The Fulton County Hospital Board of Governors met in regular session on Monday, Oct. 25 and began the meeting with a presentation regarding a new financial management tool for the hospital.
Tom Barnhardt, of Dixon Hughes, made a presentation to the board members regarding a service package that the large CPA firm has created for smaller, Critical Access Hospitals, to assist them in managing their Medicare and Medicaid reimbursements.
"Healthcare is our largest niche industry as a firm," said Barnhardt. "We specialize more in healthcare consulting, than in auditing. My specialty is critical care access hospitals and rural facilities. What we have proposed are a couple of services. One we call Navigator, which is a unique service which combines strategic planning, financial organization, cost reimbursement consulting and a custom designed platform for each individual hospital. What the program does, is it is a process that allows us (Dixon Hughes) to meet on site at the hospital once a quarter and have conference calls with senior management on other months, to address the specific needs at that time, of the hospital. We also provide routine consulting to assist with operations during the month. The Critical Access Hospital model we provide assists with the Medicare and Medicaid cost reports that are crucial to critical access hospitals. We provide that as part of our 2010 Cost Report analysis. The overall goal of all of this is to help management reach your goals."
The costs involved in the services provided by Dixon Hughes would be a one time fee of $5,000, followed by a monthly fee of $3,000 plus any travel expenses. Barnhardt also quoted $12,000 for doing the 2011 year end cost report for the hospital.
"Is the clinic going to be reimburseable to us?" asked Board Chairman Al Roork.
"Yes, if it is set up properly," said Barnhardt. "There are three ways to set up a clinic like that. You can have free standing, where the hospital is billing for the physician. The second is a provider based clinic, which is what I had recommended to Joe early on. You are currently billing as a free standing clinic. Once you bill as a provider based clinic, you can think of it kind of how you operate the Emergency Room in regards to Medicare and Medicaid. You have the service fee and the physician fee. On the clinic, you would have a clinic fee and a physician fee. The clinic fee would be cost reimbursed, including staff salaries, overhead and such. The physician fee would still be paid on a fee schedule."
"In essence, in a provider based facility, what amount would be reimburseable?" asked Roork.
"For example, if 60 percent of your patients qualify as Medicare/Medicaid, then 60 percent of your clinic fees would be reimburseable," said Barnhardt.
"We'll be switching the clinic over to provider based by Jan. 1," said hospital CEO Joe Hammond.
"How is this program comparable to what we are getting right now?" asked Board Member Danny Perryman.
"Using this model, we'll have an opportunity to watch how much we're getting back from Medicare and Medicaid, so we can have a truer picture each month of our bottom line," said Hammond.
Several board members asked for additional time to consider the proposal from Dixon Hughes and the item was tabled until next month.
Bill Couch from Hughes, Welch and Milligan then presented the financial report for the hospital for the month of September and the year end report.
"Looking at the annual report, we've seen a 15 percent increase in average number of patient days over last year, which is very good," said Couch. "Total operation revenue decreased $137,000 over last year though, even with our average patient days going up. Looking at total operating expenses, they were up $595,000 for the year over the previous year. That is primarily concentrated in salaries and benefits. Sales tax revenues were also down this year, compared to the previous year."
Couch then presented a graph comparing Fulton County Hospital to other similar sized, critical access care hospitals in Arkansas. Fulton County Hospital came in third out of ten for total number of patient days. In patient charges, the hospital ranked eighth, prompting Couch to suggest some selective charge increases to bring the hospital more in line with their counterparts.
"The hospital's overall annual loss of $456,000 is ranked sixth among the hospital's presented, and with all that said and done, this has not been an easy year for critical care access hospitals," said Couch. "Some of the other hospitals shown here have significant help coming from their foundations, some to the tune of almost $300,000 a year."
Looking at the hospital's September financials, year to date, revenues at the hospital have increased close to $200,000 a year versus this time last year, but wages and salaries have also increased $200,000 over last year, year to date. In September, the hospital showed a loss of $199,804, with a year to date loss being shown of $409,128.
"Looking at the cash receipts for the hospital, we are seeing an increase in revenue month to month for the current year (July-September) and that is a positive trend that needs to continue," said Couch.
Hammond then moved on to the recent golf tournament put on by the Fulton County Hospital Foundation at the Golf Course on Turkey Mountain in Horseshoe Bend that raised approximately $5,000.
"We had an excellent turnout and a good time was had by all," said Hammond. "This past week, our volunteers hosted a scrubs sale here at the facility and netted $1,000 from that venture."
Chief of Staff, Dr. Jim Bozeman, then gave the board an update from the recent staff meeting, including presenting credentialing for two doctors. "One is a radiologist with NightHawk who reads films during the overnight hours and the other is a cardiologist from OMC," said Bozeman. The board agreed to approve the credentials for the two.
Hammond then summarized the settlement agreement presented to Fulton County Hospital regarding the radiology technician who was discovered operating without a license at the facility back in January.
"The investigation has culminated in a settlement offer of $266,000," said Hammond. "That number was arrived at by taking the total salaries and benefits over the period from 2002 to 2010, when this was discovered, and then multiplying it by the factor of our federal reimbursement for those amounts. We were not penalized nor did they ask for us to repay any claims that were paid for services during that time, nor were we fined for any of those claims. It is strictly reimbursing the government for salaries paid during that time to this individual. Once this is completed and closed, it will be closed for good. There will not be any retroactive opening of the case. It will also not involve any exclusion from the Medicare program, which is the death knell to any provider. We are negotiating now is how and in what increments that amount will be paid back. I believe we have gotten away as lightly as we could."