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VAN DYKE -- The Comanche County Medical
Center Board of Directors met on Tuesday, July 25, with all members
present for a relatively short meeting. Discussion of changes in the
medical staff, financial operating results and departmental reports
took up much of the hour and twenty minute meeting.
Following the approval of the prior
meeting's minutes with a minor change, Chief Executive Officer Evan
Moore announced that Dr. Todd Davis had signed a contract with the
hospital to join the clinic and medical staff early in October. Moore
said the contract was at the same rate and terms as other physicians,
with only minor exceptions related to moving expenses and the first
year reimbursement rate for the number of patient encounters. Both Dr.
Davis and his wife grew up in Comanche County. An announcement and
photos are pending. Dr. Davis' contract was approved as presented by
unanimous vote on a motion made by Joe Locke.
Joe Locke gave the report for the quality
improvement and compliance committee. "There wasn't anything
particularly unusual in the report that's not being addressed and
taken care of. There wasn't any real issues not being handled." After
a pause, Board president Charles Mazurek said, "Well, I guess that's a
good report" as there was a smattering of laughter in the room.
The QI/Compliance committee, which
consists of two directors, Joe Locke and Gale Easley, along with
senior departmental representatives from various parts of the
hospital, is the body that deals with operational problems that have
occurred and work to assure that any mistakes made are not repeated.
Although QI/Compliance reports were in
earlier times presented to the Board in significant detail, in recent
months the committee activity has been distilled by one of the Board
members into a very brief and sanitized report.
The Board next reviewed and approved by
unanimous vote the amended hospital bylaws. The motion to approve was
made by Mary Jane Atkins.
Purchasing Department Report
Jana Morris reviewed the operational
status of the purchasing department, noting that it was responsible
for everything that came into the hospital, but not for the clinic.
Beginning in June, everything received, other than prescription drugs,
is labeled and entered into a new computerized inventory system.
Chief Financial Officer Pam Rice stated
that the new purchasing and inventory system will be "wonderful" for
more accurately distributing the cost of supplies to the various
departments and for inventorying and reordering.
Morris praised the employees in her
department, including Martha Sides and Pam Abbe, and the hospital
volunteers who have assisted in the computer system implementation and
departmental operations. She noted that the hospital makes many of its
purchases through the Group Purchasing Organization, which serves
small and rural hospitals. Morris noted that other sources are
investigated as well and that often a better price for needed
materials is obtained by the department's diligence. She also cited
examples of the purchasing department obtaining credits from vendor
overbillings.
Medical Staff Report
Dr. Guyle Donham reported that all is
going well, but that the medical staff was very busy due to vacations.
He noted that the Emergency Room staff would get even busier at the
end of the month when three physicians either depart or go to work
elsewhere. Those departing physicians include Dr. David Long (moving
to Big Spring), and Dr. Brandon Gilmore and Dr. Beau McCrory (going to
work in the Brownwood emergency room). In September, Dr. Michael
Reeves will also depart as his family moves back to Alaska. Dr. Peter
Fagan will begin work at the ER in September. Dr. Donham said he was
looking forward to Dr. Davis' arrival. Dr. Howard Dickey handles the
ER scheduling.
Medical Records Department Report
Molly Gaines reported that all is running
smoothly in her department. She stated that the new medical
transcription equipment system is working very well. She noted that a
medical coding consultant is used on high dollar billings to verify
that everything appropriate is billed and billed correctly. She stated
her hopes that improved software will be obtained in 2008 that will be
both more capable and lower cost. The medical records department has
had considerable HIPPA (Health Insurance Portability and Privacy Act)
training in recent weeks (following an earlier incident in which the
HIPPA law requirements were not followed}.
Executive Report
Evan Moore noted the tremendous
improvements in service, morale and staffing in the Nursing department
since Shannon Steigleder had been appointed Chief Nursing Officer. He
noted that the property survey of the old Comanche hospital had been
completed and that it was up to the attorney to complete the documents
for the transfer of title to the County of Comanche to be executed,
probably at the next month's meeting.
Moore reviewed plans for the Comanche
Healthcare Foundation's big fundraiser planned for August 26. He noted
that he had been contacted by the Upper Leon River Municipal Water
District in regard to investigation of wind powered electrical
generation. The prospects of an ethanol plant to be constructed in the
area was discussed.
