Bill Couch and John Ed Welch from Hughes, Welch and Milligan were on hand to present the financial report and were addressed by board member Danny Perryman regarding comments made around town about the new clinic.
"I would like to hear ya'll expound on whatever you told the Quorum Court and the Judge that caused us trouble with the bank, with a loan; this stuff about the clinic over there," said Perryman. "Tell me, because you haven't described the situation adequately in your reports."
"I was asked a couple of questions," said Couch. "One of which was about the clinic and its operation. The operation of the clinic, my concern is the only benefit the hospital receives from that clinic is when a patient requires a further test and they would come over here to get that lab work done. This way, the hospital would bill that as their outpatient at that point, as the service was beyond the services of the clinic. That would be a benefit to the hospital and would qualify for cost reimbursement."
"We're burning cash over there at the clinic right now, and it won't be reimbursed by Medicare," said Welch. "The only way it's going to work is when the clinic is up and running to its full potential, which means getting more patients and hopefully getting more patients admitted to the hospital from the clinic. It's costing you $55,000 a month right now to operate the clinic, and the gross revenues through August are only $18,000."
CEO Joe Hammond pointed out that the clinic has only been in operation since July 19, meaning the numbers reflect only six weeks of operation at the newly opened clinic. Board members then asked Welch what costs from the clinic can be applied to cost reimbursements for the hospital.
"The hours that the doctors from the clinic work in the ER are billed through the ER department and that makes them reimburseable costs," said Welch. "Anything that you can bring from that clinic over to the hospital, that can be reimbursed."
Perryman then asked what could be changed in regards to the operation of the clinic to make the costs incurred there more reimburseable, and Couch responded that making the clinic a Rural Health Clinic would make costs there reimburseable.
"You have to get a survey, and you can't bill until you get a survey, and right now they're about a year out in getting surveys done," said Hammond. "There were three ways to set up the clinic -- stand alone, provider-based or as a rural health clinic. The rural health clinic is beyond our reach right now. The provider-based allows us to connect it to the hospital and that's how we set it up."
Perryman then asked Couch and Welch if, in their opinion, the Board should consider closing the new clinic.
"We should be mindful of the fact that its costing us money while they build up a clientele," said Couch.
"This is just my opinion, but I think the clinic has some potential to do good for the hospital," said Welch. "I would advise you to look for ways to get more of the costs over here to the hospital to qualify for reimbursements."
Chairman of the Board, Albert Roork, then addressed the Board. "If we could have moved Dr. Kaufmann over there, we would have had an instant successful practice," said Roork. "We moved two doctors in here that no one knows yet, and you're not going to have a viable practice in less than two months time. It does not work that way. If we see, in a given point of time, that the numbers are not increasing, then there's time to take some action. We do not know if Dr. Kaufmann will ever be back. We hope that he will be back, but we don't know. Dr. Phillips, Dr. Bozeman and Dr. Arnold cannot continue to sustain this facility. We had to do something to try to increase the volume in this facility and that was not going to happen overnight -- that's the bottom line. Was it a gamble? It was a gamble, but I think the alternative was not a gamble but a definite. We took a gamble; will it work or not? I don't know, but we didn't have a choice."
"One thing people tend to forget is that we're dealing with an aging population of physicians here," said Chief of Staff, Dr. Jim Bozeman. "We don't have people tripping over themselves coming in here looking for a place to practice."
"At this point and time, it is premature, I think, to consider jerking the rug out from under the clinic," said Roork.
Board member Jerry Estes echoed that sentiment. "We're not going to bail on this. We are committed to the clinic."
With that discussion ended, the Board focused on the main pieces of the financial report.
"Year to date we are showing, roughly, a $200,000 loss," said Couch. "One thing to keep in mind is that this includes bad debts and depreciation costs. Without those, we would be looking in more of a positive light. Gross revenue, year to date, is up $168,000 over last year with fewer patients. From a paper stand point, it looks pretty good, but from a cash in the door view, it doesn't look as good. We have received our Medicare and Medicaid settlements from the cost report we filed last month. Medicaid was $274,000 and Medicare was $595,000 for a net total of $869,000. The short term loan at the bank has been repaid out of those funds and we're working on catching up the Accounts Payable in that we have that paid down to just 60 days out."
Couch then pointed out a significant change in the amount of full-time employees from the same period in 2009. "We're down about four patients a day, and for every patient, we've had 5.8 full-time employees to take care of each of them and last year we had only 4.6 employees per patient. That 5.8 figure is high."
Next on the agenda, Ken Harper and Trena Spears from the Fulton County Hospital Foundation gave a report to the Board on events they have coming up.
