Hospital board discusses financials, billing

At the September Hot Springs Health board meeting, CEO Scott Alwin introduced Dominic Symes, EVP of Staffing Solutions and Chief Revenue Officer of Health Tech, who was visiting from Orange County. Symes looks after all the different areas of consulting and directly reports to their chairman, Derek Morkel, and works side by side with him, meeting every single day. Symes also oversees the overall marketing strategy for the company, such as branding and design elements. Symes highlighted the coming CEO meeting that they plan on having twice each year.

Part of Syme’s agenda for that meeting includes, “I really want to make sure that we capitalize on the time with the CEOs to actually cross-pollinate with ideas and with best practices and success stories. In the past, we’ve had these meetings, and some of the CEOs will come in and give an update from the hospital and financial figures and maybe a few other areas that are of interest such as, looking at buying the building and things like that. We try to do a lot less of that and really concentrate on the stuff that the CEOs can go back to their own hospitals and it can help the hospital in terms of quality revenue, whatever it might be.”

Symes is also assisting Hot Springs Health in bringing in an interim Accounts Receivable Expert to help review and analyze their internal revenue cycle process. Alwin said, “The goal is to improve the efficiency and streamline the revenue cycle, which will in turn improve the billing experience here at Hot Springs Health.”

Dr. Stephen Asay gave the medical staff report and said regarding quality and compliance, they were discussing ER, inpatients, and readmissions to brainstorm on ways to improve that situation. They recently hired a trauma coordinator who is starting orientation. For the critical care and ICU

committee, they discussed stroke medications, which resulted in a change in their policies based on some new evidence. The information is going out to the providers for a vote on that policy change. For pharmacy and therapeutics, there was a discussion about certain labs that needed to be sent to Casper or they were going to get blood levels for monitoring. The medical staff also discussed take-home packs, which are often used in the emergency department if it is after hours for the pharmacy. They discussed how to order those and administer them properly with matching documentation. For OB, Asay said they discussed some devices that have been used with good success for augmenting labor.

Alwin gave his report and said the turnover rate has dropped to 13.19%. This was down from 25% in July 2022. Regarding Patient Experience, Alwin said, “The next phase of our Service Excellence Initiative is to launch Do-IT projects or (Departmentally Organized Improvement Tactics). These are department-specific process improvement projects to improve the patient and or employee experience. This is really the heart of the Service Excellence Initiative since it engages all staff members in making improvements. You will see and most likely participate in some portion of these improvement strategies.”

Alwin added about the Patient Experience, “It really is kind of the heart of the overall initiative because it takes front-line staff members and gets them engaged, making changes for the positive for the patient experience, the overall, improving workflow processes and making sure that they are making improvements on efficiency and safety and quality.”

Under growth, Alwin said that on November 1, Dr. Asay will be transferring to the Worland clinic and notifications will be sent out to patients.

CFO Kevin Benson gave the financial report and said, “After two months operating margin is just a slight $3,000 and almost to essentially break even both months were positive on our net income. We’re exceeding last year, where our average monthly operating loss was $150,000. So I think that’s trending in the right direction. We saw a significant turnaround in terms of the financial results from the clinics, and I think four out of five of them had a positive net income, which is a refreshing change from the prior year.

Benson continued and said, “The last thing I wanted to comment on was perhaps there is a concern in the community regarding our tax revenue. We get a three mill tax levy for the hospital that was put in place when the hospital district was organized and the purpose of that tax levy is to be used for debt service on the expansion of the hospital building. We get a monthly deposit from the county and that money goes into a restricted fund and the only money that moves out of that fund is for the debt payment to the USDA. None of the tax levy revenues are used for operations either within Hot Springs County or in communities outside of Hot Springs.”

In response to an inquiry, Benson said that the debt for the 30-year loan from the USDA is currently $27 million.

Benson then explained how the increases of days in accounts receivable (AR) has been increasing over time happened. The current days in AR are now 83. Benson said, “The question is, how did we get here? We’ve been hit with three different events that have had an adverse effect on our accounts receivable process. The first was at the end of January. We had the implementation of the integrated health record and that’s where we moved our current health records into the whole of Billings Clinic. And that was a process that took us out of billing for anywhere from 4 to 6 weeks. And because we had to get the combining of the records was difficult. It took longer than expected. We weren’t able to bill until those had been cleaned up. In April we turned over two-thirds of our billing staff, which took another four to six weeks to rehire and train, and they’re still there on training is ongoing, but they are becoming more proficient. Then the last item at the end of June was the implementation of the Cerner to the operations to replace the clinical works. That was a difficult implementation from a billing perspective and also had an adverse effect on processing our AR. Those three cascades of events are really what got us to where we’re at today.”

Regarding where they are currently, Benson said, “Our billers have become more proficient. The average number of days that it takes to get an account bill dropped from 17 two months ago to 10.”

Nina Landis gave the Quality/Risk report and said, “We are continuing to track 72-hour returns to the ER and 30-day outcomes readmissions. 72-hour returns to the ER to date are 42%, and 30 days are 2.8% That isn’t our goal for the year, but we’ll continue to track quality metrics. We have to look at it. Do-It projects have started coming to the Quality Committee. We had two directors come and present their projects and that is going well.”

In the Compliance report, CCO Dan Hemann said that CFO Kevin Benson has taken over as the privacy officer for the organization, which is a central piece of compliance.

Hemann added, “There is some new legislation that’s pretty hot on our radar right now is the way we put out some guidance on information logging which I think is really a good thing, actually. And it just says that organizations can’t do anything to impede patients’ access to their information beyond general safety practical checks.

If you would impede that, you could be facing up to a $1,000,000 fine per violation. From my experience in organization, I don’t think we have a lot of risk here, but we should be aware of that.”

In new business, the board voted and passed the approval of the new Infection Control Plan. The change in this plan is the appointment of Nina Landis as the Risk and Quality Director who would report to the board risks and infection matters.