Moore noted that the Kronos employee
hours and payroll system is now working on a test basis and should be
implemented by the entire hospital very soon, yielding a tremendous
reduction in administrative workload associated with payroll.
Operating Report
Chief Operating Officer Mike Hare
complimented Dr. Donham for his fine performance in his early months
of work on the hospital and clinic staff. Evan Moore added his
enthusiastic second to Hare's comments.
Hare pointed out that the hospital had 64
surgeries and special procedures during June, a number significantly
above the 53 budgeted and one year earlier. Both acute admissions and
discharges were below May totals. Hare noted that the average length
of stay figure remained in the favorable range of under four days. The
average patient census in June of 20.9, however, was slightly above
the May total, yet below the budgeted figure of 24. There were 498
emergency room visits in June, below the May total of 532 and well
below the budgeted total of 600.
Hare noted that the matter of the
proposed use of the old DeLeon Nursing Home facility will be brought
before the DeLeon City Council meeting on Thursday. (See City Council
meeting article) He noted that the hospital's social services
director, Rick Goodner, had been working with the parties wishing to
purchase the DNH building and parking lot.
Financial Report
No detailed financial statements were
presented, although, some financial data was presented in graphical
form by Pam Rice. One slide presented in summary form the new
hospital's revenues, expenses and net income for the first year of
operations, and compared to a proforma projection made by the
independent auditor prior to the hospital opening.
The new hospital's first year of
operations ending June 30 show total billed revenues of $27 million
exceeding the auditor's projections by more than 15%, matching the
auditor's projection for the second year of operations. At the same
time, current year expenses of $16.5 million were $633 thousand below
the auditor's projection.
Despite this combined $4.9 million
favorable performance, when compared to the auditor's projection, the
hospital's unaudited operating loss of $409 thousand was $185 thousand
greater than the auditor's projected first year loss. Rice noted that
if the unexpected $200 thousand negative cost adjustment report from
prior year operations had not occurred, that the bottom line would
have been slightly better than the auditor's first year projection.
Contractual adjustments, however, were
described as having negatively offset most of the favorable first year
revenue and expense results. Contractual adjustments result when
payment for hospital billings are less than the total amount billed.
Payments by third party payers, such as Medicare, Medicaid and
insurance companies, are generally a fraction of the total amount
billed. Contractual adjustments also includes provision for charity
and uncollectible accounts.
Rice noted that final audit-related
adjustments for inventories, contractuals and the Medicare cost report
have not yet been made, although she stated that she did not expect
any major changes. She stated that the higher than projected
contractual adjustment numbers were a concern.
Evan Moore added that the hospital still
has not seen any benefit from the Sole Community Provider cost
reimbursement procedure adopted earlier in the year. Pam Rice said she
had been told that the benefit would show up in the cost reports on a
one or two year delayed basis.
Rice stated that Medicare is cutting back
on the amount it is reimbursing the hospital for the work it performs,
and added that it was "pretty scary." Moore noted that Medicare
reimbursement cutbacks were a nationwide trend.
Both Moore and Rice expressed their
opinion that the hospital had performed well during its first year of
operations by exceeding projected performance in both total billed
revenues and operating expenses. Rice noted that she was pleasantly
amazed that total expenses were virtually even with the hospital's
internal budget, since there was no operating history on which to base
the plan.
Rice also described considerable progress
in completing the adoption of new accounting software throughout the
hospital. She noted that it was resulting in a tremendous reduction in
printing and paper consumption.
Board president Charles Mazurek stated
near the end of the meeting that he thought the administration and
staff were to be commended for their good work in connection with the
areas that they can control, noting that the unfavorable developments
in contractual adjustments was largely beyond their ability to
control. "I appreciate their efforts, and those are numbers we can be
proud of."
John Mack Weaver noted that the cash for
the first year's bond payment was already set aside and Pam Rice added
that the hospital had better cash reserves than had been typical in
the past.
Mazurek continued, "I'm glad we did what
we did just in time. It didn't happen overnight, but with these bigger
contractuals, it's hard to imagine what it would be like if we were
still operating two separate hospitals." Another offered a comment
that the District might not have been operating any hospitals. Evan
Moore responded, "Our fears would have come true." |
