Hospital board removes vaccination policy agenda item

At the November 30, Hot Springs Health board meeting, Chairman Dr. Bill Williams started the meeting and said, “I call it to order with some sadness… Dan Herdt passed away a week ago today, and I can’t tell you not only the sadness for his family, but the loss of a valuable board member to this group. He always had a perspective that we appreciated, listened to. He didn’t talk very often, but when he did, we listened because he had good points to make and we will miss him immensely on this board.” Dan Herdt was the board’s secretary/treasurer.

During the approval of the agenda portion of the meeting, Chairman Williams said, “We’re going to delete the vaccination policy since by judicial fiat, that has become a moot point for the time being, anyway.”

Hot Springs Health CEO Margie Molitor gave her growth report and said that the Christmas Tree Festival is back this year. Hot Springs Health is one of the major sponsors, along with Pinnacle Bank. All the proceeds go toward the community fund. The event was held at the fairgrounds without paying any rent since it is a benefit for the community. The auction items included 11 trees, 13 wreaths and eight special items. 

Molitor also reported that Premiere Bone and Joint had their first clinic on November 30. Dr. Fournier performed surgery and saw three patients. These doctors are from Laramie and fly into Hot Springs County every other week to see patients. Molitor added, “And then, in addition, with Dr. Francisco being here, I think we’ll have a good complement of orthopedic coverage. So I’m excited about that.”

Molitor reported they have CRNA interviews scheduled for next week. Molitor said, “We have two really strong candidates, and that’s to replace Kevin Ryan, who is semi-retiring. He’s done great work for our hospital for many, many years, and we’ll miss him. He’s still going to help out occasionally when we need two CRNAs, but we’ll greatly miss him and I appreciate everything he’s done for us.”

Additionally, Molitor said Scott Allwin, the new Chief Clinical Officer, will start on December 13.

Molitor also said, “We continue to have excellent scores on our inpatient patient satisfaction, and that’s very nice to see. We’re doing great work and the patients are appreciating it.”

Molitor announced that CFO Shelly Larson is retiring on January 14 and they are looking for both an interim and permanent replacement for her position. Already they have received two applications that Molitor wants to vet.

For the Quality report, Miranda Nelson said, “So in August, we really started looking at these numbers when we set our goals for readmission. And I’d say about mid-August when we really started to address the E.R. patients. That’s also where we had our surge, though, with a lot of people that needed oxygen setups. So what we were doing is trying to set up home health right from the E.R., as well as oxygen. So we were able to get Rotech from Riverton, Cody, to supply the bottles. And I think the numbers show that’s been really helping. Our percentage in August is 5.6% for readmission rates and that’s because of the 72 hour same or similar diagnosis. In September, it went down to 3.6% and in October we went down to 2.2%. So I think that those interventions have really helped. Our readmissions for the floor with acute patients within 30 days in August were 4.9%. September, we had some readmissions, just people that are really sick, Covid and different things that end up rebounding. So that went up to 12.5%, but then in October, we were back down to 3.6%. Which I think is one of our lowest percentages for the whole year.”

Molitor added, “We do think that COVID is affecting the readmission rates because those people I mean, if they don’t do well at home, they come back in.”

For the financial report, Shelly Larson said for the month of October their days in accounts receivable reduced from 55 days to 52.2. Both the hospital and the clinic combined collected in excess of $2.4 million, which was up from last month. The hospital has now come under the 50-day mark for days in accounts receivable.

Larson also reported that they extended their contract with Extend. There was some confusion about the timing of their ending, but it was extended to January and Larson said it was mutually beneficial. Larson continued and said they have collected about $400,000 in accounts receivable payments the past month, which will show in November’s report. 

Their days of cash on hand decreased from 162 days in September to 155. This is primarily due to their qualified rate adjustment QRA fund match that they send to Medicaid in order to match federal funds as a rate adjustment for the previous year. That amount was about $333,000. They did receive their match of $666,000 in November already.

In October, they also had $235,000 in funds that were withheld from their Medicare payments and applied to their Medicare advance loan. The current amount of that is now $2.7 million. Larson said, “With respect to that loan, they just started collecting on that in April, so it’s gone very quickly on anything.” Larson explained that the loan is interest-free for the first 17 months. Larson added, “However, I can tell you that as fast as they’re collecting that on our payments, we should have that paid off well in advance.”

Larson also provided their cost report, which was provided by Eide Bailly, which comes from audited information. The report said they have a net receivable of about $143,000, which comes from two components. One, the impatient payable of about $173,000 and then the outpatient side, which includes the outpatient services and all of their rural health clinics. They had a receivable of about $315,000. They had about a $140,000 dollar net impact. Larson said, “This cost report will set our rates beginning in probably about January or February for the current year. We will see an increase in our inpatient per diem rates, our swing bed per diem rates. That’s our daily rate. And then we will also see an increase in our gross charges, the cost to charge ratio for outpatients.”

Larson also said, “I think it was January or February of last year there was new legislation that came out and they were giving PPS hospitals a little bit more reimbursement, but they took from the rural health clinics. And so now we do have a cap in connection with our rural health clinics. That will require us to be a lot more diligent about making sure that we’re maximizing patient visits and minimizing our expenses to the extent possible.”

The board voted and passed approval to accept the cost report.

Larson continued and gave information about the provider relief funds update and accounts receivable discounts. For the relief funds, it was funding that they received through June 30 of 2020 for a total of $4.2 million. They were able to utilize $1.168 million and will return $3,093,000 by December 30. Larson added, “I also want to let you know that we did receive additional provider relief funds of $569,000. Those funds have to be utilized, I believe, by December 2023, and the reporting is sometime after that.”

Larson moved on and said, “We made the decision to change our third-party billing services from First Party Receivable Solutions (FPRS) to Revenue Enterprises. I’m looking forward to seeing a lot of really nice changes. They’ll make the process much more efficient and much more patient-friendly. There are some really neat features with respect to being allowed to go in and utilize a portal to set up payment plans to make payment online. And you can even receive a text or an email reminder through that system. I’ve looked at the statements. They’re a much easier statement to read much more, a lot more information on the statements. So I am looking forward to seeing that we do go live with them tomorrow, December first.” 

Larson added, “One of the things that we would like to do is to try and clear those balances out of FPRS. So we will be offering a one-time, 30% discount to those who wish to pay off their existing balances that are currently being billed through FPRS. We will hold that open for 90 days from the first of December through February 28 in order to allow people to make some plans and get those balances paid off and get a nice discount. That is done so that we can avoid or alleviate any kind of pain the hospital has, and more importantly, that our patients have.” Larson clarified that these billing matters are for the hospital only, not the clinics.

Under new business, the board held their annual officer elections. The results were Dr. Bill Williams - chairman, Heath Overfield - vice-chairman and David Koerwitz - treasurer/secretary.