home and we are in the process of getting his professional liability together. He is planning on being here and getting started on Aug. 1. We have placed ads in the paper for LPN's, clinic technicians and a file clerk/receptionist. Dr. Saab's wife has been very involved in his practice over the years, and I would like to talk with him and get a clear picture about how involved she wants to be here. Ideally, I would like to find a business manager for both physicians in the clinic."
Chairman of the Board Al Roork then commended the staff of the hospital and the construction workers on their quick work remodeling the clinic for the two new doctors.
"There has been a lot of coordination to get it done this quickly and I am really impressed," said Roork.
Hammond also noted that COO Tammy Friel had been handling a large part of the project coordination and had done an excellent job.
Moving on to new business, Hammond presented two doctors whom the medical staff of the hospital had recommended for privileges at the facility. Dr. Leah Braswell is a radiologist with the NightHawk Radiology Services that White River Medical Center uses and was recommended for consulting privileges. The other doctor recommended was the incoming Dr. Krish, who they felt should receive full active staff privileges. Both were approved by the board.
Next up was a look at how the new clinic would be established. "There are three ways to set the clinic up," said Hammond. "One is as a freestanding LLC or LLP, another is as a provider--based clinic and the last is as a rural health clinic. We can get a rural health clinic provider number, but CMS won't be able to survey it to get it open this year. In the meantime, I've tried to follow some opportunities to acquire a rural health clinic number. I know of a local hospital that has three that may be willing to share one of them. To begin we're going to open the clinic as a provider--based clinic, and what that means for us is that everything except the physician salaries -- all the costs that go into that, since it will essentially be a department of the hospital -- will accrue to our benefit on the cost report. The staff will be employees of the hospital. The only thing we will not be able to get credit for are the physician salaries, because that component is reimbursed by Medicare Part B payments."
Hammond noted that the ideal circumstance would see the clinic identified as a rural health clinic, but again they would need to obtain the provider number to do that.
"If we can buy a number, then we don't have to wait for a survey," said Hammond. "We merely change the ownership and file the paperwork and then we could move forward."
At the May Board meeting, Hammond brought up the possibility of purchasing a system that would allow the hospital to track Medicare and Medicaid reimbursement statistics on an on-going basis.
"I have a proposal from Dixon Hughes to monitor our cost reports, to do our annual cost report, and also to provide monthly conference calls and quarterly on site visits to help steer us down this road so we don't end up giving any money back and we maximize our opportunities for reimbursement," said Hammond. "As you can see, their proposal includes the cost report preparation, a cost report model that we can use to model our cost report on an ongoing basis, and their manager program, all for $53,000. I am very comfortable with this program, with this firm and the people working here. In the meantime, I have visited with a CPA by the name of Ken Marks, who is associated with the national accounting firm of Baird, Kurtz and Dobson (BKD) and he is putting together a proposal for similar services for us."
Several board members inquired about the hospital's current CPA's, Hughes, Welch and Milligan, and if they would no longer be needed.
Hammond stated that the new system would be used only for the cost reporting.
"In comparison to Hughes Welch and Milligan, services from Dixon Hughes or BKD would include a cost report being done initially one time for the end of this fiscal year, then there would be monthly conference calls as they monitor our finances and the data input and provide direction and advice for us about where to tweak, where to contain costs and how to manage that reimbursement formula on an on-going basis," said Hammond. "Then once a quarter, one of their people will be here on site to help us. They would keep us up to date on the reimbursement formula and let us know when it's time to file an interim cost report."
Board member Danny Perryman then asked why Hughes, Welch and Milligan had not been monitoring the hospital's financials more closely.
"I don't like the fact that we have to inform Hughes, Welch and Milligan that we have a problem before we can get anything done," said Perryman. "They promised us, after we got out of that other mess where we had to pay back a lot of money, they promised us that they would do a quarterly report so we wouldn't have a great big hit at year end. To my knowledge, we haven't had that. We asked for that, and they promised they would do it so we could make adjustments if we needed to. It was about the same time they asked us for a raise if I remember correctly."
Board member Bill Pace asked Hammond if he could justify the expense of such a program for the facility.
"Denice (Innis) does an excellent job with the bookkeeping and the accounting, but the financial modeling that is at the Chief Financial Officer level--which is the kind of input that would come with a Dixon Hughes or a BKD--$53,000 a year for that level of input compared to $95,000 to $105,000 salary plus benefits for a CFO worth their salt, in the long run something like this would be a better fit for us," said Hammond. "It would give us the numbers at our fingertips on a day to day basis."
The Board agreed to table the matter until the July meeting, to give Hughes, Welch and Milligan the opportunity to present a proposal of their own for a similar program to Dixon Hughes and BKD.
The Board then adjourned into executive session. Upon their return, it was announced that Albert Roork had been re-elected as Chairman for another year, Jerry Estes had been elected as Vice Chairman, replacing Dr. Griffin Arnold and Sue Hertzog had been re-elected as Secretary. With that, the Board adjourned for the evening.