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VAN DYKE -- The DeLeon Hospital and
Clinic buildings, which have been closed for almost two years and last
served as a refuge for hurricane evacuees, will likely soon see much
activity and new life as a part of the DeLeon Independent School
District.
This and budgetary and financial matters
were the most notable items discussed or acted upon in public session
in a meeting that was dominated by an approximately three hour closed
executive session in which several different topics were considered.
The Board of Directors of the Comanche
County Consolidated Hospital District, the governing body of Comanche
County Medical Center and Doctors Medical Clinic, met at the hospital
on Tuesday, June 26.
Board president Gale Easley conducted the
meeting with board members Charles Mazurek, Karen Petty and Billy Ray
Evans participating. Board members Joe Locke and Janna Morris were
unable to attend.
At noon there was a public hearing on the
proposed budget at which no members of the public attended. The
meeting officially convened after a break for lunch when a sufficient
number of directors were present for a quorum.
Proposed Budget for New Fiscal Year
Interim Chief Financial Officer Jim
Gardner, who was ending the most active phase of his three month
tenure at the hospital at the meeting, discussed the proposed budget
for the hospital's new fiscal year beginning on July 1. Both Gardner
and Chief Executive Officer Kevin Storey described the budget as
"conservative" and even as a "worst case scenario."
The proposed budget had a loss of
$190,076 on the bottom line. Gardner listed the major assumptions in
the budget. He said it included no projected increases in the price
the hospital charges for its services.
The 3.3% increase in gross billings to
$29.2 million was based only on projected volume increases.
Gardner noted that he had included provision for 2% salary and wage
increases as determined by management on the employee's anniversary
date. Other operating costs were projected to grow by 3%, with the
exception of utilities, which were projected to increase by 5%.
No provision was made for increased
property tax revenues, given that the assessment rate had been left
unchanged, and despite the fact that property values have been
increasing.
Capital expenditures of $210,500 were
projected, the largest single item of which was $65,000 for an
ambulance replacement. No provision was included for computerized
medical records conversion, since Gardner noted that no decision had
yet been made regarding what type of system will be purchased, and he
added that there was a wide range of costs possible.
Gardner noted that despite the projected
net loss and capital expenditures, that the hospital would experience
a positive cash flow of $282 thousand because of the non-cash $1.17
million provision for depreciation and amortization that was deducted
when calculating the projected net loss.
The staffing budget showed an essentially
flat level of employment with 196.3 full time equivalents. Most
hospital services and patient activity levels were shown to increase
by 2%.
Another significant item that had no
changed budgetary assumptions involved the payments to physicians,
which Gardner said "pretty well remained the same."
Charles Mazurek noted that no projected
improvements in cost controls and purchasing had been included in the
budget, although cost savings were believed to be possible.
Kevin Storey added that he believed that
there was ample opportunity available for improvements in
profitability, despite the projected loss.
After further discussion Gale Easley said
that she was comfortable with a worst case scenario, and after hearing
no further questions asked the Board if there was a motion regarding
the budget.
Charles Mazurek moved that the budget be
approved as presented, Karen Petty seconded, and the vote of approval
was unanimous.
Medical Staff Report
Dr. Howard Dickey, Medical Chief of
Staff, reported on the medical staffing recommendations approved at
the last meeting of the medical staff.
Dr. Dickey noted that Drs. James
Herbertson and James Fowler were not requesting that their courtesy
staff privileges be renewed. It was noted that neither physician had
been very active at Comanche County Medical in the preceding year.
The medical staff reviewed and
recommended for Board approval the reappointment to the courtesy
medical staff of Drs. Paul Fragua and Billy Don Jones, and the request
for additional privileges for Dr. Neil Bealka.
Executive Session
Following Dr. Dickey's brief report, the
Board adjourned into executive session. Dr. Dickey remained in the
meeting for a lengthy time. One of the individuals called into the
executive session was DeLeon Independent School District
Superintendent, Dr. Randy Mohundro, who also spent considerable time
in the meeting.
At the conclusion the long executive
session, the Board resumed public session. The first item of public
business involved action on executive session discussion items, as
needed.
Karen Petty offered a motion, seconded by
Charles Mazurek, to approve the reappointment of Drs. Fragua and Jones
to the hospital's courtesy staff and the granting of additional
medical privileges to Dr. Bealka. The vote of approval was unanimous.
Sale of DeLeon Hospital Property
Approved
Charles Mazurek then offered a motion to
accept the DISD's proposal for an interlocal agreement on the DeLeon
Hospital property, subject to the changes that the sale price would be
$50,000 "as is" and that the DISD lease back the laundry and storage
buildings for one dollar per year. Karen Petty seconded the motion.
