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Tuesday, May 3, 2016

Fulton County Hospital takes on big funding challenges

Wednesday, September 5, 2012

Tony Thompson, the new administrator of the Fulton County Hospital, seems to have enjoyed getting to know employees and citizens, and getting involved in hospital programs. But, at the Aug. 27 Board of Governors meeting, he experienced the downside of being the boss -- delivering bad news to the board.

"We've had two bad Mondays, where we had employee benefit notices that we received," Thompson told the board. The notices, from the hospital's insurance company, notified Thompson the hospital owed about $270,000 for employee claims before the current policy expired on Aug. 31.

The hospital insures employees through a self-insurance plan, which means it pays the bulk of the cost for employee claims.

Using proceeds from its home health license sale, FCH paid the employee benefit bill on Aug. 31 as required.

During the board meeting, Thompson said hospital income was down in August because in-patient and swing bed admissions and total patient days spent at the hospital were both down. Net Patient Revenue was $138,434 less than budgeted.

Thompson noted that he intended to work on reversing the declines in the number of swing bed patients and their length of stay, "as we move forward."

In looking at the financial report, board member Danny Perryman said vendors were owed about $360,000 in July and, "I believe you said you were going to start paying on that."

In July, hospital officials were optimistic that income and reimbursements were improving. In response to Perryman's question about a lack of bill paying in August, Finance Manager Denice Innis replied that, "We had hoped to pay (accounts payable), but money slowed down."

Thompson said the hospital, like others, is continuing to have trouble receiving reimbursements from Medicare, because of problems caused by changes in procedures by Blue Cross Blue Shield, which handles regional claims for Medicare.

In July, the hospital owed about $330,000 in accounts payable. In August, the total rose to about $365,000 and, because money is tight, outstanding bills are being paid "pretty much, on demand," according to Thompson

Thompson added he has been working with physicians discussing the addition of some new services to generate new revenue.

"I think, if we can begin to address those services that will add some additional revenue for us, we can begin paying those (bills) down," Thompson told the board. "I don't think we're going to be able to do it in the first quarter but, in the course of this fiscal year, we are going to make a big dent in this (accounts payable)."

Hospital Chief of Staff, Dr. Griffin Arnold explained the new services physicians have been discussing. The first is establishing a weekly wound care clinic, to help people with wounds, often caused by diabetes, that are troublesome to heal.

"Wound clinics have been very popular, and are also very profitable," Arnold told the board. "There is also great satisfaction for the patient to see something healing and improving, and to teach them how to take control of their health."

According to Arnold, some nursing homes in the area hold monthly wound clinics, but many people travel to larger hospitals for wound care. He believes establishing a weekly wound care clinic would be a win for patients and the hospital.

Thompson said critical access hospitals in Clinton and Piggott, Ark. have both recommended a company they have successfully used to help them run wound care programs -- Wound Care Specialists.

"The company provides the training of (hospital) nurses who want to learn that skill, or they will bring in nurses, either way," Thompson said. "They do pre-screening to insure payment, which will mean less bad debt, and they will help with marketing too."

Thompson indicated he will bring a proposal for a partnership with Wound Care Services to a future meeting.

Dr. Arnold said physicians had also approved a change of policy which could increase business for the hospital lab and x-ray unit. Under the change, chiropractors and podiatrists will not have hospital privileges, but they will be allowed to order tests and x-rays from the hospital for their patients.

Arnold said progress is being made toward establishing a policy that will allow the hospital to treat emergency room patients who come to the E-R with non-emergency complaints, if they are willing to pay for the service, just as they would in a doctor's office.

"More and more people are using emergency rooms as their clinics," Arnold said. "We're gearing up to have a way to charge them for non-emergent visits."

According to Arnold, most hospitals in the region have already established policies, and FCH is reviewing those policies as it works to establish a policy of its own. Since it would not automatically turn away E-R patients who do not have true emergencies, the policy should result in increased revenue for the hospital.

There was good news concerning the hospital's need to start implementing an electronic health record system. It is under pressure to choose a company to provide and install software and training that will allow the hospital to go "paperless."

Under federal regulations, all Medicare and Medicaid claims must soon be submitted electronically. Part of the new system must be up and running by July 2013, so the first phase can be tested to demonstrate the hospital is making progressto qualify for reimbursement of part of its costs.

The problem for FCH has been, it is expected to borrow money for the new system, which could cost up to $600,000, and get started.

At the August board meeting, Thompson said the idea of using a company called Meditech, which the Ozarks Medical Center is using, has been rejected. According to Thompson, the company sells large, powerful systems more suited to large hospitals.

Then came the good news. Three companies have been identified who have designed electronic medical record systems for smaller hospitals, and have signed contracts with other critical access hospitals in Arkansas.

"They've all agreed to fund the implementation by way of the stimulus money we would receive (from Medicare). So, that addresses the issue of how to get this done," Thompson said.

In other words, if one of the three companies is chosen as the hospital's electronic medical record provider, the company will not expect to be paid up front. It will begin installing the system, and take payment as federal reimbursements are received by the hospital.

"We were worrying about how we were going to pay for this, and that solves that problem," board member Bill Pace said.

At least it's an encouraging start. Those experienced with the process have said, at past meetings, that federal reimbursements will not cover the whole cost of an electric medical record system.

Thompson said, by the September board meeting, the medical staff and hospital leaders will have heard presentations from all three companies in the running, and seen how their systems work. He intends to make a recommendation on which company is judged the best for the hospital, so the board can authorize a contract.

"We need to start, because we have two more phases we've got to finish (to get a system up and running)," Thompson said.

The August meeting was the first for Steve Hall, Human Resources Director for North Arkansas Electric. Hall was appointed by Quorum to replace Sue Hertzog, whose term expired in July.

Sept. 24 is the hospital board's next regularly scheduled meeting. The meeting will take place in the hospital conference room at 6 p.m. The meeting is open to the public.

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