Fewer patients, less income for PMH
Losses resulting from HMS' poor billing practices and problems with the hospital's HMS software program appear to be headed toward resolution. Those troubled areas received considerable attention at the Pocahontas Memorial Hospital Board of Directors meeting on Thursday.
Billing has been in-house for six months, and hospital employees now have full-time support from an in-house IT or Information Technologist.
New IT guy and former Droop Mountain resident Aaron Vaughan has returned to the county and will oversee the computerized portion of the hospital's operation.
Employee turn-over, constant training, failure to capture charges and sporadic consultations in the past have negatively impacted the full implementation and utilization of what the HMS program has to offer for clinical and financial record keeping.
"I'm hopeful that this product is better than we thought, and it is just a matter of implementation," said Interim CEO Barbara Lay.
Capturing charges has been one of the main focus points of the interim administration.
In-patient charges for April averaged $2,036, where in previous months these same charges were reported as low as $828.
"If we had been capturing all our charges, that would have given us an additional $1.5 million for the year," said CFO Chad Carpenter.
Lay told the board that the hospital was capturing all the charges now and that they need to make sure what they have put in place stays in place.
Low in-patient census for the month of April led to a drop in revenue, resulting in a loss of $222,000 for the month.
The YTD loss now stands at $138,871, due in part to an April write-off in the amount of $109,000 which was deemed to be uncollectible.
"We need to look at this in perspective," said board president Dr. Bob Must. "We have taken two steps forward, one step back, but there is forward progress."
Carpenter provided the board with a financial comparison showing just how much forward progress has been made.
At the end of April 2010, the hospital was drowning in a YTD loss of $1.2 million.
A popular topic at past board meetings gained the attention of new board member Dan Lewis who questioned staff about the number of FTEs, or full-time employees.
FTEs for April were reported at 102.3.ﾠ This calculation, based on a 40 hour work week and total wages paid, represents hours and not necessarily bodies.
April admissions, in-patient days and average census compared to those same categories for March were reduced by about one-half.
"You are at one-half on utilization, what are you doing on the cost side?" asked Lewis. "Are you running full staff even if you have nobody in the beds?"
Lay told the board that some employees have taken time off without pay, and others have taken vacation.
"We need a core staff," she said, "whether there are two patients or 15."
PMH Clinic also showed a loss for the month in the amount of $31,624. But there too, April clinic visits of 492 were down in comparison to March's 684.
Another loss was reported to the board that was not of a financial nature.
Dr. Jeffrey McCray tendered his resignation, effective the end of July.
McCray has been a vital part of the PMH staff since August 2010.
The interim administration is searching for a replacement in a market that is short on primary care physicians.
Our Ambulance reported a loss of $14,000 for theﾠ month of April, partially due to an overhead allocation of $17,227.
But as with the other entities, there were fewer ambulance runs during the month, only 43, theﾠ lowest number reported since October 2010.
Carpenter told the board that ambulance salaries had dropped, but expenses had stayed the same.
Salaries in July were more than $50,000
For the month of April that number was $23,382.
Despite the continued losses for Our Ambulance, Lay told the board that the service is vital to the county.
"Two things we need to look at: we can reduce our EMT component, or talk to the county commission to see if they would help with this service," she said.
Our Ambulance covers approximately 76 percent of the runs in the county and EMTs are being used in the ER during their down-time.
The hospital needs a better plan for ambulance service before July 1, the beginning of the next fiscal year.
Although losses have been reduced under the interim administration, the ambulance service continues to operate in the red.
"The state did a survey and they found that it takes 1,100 to 1,200 runs a year to break even," said board member Donald McNeel.
There are not that many runs in the entire county.
"A lot of counties have one ambulance service," he said. "But for care purposes in this county, you can't have one ambulance service, one crew, in one station."
Our Ambulance provides a much needed service and though it may continue to operate in the red, PMH cannot continue to sustain a $200,000 per year loss for that service, Lay told the board.
The interim staff continues to move forward, looking for new programs and funding, and revamping and restructuring the operations of the hospital.
In the area of revamping, staff reported that consideration of a new and much needed phone system had finally made its way to the table.
As for the problems with HMS, Carpenter and Vaughan will meet with their counterparts in other hospitals that use the program before the interim staff makes a recommendation to the board concerning an upgrade of this facility's HMS server and software.
Lay is working to gain Rural Healthcare Status for the hospital.ﾠ She asked the board for permission to seek a Governor's Waiver.
"For reimbursement, it is vital that we have Rural Healthcare Status," Lay said.
A federal analyst has had the hospital's paperwork for some time, but the current back-log in that office could delay PMH's request indefinitely. The Governor's Waiver is an alternative and, at this point, appears to be the quickest route to rural status.
Must commended staff for the progress that has been made and continues to be made.
"Even though the hospital has stepped back into the red for the month, we need to look at how far we've come," said Must.ﾠ "We are far from coming out of the woods, but policies have been put into place that are leading us in a positive direction and a lot of what contributed to that loss has been corrected through the year.ﾠ We are paying now for poor performance by our billing service and we are also paying by these big write-offs that we have seen - things that shouldn't have to be written off."
"Morale in the hospital is better and we will keep tuning."