The DISD had originally offered $100,000
for the buildings with a new roof to be provided by the hospital’s
insurer. The insurance company noted, however, that the hospital roof
was not hail damaged.
During the brief discussion that followed, it was noted that the
property would be subject to a deed restriction preventing it from
ever being used for a purpose that competed with the hospital,
although normal school-related medical purposes could be conducted
therein. Mazurek noted that the hospital's attorney had drafted
language to that effect. The vote of approval of the sale was
unanimous.
No action was taken regarding an item
considered in executive session described as the "RHC Physician
Contract Proposal" or on the item "to consider candidate for Chief
Financial Officer position". A candidate for the CFO position had been
called into the executive session, although it was later noted that
other candidate interviews are planned.
Arbitrage Audit Report
Jim Gardner reported that the mandatory
arbitrage audit conducted by First Southwest Asset Management on the
temporary investment and subsequent expenditure of the proceeds of the
hospital's construction bond issue had been completed and found that
no liability had been found owing.
Chief Executive Report
Kevin Storey's first CEO report to the
Board was summarized in a three page outline which reviewed the
activities that he had been involved in during the preceding month.
Storey noted that an agreement had been
negotiated and signed with Southwest Medical Associates to provide
physician coverage in the Emergency Room. He also reported work was
under way on renewing the hospital's contracts with its staff
physicians.
Storey said he was working on
renegotiating the hospital's contract with Blue Cross and had engaged
a consultant in that regard in order that the hospital might obtain a
higher rate of cost reimbursement for services provided to insureds.
The hospital's schedule of pricing for its services was also planned
for review work.
Storey said that he had located a company
other than PHNS to provide consulting to the hospital regarding
information systems. He noted that the new company's consulting cost
would be roughly half of the PHNS cost.
Storey indicated that he was working with
EMS department head Danny Owen regarding EMS staff scheduling, and had
completed individual meetings with most departmental managers. He had
also begun meeting the hospital's patients to see if they were
satisfied with the hospital's medical services being provided.
An item in Storey's report regarding
changes in the hospital's organization chart and the hiring of a new
position described as Administrative Director of Ancillary Services
was questioned by Gale Easley. Her questioning prompted Storey to
offer a lengthy explanation of why he felt the new position was needed
and the person he had in mind to fill it.
As Storey described it, the individual,
recently retired and living in the area but whose name was never
mentioned, would more than justify his salary through cost savings he
could identify. Storey indicated his desire to proceed immediately
with the hiring.
There were numerous questions and
considerable discussion regarding the proposal.
At the conclusion of the discussion,
Easley noted that a change in the organizational chart required Board
action and that the item was not on the agenda for the current
meeting. She said she and other Board members wished to consider the
matter further and suggested that Storey should wait for specific
Board approval before proceeding with the hiring.
Consent Agenda
At the conclusion of the CEO report, the
Board acted to unanimously approve the consent agenda regarding
authorization for the payment of accounts owing and then two Board
members, Mazurek and Petty, left the meeting.
Clinical Overview
Chief Nursing Officer Shannon Steigleder
reported that the results of the hospital's first required Hospital
Care Assurance Program survey of Medicare patients had been received
from the third party firm that conducted telephone interviews with a
broad sample of former hospital patients. Steigleder said that the
clinic services satisfaction rating was very good, 3.98 out of a
possible 4.0. "All of the patients were very happy and the survey
reports that I read were very positive," Steigleder reported.
Steigleder noted she had been doing a 50
mile radius survey of Licensed Vocational Nurse pay rates since the
hospital has had some difficulty in hiring and retaining LVNs. She
added that the budget presented reflected pay rate adjustments that
were indicated to be needed from the survey. A recruitment lunch for
the Ranger College LVN August graduating class is planned for
mid-July.
Steigleder reported the hospital had
completed 64 surgical procedures in April and 66 in May. She said that
the June total was expected to be around 75. The total number of
visits for Home Health and Hospice in April was 426.
Financial Report
Jim Gardner gave his last financial
report to the Board by noting that overall revenues for May were down
for the month. The revenue shortfall when compared to the budget
accounted for the hospital's net loss for May of $166,000.
Total operating expenses were up very
slightly up from the previous month, however, were virtually on
budget.
Gardner reviewed the key operating
statistics. The number of full time equivalent employees increased
from 197 to 198, yet still far below the 236 figure at the beginning
of the fiscal year. The days of average accounts receivable dropped
toward the low 60 days, not as low as the 50 days Gardner would
prefer, but still much improved from earlier levels in the fiscal
year.
Progress continued on decreasing the
level of outstanding accounts payable with the figure at the end of
May only slightly above $600,000.
Gardner expressed his enjoyment of
working at CCMC for the preceding 120 days or so and indicated he
would be available for future inquiries as and if needed.
With that, the marathon meeting was
adjourned. |