"We have a golf tournament coming up on Oct. 9 at Turkey Mountain in Horseshoe Bend," said Harper. "We have $2,700 in hole sponsors, Freedom Ford is sponsoring the hole-in-one contest with a vehicle, we have $600 in other sponsorships, about $600 worth of items to give away and we are expecting a full tournament. We've had a tremendous response from several counties. We're looking to net about $3,000 from the tournament."
Spears then pointed out that sales of the sponsorship plaques in the hospital lobby have been going very well, with the Foundation raising close to $14,000 since january.
"We are anxiously awaiting the opening of a thrift store here in Salem," said Harper. "We are going to find a place, hopefully on the square, and we are looking to sell a lot and raise a lot of money. There are several thrift stores we have visited within the surrounding communities, and three thrift stores close to us, bring in close to $400,000 a year selling 25 cent, 50 cent and dollar items."
Harper then moved on to the subject of the hospital's gift shop. "We would like to enter into a contract with the hospital, if you feel it would be beneficial to the hospital, for us to take care of the gift shop for you. We would manage it and operate it with the help of the auxiliary."
Hammond agreed that further discussion on the matter would be needed before moving forward. Spears then clarified for the Board as to what purposes the funds raised by the Foundation would be used for.
"The funds we hope to raise from these endeavors will be given back to the hospital," said Spears. "We want to give back to hospital employees and their families by providing scholarships. That's the purpose of the Foundation, to assist the hospital with necessary purchases and improvements."
Harper then went on to explain that the Foundation would like to use some of the funds to help the hospital purchase a new security system, in light of recent altercations taking place at the facility in the overnight hours.
"We've evolved to a point to where, particularly late at night, there are many drug seekers that come to emergency rooms at hospitals and these people are often agitated or easily agitated, and sometimes combative and even dangerous," said Roork. "We've been getting quite a few police calls, and due to the size of the facility and everything else, a video surveillance system is badly needed at this facility. In the parking lots, lobbies, nursing stations and hallways. We have had two occasions in recent months where we have had hospital employees injured by these types of people, inside the facility."
"We have two estimates: one at $23,082 and another at $34,388," said Hammond. "The higher amount includes an upgrade in the quality of the hardware, though both systems offer the same coverage. If we hired a security guard, and covered two shifts, you would already have gone past that amount of money. This does not add labor or benefits, but would accomplish the purpose. Our staff do worry. It's a dark place at night."
Spears then presented to the Board a grant from the Susan G. Komen Foundation to provide mammography services to Fulton County residents.
"We are coordinating with the Fulton County Healthy Arkansas Coalition and the Fulton County Health Department to pursue a Susan G. Komen grant for breast health and breast cancer education, treatment, support and screening projects," said Spears. "The grant would provide mammogram screenings and diagnostics for uninsured and underinsured Fulton County residents. This will bring more people to the hospital and raise community awareness and it will bring people here."
"The medical staff are 100 percent behind this initiative," said Bozeman. "We just recently had a staff meeting and it was strongly suggested that we offer mammography services. We used to do mammograms years ago."
The Board voted unanimously for the Foundation to pursue the grant.
Next up, Hammond informed the Board that the current line of credit with the Bank of Salem ran out at the end of September and asked for a motion to renew the line of credit for $250,000 in order to be able to operate. The Board approved unanimously.
Hammond then moved on to discuss a piece of equipment that needs replacing. "The hematology analyzer is at the end of its current lease," said Hammond. "This is our blood analyzer which we have to have in order to provide critical information to the doctor's. I recommend going with a five year lease on a refurbished model at $9,500. A new analyzer would cost us in the range of $62,500, so we are getting a good deal, plus it also comes with a service contract for the length of the lease."
The board unanimously approved the lease.
Next on the agenda was discussion of new software to assist in running the clinic more efficiently.
"We are mandated to be in compliance with electronic information management systems by the state by 2015," said Hammond. "Currently, Dr. Saab is using E-clinical Works at the clinic and we need to purchase a site license for Dr. Krish. The cost is a one time fee of $10,000 for the site license, plus a monthly fee of $310. Dr. Phillips is also using this software at her offices. The Sisters of Mercy have just announced that they have connected all of their clinics and hospitals in four states through E-clinical Works, allowing patient records to be available to doctors in any facility. Billing and everything else runs through this system, so we have to have this software in place."
Again, the Board unanimously approved the purchase of the site licenses.
In final business, Nurse Practitioner Ruth Scarpiates requested privileges at the hospital to make rounds on patients. "The medical staff has recommended granting Allied Health Professional privileges so that she can order lab tests and x-rays, plus make rounds on her patients here at the hospital," said Hammond.
The Board approved the granting of privileges and adjourned for the evening.