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Fulton County Hospital seeks to lower deficit with new budget

Thursday, August 2, 2012

Two new Fulton County Hospital leaders went right to work on Monday, July 23, helping pass a new budget for the Fiscal Year which began on July 1. Tony Thompson (right) is the new hospital administrator, while John Ed Welch, who was appointed to the Board of Governors last year, was chosen by fellow members as the new board president. Photo by Richard Irby [Order this photo]
At its July 23 meeting, the Fulton County Hospital Board of Governors wrapped up its current fiscal year, and prepared to begin the new one on July 1 by passing a new budget.

"For the month of June, our revenues were down quite a bit," Kim Thompson reported, attending her last meeting as interim administrator. Thompson has worked at the hospital since Oct. 2011, when her employer, the Ozarks Medical Center, took over FCH day to day management.

According to Thompson, a lack of patients was responsible for the dip in revenue. The number of patients admitted to the acute care wing, and the swing bed unit were both down from previous months.

Thompson said the $32,415 net loss would have been higher, but hospital staff "did a very good job of managing expenses." June expenses were 13.4 percent below budget. Part of the savings were created by reducing staff, by moving swing bed patients to the acute wing, when the patient census was low in both units.

For the twelve months ending June 30, Thompson reported that, "Admissions were below budget by 5.2 percent. Swing bed was below budget by 20.9 percent. Other volumes were down as well, including outpatient procedures. You can see that we did not meet our goals on (patient) volume, and also revenue. But, hopefully, that will begin to improve as we begin to look for other services and things like that (to generate more revenue)."

The end of the fiscal year operating loss is a bad news/good news situation.

The worst news is, operating income, which is patient revenue minus expenses was a big loss.

"So, overall, we had an operating (income) loss for the year of $889,950, compared to a budgeted operating loss of a million-eight ($1,800,000)." Thompson reported.

While the $889,950 operating loss is high, it is about $350,000 less than last fiscal years's (2011-2012) operating loss of $1,239,994.

Thompson noted that the $1.6 million dollar sale of the hospital's home health license brought in badly needed revenue, allowing the hospital to pay off $800,000 in debts, and create a small cash reserve.

When you add in the health license revenue plus sales tax and other non-operatng revenue, the loss drops to $536,000.

The 2012-2013 budget forecasts an operating loss of $347,916 -- a big improvement over this year's $889,950 loss, but still a cause of concern.

"This budget does not, by any means, indicate that we are out of the woods. We are deep in the woods. The staff will have to work diligently to identify any efficiencies," new administrator Tony Thompson told the board.

"I'm hoping that our operating loss will be less than that ($347,916). I'm hoping that our (performance) will be able to exceed our budget," Board President John Ed Welch said.

When you add non-operating revenue, an estimated $348,589, into next year's budget, the hospital would show an over-all profit of $673.

The board unanimously passed the proposed budget for the 2012-2013 fiscal year.

Kim Thompson reported that it appears new software is finally working properly, ending a long period in which the hospital was not receiving Medicare and Medicaid reimbursements. It took awhile for glitches to be worked out in a new system by which reimbursement requests are submitted -- causing payment delays to many hospitals nationwide.

"So, with some of the cash starting to come in, as well as completing some of the (physician) charts that were outstanding, we are starting to see some improved cash flow," Thompson said.

During the time federal reimbursements were not being received, the hospital cut back on payment of its bills, which is a worry to board members.

"How about the trade accounts payable?" board member Jerry Blevins asked.

Chief Financial Officer Denice Innis reported that, as of July 23, $351,500 was owed to vendors. She was in the process of paying more bills to lower the total to $222,000.

"Now that we have cash flow, we are going to try to keep those (accounts payable) more up to date," Thompson said.

"My only concern is, I saw this thing (accounts payable) go from $88,000 to $750,000. I don't want to see it again," long-time member Blevins said.

Board members and hospital management both agreed keeping bills paid and vendors happy must be a top priority.

As the hospital continues to work to attract more patients and bring in more revenue, it faces a big outlay of cash to meet deadlines to start the switch to a paperless, electronic medical record system.

Kim Thompson and Tony Thompson recently met with Beacon and Associates, a company recommended by OMC I-T specialists to develop a plan to obtain equipment and software, and begin implementing electronic medical records.

Since OMC's I-T department is tied up getting its electronic system up and running, outside help is needed at FCH. But the administrators agreed that Beacon's $30,000 proposal to write a plan was too high.

While the hospital continues to review options for an electronic system, it must make decisions fairly quickly. Part of the system must be up and running by July 3, 2013 to allow time for a 90 day test to show the federal government "meaningful use ( that the system is working) to qualify for financial assistance.

The hospital does not see enough Medicaid patients to qualify for Medicaid stimulus money, which would be paid up front. Medicare requires hospitals to invest in equipment, and offers partial reimbursement, in stages, as systems are installed.

"Since we don't qualify for Medicaid stimulus funds, which you get up front, we're going to have to finance (the cost) in some way," Kim Thompson said.

According to OMC President David Zechman, the Meditech system the hospital is considering installing will cost about $600,000. He estimated that, if the hospital met all of its progress deadlines, it will recover about $500,000 of the cost.

The board was told that some special meetings may be needed to make electronic medical record decisions as quickly as possible.

"So, if we don't do it (begin implementation) by July 3, 2013, we will not be eligible for the Stage One money (paid in Oct. 2013). We would always be behind, and never get the full amount (of reimbursement available)," Thompson said.

Kim Thompson was recognized by the board at the end of its meeting for her 10 months of service as FCH's interim administrator. Besides taking on the demanding job of implementing OMC's day to day management at FCH, Thompson also had to devote time to her duties as OMC's Chief Financial Officer.

The next regular meeting of the Fulton County Board of Governors is scheduled for Monday, Aug. 27 at 6 p.m. Meetings are held in the hospital conference room, and are open to the public.

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